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Gainullin M, Federico L, Røkke Osen J, Chaban V, Kared H, Alirezaylavasani A, Lund-Johansen F, Wildendahl G, Jacobsen JA, Sarwar Anjum H, Stratford R, Tennøe S, Malone B, Clancy T, Vaage JT, Henriksen K, Wüsthoff L, Munthe LA. People who use drugs show no increase in pre-existing T-cell cross-reactivity toward SARS-CoV-2 but develop a normal polyfunctional T-cell response after standard mRNA vaccination. Front Immunol 2024; 14:1235210. [PMID: 38299149 PMCID: PMC10827924 DOI: 10.3389/fimmu.2023.1235210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024] Open
Abstract
People who use drugs (PWUD) are at a high risk of contracting and developing severe coronavirus disease 2019 (COVID-19) and other infectious diseases due to their lifestyle, comorbidities, and the detrimental effects of opioids on cellular immunity. However, there is limited research on vaccine responses in PWUD, particularly regarding the role that T cells play in the immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we show that before vaccination, PWUD did not exhibit an increased frequency of preexisting cross-reactive T cells to SARS-CoV-2 and that, despite the inhibitory effects that opioids have on T-cell immunity, standard vaccination can elicit robust polyfunctional CD4+ and CD8+ T-cell responses that were similar to those found in controls. Our findings indicate that vaccination stimulates an effective immune response in PWUD and highlight targeted vaccination as an essential public health instrument for the control of COVID-19 and other infectious diseases in this group of high-risk patients.
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Affiliation(s)
- Murat Gainullin
- KG Jebsen Centre for B cell Malignancies, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NEC OncoImmunity AS, Oslo, Norway
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Lorenzo Federico
- KG Jebsen Centre for B cell Malignancies, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Julie Røkke Osen
- KG Jebsen Centre for B cell Malignancies, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Viktoriia Chaban
- KG Jebsen Centre for B cell Malignancies, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Hassen Kared
- KG Jebsen Centre for B cell Malignancies, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Amin Alirezaylavasani
- KG Jebsen Centre for B cell Malignancies, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Fridtjof Lund-Johansen
- Department of Immunology, Oslo University Hospital, Oslo, Norway
- ImmunoLingo Convergence Center, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | | | | | | | | | | | - John T. Vaage
- Department of Immunology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kathleen Henriksen
- Agency for Social and Welfare Services, Oslo, Norway
- Student Health Services, University of Oslo, Oslo, Norway
| | - Linda Wüsthoff
- Unit for Clinical Research on Addictions, Oslo University Hospital, Oslo, Norway
- Norwegian Centre for Addiction Reasearch, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ludvig A. Munthe
- KG Jebsen Centre for B cell Malignancies, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital, Oslo, Norway
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Suen LW, Vittinghoff E, Wu AHB, Ravi A, Coffin PO, Hsue P, Lynch KL, Kazi DS, Riley ED. Multiple substance use and blood pressure in women experiencing homelessness. Addict Behav Rep 2023; 17:100483. [PMID: 36875801 PMCID: PMC9975611 DOI: 10.1016/j.abrep.2023.100483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/15/2022] [Accepted: 02/12/2023] [Indexed: 02/15/2023] Open
Abstract
Background Substance use increases risk of cardiovascular events, particularly among women with additional risk factors like housing instability. While multiple substance use is common among unstably housed individuals, relationships between multiple substance use and cardiovascular risk factors like blood pressure are not well characterized. Methods We conducted a cohort study between 2016 and 2019 to examine associations between multiple substance use and blood pressure in women experiencing homelessness and unstable housing. Participants completed six monthly visits including vital sign assessment, interview, and blood draw to assess toxicology-confirmed substance use (e.g., cocaine, alcohol, opioids) and cardiovascular health. We used linear mixed models to evaluate the outcomes of systolic and diastolic blood pressure (SBP; DBP). Results Mean age was 51.6 years; 74 % were women of color. Prevalence of any substance use was 85 %; 63 % of participants used at least two substances at baseline. Adjusting for race, body mass index and cholesterol, cocaine was the only substance significantly associated with SBP (4.71 mmHg higher; 95 % CI 1.68, 7.74) and DBP (2.83 mmHg higher; 95 % CI 0.72, 4.94). Further analysis found no differences in SBP or DBP between those with concurrent use of other stimulants, depressants, or both with cocaine, compared to those who used cocaine only. Conclusions Cocaine was the only substance associated with higher SBP and DBP, even after accounting for simultaneous use of other substances. Along with interventions to address cocaine use, stimulant use screening during cardiovascular risk assessment and intensive blood pressure management may improve cardiovascular outcomes among women experiencing housing instability.
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Affiliation(s)
- Leslie W Suen
- National Clinician Scholars Program, Philip R. Lee Institute of Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States.,San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Alan H B Wu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Akshay Ravi
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Phillip O Coffin
- Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, United States.,San Francisco Department of Public Health, San Francisco, CA, United States
| | - Priscilla Hsue
- Division of Cardiology, Chan Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Kara L Lynch
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Dhruv S Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Elise D Riley
- Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Wu J, Guo X, Zhou X, Wang M, Gu J, Miao Y, Tarimo CS, He Y, Xing Y, Ye B. The pattern from the first three rounds of vaccination: declining vaccination rates. Front Public Health 2023; 11:1124548. [PMID: 37250076 PMCID: PMC10213674 DOI: 10.3389/fpubh.2023.1124548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/04/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Vaccination rates for the COVID-19 vaccine have recently been stagnant worldwide. We aim to analyze the potential patterns of vaccination development from the first three doses to reveal the possible trends of the next round of vaccination and further explore the factors influencing vaccination in the selected populations. Methods On July 2022, a stratified multistage random sampling method in the survey was conducted to select 6,781 people from 4 provinces China, who were above the age of 18 years. Participants were divided into two groups based on whether they had a chronic disease. The data were run through Cochran-Armitage trend test and multivariable regression analyses. Results A total of 957 participants with chronic disease and 5,454 participants without chronic disease were included in this survey. Vaccination rates for the first, second and booster doses in chronic disease population were93.70% (95% CI: 92.19-95.27%), 91.12% (95%CI: 94.43-95.59%), and 83.18% (95%CI: 80.80-85.55%) respectively. By contrast, the first, second and booster vaccination rates for the general population were 98.02% (95% CI: 97.65-98.39%), 95.01% (95% CI: 94.43-95.59%) and 85.06% (95% CI: 84.11-86.00%) respectively. The widening gap in vaccination rates was observed as the number of vaccinations increases. Higher self-efficacy was a significant factor in promoting vaccination, which has been observed in all doses of vaccines. Higher education level, middle level physical activity and higher public prevention measures play a positive role in vaccination among the general population, while alcohol consumption acts as a significant positive factor in the chronic disease population (p < 0.05). Conclusion As the number of vaccinations increases, the trend of decreasing vaccination rate is becoming more pronounced. In future regular vaccinations, we may face low vaccination rates as the increasing number of infections and the fatigue associated with the prolonged outbreak hamper vaccination. Measures need to be found to counter this downward trend such as improving the self-efficacy of the population.
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Affiliation(s)
- Jian Wu
- Department of Health Management, College of Public Health, Zhengzhou University, Henan, China
- Henan Province Enginering, Research Center of Health Economy and Health Technology Assessment, Zhengzhou, Henan, China
| | - Xinghong Guo
- Department of Health Management, College of Public Health, Zhengzhou University, Henan, China
| | - Xue Zhou
- Department of Public Utilities Management, College of Health Management, Mudanjiang Medical University, Mudanjiang, Heilongjiang, China
| | - Meiyun Wang
- Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jianqin Gu
- School of Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Yudong Miao
- Department of Health Management, College of Public Health, Zhengzhou University, Henan, China
- Henan Province Enginering, Research Center of Health Economy and Health Technology Assessment, Zhengzhou, Henan, China
| | - Clifford Silver Tarimo
- Department of Health Management, College of Public Health, Zhengzhou University, Henan, China
| | - Yilin He
- Department of Health Management, College of Public Health, Zhengzhou University, Henan, China
| | - Yuhan Xing
- Department of Health Management, College of Public Health, Zhengzhou University, Henan, China
| | - Beizhu Ye
- Department of Health Management, College of Public Health, Zhengzhou University, Henan, China
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Agabio R, Saulle R, Rösner S, Minozzi S. Baclofen for alcohol use disorder. Cochrane Database Syst Rev 2023; 1:CD012557. [PMID: 36637087 PMCID: PMC9837849 DOI: 10.1002/14651858.cd012557.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Alcohol use disorder (AUD) is one of the most widespread psychiatric disorders leading to detrimental consequences to people with this disorder and others. Worldwide, the prevalence of heavy episodic drinking (30-day prevalence of at least one occasion of 60 g of pure alcohol intake among current drinkers) is estimated at 20% and the prevalence of AUD at 5% of the adult general population, with highest prevalence in Europe and North America. Therapeutic approaches, including pharmacotherapy, play an important role in treating people with AUD. This is an update of a Cochrane Review first published in 2018. OBJECTIVES To evaluate the benefits and harms of baclofen on achieving and maintaining abstinence or reducing alcohol consumption in people with AUD compared to placebo, no treatment or any other pharmacological relapse prevention treatment. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search was 22 November 2021. SELECTION CRITERIA Randomised controlled trials (RCTs) of at least four weeks' treatment duration and 12 weeks' overall study duration comparing baclofen for AUD treatment with placebo, no treatment or other treatments. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. relapse, 2. frequency of use, 3. amount of use, 4. adverse events, 5. dropouts from treatment and 6. dropouts from treatment due to adverse events. Our secondary outcomes were 7. craving, 8. anxiety, 9. depression and 10. frequency of most relevant adverse events. MAIN RESULTS We included 17 RCTs (1818 participants) with a diagnosis of alcohol dependence according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition or International Classification of Diseases 10th edition criteria. Mean age was 46.5 years and 70% were men. Ten studies compared baclofen to placebo or another medication; seven compared two baclofen doses to placebo or another medication. Globally, 15 studies compared baclofen to placebo, two baclofen to acamprosate and two baclofen to naltrexone. In 16 studies, participants received psychosocial treatments. We judged most studies at low risk of selection, performance, detection (subjective outcome), attrition and reporting bias. Ten studies detoxified participants before treatment; in seven studies, participants were still drinking at the beginning of treatment. Treatment duration was 12 weeks for 15 RCTs and longer in two studies. Baclofen daily dose was 30 mg to 300 mg: 10 RCTs used low doses (30 mg or less); eight RCTs medium doses (above 30 and 100 mg or less) and four RCTs high doses (above 100 mg). Compared to placebo, moderate-certainty evidence found that baclofen probably decreases the risk to relapse (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.77 to 0.99; 12 studies, 1057 participants). This result was confirmed among detoxified participants but not among other subgroups of participants. High-certainty evidence found that baclofen increases the percentage of days abstinent (mean difference (MD) 9.07, 95% CI 3.30 to 14.85; 16 studies, 1273 participants). This result was confirmed among all subgroups of participants except non-detoxified or those who received medium doses. There was no difference between baclofen and placebo in the other primary outcomes: heavy drinking days (standardised mean difference (SMD) -0.18, 95% CI -0.48 to 0.11; 13 studies, 840 participants; moderate-certainty evidence); number of drinks per drinking days (MD -0.45, 95% CI -1.20 to 0.30; 9 studies, 392 participants; moderate-certainty evidence); number of participants with at least one adverse event (RR 1.05, 95% CI 0.99 to 1.11; 10 studies, 738 participants; high-certainty evidence); dropouts (RR 0.88, 95% CI 0.74 to 1.03; 17 studies, 1563 participants; high-certainty evidence); dropouts due to adverse events (RR 1.39, 95% CI 0.89 to 2.18; 16 studies, 1499 participants; high-certainty evidence). These results were confirmed by subgroup analyses except than for the dropouts that resulted lower among participants who received high doses of baclofen and studies longer than 12 weeks. Compared to placebo, there was no difference in craving (SMD -0.16, 95% CI -0.37 to 0.04; 17 studies, 1275 participants), anxiety (MD -0.01, 95% CI -0.14 to 0.11; 15 studies, 1123 participants) and depression (SMD 0.07, 95% CI -0.12 to 0.27; 11 studies, 1029 participants). Concerning the specific adverse events, baclofen increases fatigue, dizziness, somnolence/sedation, dry mouth, paraesthesia and muscle spasms/rigidity. There was no difference in the other adverse events. Compared to acamprosate, one study (60 participants) found no differences in any outcomes but the evidence was very uncertain: relapse (RR 1.25, 95% CI 0.71 to 2.20; very low-certainty evidence); number of participants with at least one adverse event (RR 0.63, 95% CI 0.23 to 1.69; very low-certainty evidence); dropouts (RR 0.56, 95% CI 0.21 to 1.46; very low-certainty evidence); dropouts due to adverse events (RR 0.33, 95% CI 0.01 to 7.87; very low-certainty evidence) and craving (MD 5.80, 95% CI -11.84 to 23.44); and all the adverse events evaluated. Compared to naltrexone, baclofen may increase the risk of relapse (RR 2.50, 95% CI 1.12 to 5.56; 1 study, 60 participants; very low-certainty evidence) and decrease the number of participants with at least one adverse event (RR 0.35, 95% CI 0.15 to 0.80; 2 studies, 80 participants; very low-certainty evidence) but the evidence is very uncertain. One study (60 participants) found no difference between baclofen and naltrexone in the dropouts at the end of treatment (RR 1.00, 95% CI 0.32 to 3.10; very low-certainty evidence), craving (MD 2.08, 95% CI -3.71 to 7.87), and all the adverse events evaluated. AUTHORS' CONCLUSIONS Baclofen likely reduces the risk of relapse to any drinking and increases the percentage of abstinent days, mainly among detoxified participants. It does not increase the number of participants with at least one adverse event, those who dropout for any reason or due to adverse events. It probably does not reduce number of heavy drinking days and the number of drinks per drinking days. Current evidence suggests that baclofen may help people with AUD in maintaining abstinence. The results of comparisons of baclofen with acamprosate and naltrexone were mainly based on only one study.
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Affiliation(s)
- Roberta Agabio
- Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Monserrato (CA), Italy
| | - Rosella Saulle
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
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5
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Flynn CF, King RE, Bor R, Tvaryanas A. Mental Health Implications for Aviators from COVID-19. REACH 2022:100050. [PMCID: PMC9617686 DOI: 10.1016/j.reach.2022.100050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Mental Health Implications for Aviators from COVID-19 Objective The authors present aeromedical implications from COVID-19 disruptions on the civil aviation sector, consider mental health impacts on pilots, and discuss possible helpful responses to support pilot mental health. Methods A multiple database review investigated articles from January 2002 to May 2021 on severe commercial aviation disruptions impacting pilot mental health and on pilot mental health coping or treatment. Fifteen papers were identified. Results During the COVID-19 pandemic, airline flights were severely reduced. By January 2021, airlines shed thousands of jobs and 24 airlines no longer existed. General population surveys found 13% of individuals had “serious distress” from the pandemic. In two aviation focused surveys, 40-66% of pilots agreed or strongly agreed that their mental health worsened since the COVID-19 pandemic. Compared to past Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) patients, more COVID-19 patients have mental health symptoms in the acute phase of illness; while about 10% of COVID-19 patients appear to have chronic or “long haul” symptoms. Mental Health treatment and coping strategies found helpful to pilots are discussed. Conclusions Pilots remain at risk for mental health symptoms and illness due to the COVID-19 pandemic. For those who develop severe distress or mental illness from the effects of the pandemic (or COVID-19 infection), early treatment with psychotherapy and/or approved medications may be warranted. This may decrease the likelihood of persistent physical or cognitive or mental health symptoms that would delay a return to flying status.
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Affiliation(s)
- Christopher F. Flynn
- Affiliate Member, Center for Space Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA,Corresponding author
| | | | - Robert Bor
- Centre for Aviation Psychology, Ground Floor. 62 Rosslyn Hill., Hampstead, NW3 1ND London, United Kingdom
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6
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Scarlett H, Melchior M, Davisse-Paturet C, Aarbaoui TE, Longchamps C, Figueiredo N, Ducarroz S. Substance Use Among Residents of Homeless Shelters During the COVID-19 Pandemic: Findings From France. Int J Public Health 2022; 67:1604684. [PMID: 36090832 PMCID: PMC9452639 DOI: 10.3389/ijph.2022.1604684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 07/26/2022] [Indexed: 12/01/2022] Open
Abstract
Objectives: To record the prevalence and risk factors of substance use amongst homeless persons during the COVID-19 pandemic. Methods: The ECHO study consisted in two independent cross-sectional waves of data collection in the regions of Paris, Lyon, and Strasbourg during the Spring of 2020 (n = 530) and 2021 (n = 319). Factors associated with substance use were explored using generalised logistic regression models. Results: The most prevalent substance used was tobacco (38%–43%), followed by alcohol (26%–34%). The use of both substances positively associated with each other, although risk factors varied depending on the substance. The only factors consistently associated with alcohol and tobacco use were being male, exposure to theft/assault and participants’ region of origin. Whilst the rate of tobacco use was relatively stable between Spring 2020 and 2021, alcohol use was more common in 2021. Conclusion: These findings highlight a high prevalence of substance use amongst homeless persons. People experiencing homelessness face specific challenges in the context of the pandemic, alongside greater vulnerability to illness and low healthcare access, therefore the need to improve prevention and support services for substance abuse within this population is vital.
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Affiliation(s)
- Honor Scarlett
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- *Correspondence: Honor Scarlett, ; Simon Ducarroz,
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- CNRS, Institut Convergences Migration, Aubervilliers, France
| | - Camille Davisse-Paturet
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Tarik El. Aarbaoui
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
| | - Cécile Longchamps
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
| | - Natasha Figueiredo
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
| | - Simon Ducarroz
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- CNRS, Institut Convergences Migration, Aubervilliers, France
- *Correspondence: Honor Scarlett, ; Simon Ducarroz,
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7
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Suen LW, Makam AN, Snyder HR, Repplinger D, Kushel MB, Martin M, Nguyen OK. National Prevalence of Alcohol and Other Substance Use Disorders Among Emergency Department Visits and Hospitalizations: NHAMCS 2014-2018. J Gen Intern Med 2022; 37:2420-2428. [PMID: 34518978 PMCID: PMC8436853 DOI: 10.1007/s11606-021-07069-w] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/21/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Acute healthcare utilization attributed to alcohol use disorders (AUD) and other substance use disorders (SUD) is rising. OBJECTIVE To describe the prevalence and characteristics of emergency department (ED) visits and hospitalizations made by adults with AUD or SUD. DESIGN, SETTING, AND PARTICIPANTS Observational study with retrospective analysis of the National Hospital Ambulatory Medical Care Survey (2014 to 2018), a nationally representative survey of acute care visits with information on the presence of AUD or SUD abstracted from the medical chart. MAIN MEASURES Outcome measured as the presence of AUD or SUD. KEY RESULTS From 2014 to 2018, the annual average prevalence of AUD or SUD was 9.4% of ED visits (9.3 million visits) and 11.9% hospitalizations (1.4 million hospitalizations). Both estimates increased over time (30% and 57% relative increase for ED visits and hospitalizations, respectively, from 2014 to 2018). ED visits and hospitalizations from individuals with AUD or SUD, compared to individuals with neither AUD nor SUD, had higher percentages of Medicaid insurance (ED visits: AUD: 33.1%, SUD: 35.0%, neither: 24.4%; hospitalizations: AUD: 30.7%, SUD: 36.3%, neither: 14.8%); homelessness (ED visits: AUD: 6.2%, SUD 4.4%, neither 0.4%; hospitalizations: AUD: 5.9%, SUD 7.3%, neither: 0.4%); coexisting depression (ED visits: AUD: 26.3%, SUD 24.7%, neither 10.5%; hospitalizations: AUD: 33.5%, SUD 35.3%, neither: 13.9%); and injury/trauma (ED visits: AUD: 51.3%, SUD 36.3%, neither: 26.4%; hospitalizations: AUD: 31.8%, SUD: 23.8%, neither: 15.0%). CONCLUSIONS In this nationally representative study, 1 in 11 ED visits and 1 in 9 hospitalizations were made by adults with AUD or SUD, and both increased over time. These estimates are higher or similar than previous national estimates using claims data. This highlights the importance of identifying opportunities to address AUD and SUD in acute care settings in tandem with other medical concerns, particularly among visits presenting with injury, trauma, or coexisting depression.
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Affiliation(s)
- Leslie W Suen
- National Clinician Scholars Program, Philip R. Lee Institute of Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA. .,San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
| | - Anil N Makam
- Division of Hospital Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA.,University of California, San Francisco Center for Vulnerable Populations, San Francisco, CA, USA.,Philip R. Lee Institute of Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Hannah R Snyder
- Department of Family and Community Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel Repplinger
- Department of Emergency Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA
| | - Margot B Kushel
- University of California, San Francisco Center for Vulnerable Populations, San Francisco, CA, USA
| | - Marlene Martin
- Division of Hospital Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA
| | - Oanh Kieu Nguyen
- Division of Hospital Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA.,University of California, San Francisco Center for Vulnerable Populations, San Francisco, CA, USA
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8
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Selfridge M, Card K, Kandler T, Flanagan E, Lerhe E, Heaslip A, Nguyen A, Moher M, Pauly B, Urbanoski K, Fraser C. Factors associated with 60-day adherence to "safer supply" opioids prescribed under British Columbia's interim clinical guidance for health care providers to support people who use drugs during COVID-19 and the ongoing overdose emergency. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 105:103709. [PMID: 35525052 PMCID: PMC9065674 DOI: 10.1016/j.drugpo.2022.103709] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 12/19/2022]
Abstract
AIMS In March 2020, British Columbia issued Risk Mitigation Guidance (RMG) to support prescribing of pharmaceutical alternatives to illicit drugs, in order to reduce risk for COVID-19, overdose, and withdrawal among people who use drugs. This study evaluated factors associated with 60-day adherence to novel opioid alternatives prescribed at an inner-city health centre in Victoria, Canada. METHODS A chart review was conducted to collect data on sociodemographic information, medical histories, and follow-up services among all clients prescribed novel opioid alternatives from March 2020-August 2020 (n = 286). Bivariable and multivariable regression were used to identify independent and adjusted factors associated with 60-day adherence. RESULTS Overall, 77% of 286 clients were still receiving opioids after 60 days of follow-up. Medications included hydromorphone (n = 274), sustained-release oral morphine (n = 2), and oxycodone (n = 9). The adjusted odds of 60-day adherence to novel opioid alternatives were significantly higher for those receiving a mental health medication (aOR = 3.49, 95%CI = 1.26, 11.00), a higher maximum daily dosage of RMG prescriptions (aOR = 1.03 per mg increase, 95%CI = 1.01, 1.04), and those with continuous receipt of OAT (aOR = 6.25, 95%CI = 2.67, 15.90). CONCLUSIONS Higher dosages and co-prescription of mental health medications and OAT may help support better adherence to this form of prescriber-based "safer supply". Further work is needed to identify optimal prescribing practices and the longer term impacts of differing implementation scenarios.
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Affiliation(s)
- Marion Selfridge
- Cool Aid Community Health Centre, Victoria, BC, Canada; Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada.
| | - Kiffer Card
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada,Simon Fraser University, Faculty of Health Sciences, Canada
| | - Taylor Kandler
- University of British Columbia, Faculty of Medicine, Canada
| | - Erin Flanagan
- University of British Columbia, Faculty of Medicine, Canada
| | - Emily Lerhe
- University of British Columbia, Faculty of Medicine, Canada
| | - Ash Heaslip
- Cool Aid Community Health Centre, Victoria, BC, Canada,University of British Columbia, Faculty of Medicine, Canada
| | - Anne Nguyen
- Cool Aid Community Health Centre, Victoria, BC, Canada,University of British Columbia, Faculty of Medicine, Canada,University of Victoria, Faculty of Medicine, Canada
| | - Matthew Moher
- Cool Aid Community Health Centre, Victoria, BC, Canada,University of British Columbia, Faculty of Medicine, Canada,University of Victoria, Faculty of Medicine, Canada
| | - Bernie Pauly
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada,University of Victoria, School of Nursing, Canada
| | - Karen Urbanoski
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada,University of Victoria, School of Public Health and Social Policy, Canada
| | - Chris Fraser
- Cool Aid Community Health Centre, Victoria, BC, Canada,University of British Columbia, Faculty of Medicine, Canada
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9
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Burgess-Hull AJ, Smith KE, Panlilio LV, Schriefer D, Preston KL, Alter A, Yeager C, Chizmar T, Delbridge T, Zamore K, Beeson J, Epstein DH. Nonfatal opioid overdoses before and after Covid-19: Regional variation in rates of change. PLoS One 2022; 17:e0263893. [PMID: 35263326 PMCID: PMC8906602 DOI: 10.1371/journal.pone.0263893] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/29/2022] [Indexed: 01/15/2023] Open
Abstract
Background The Covid-19 pandemic and its accompanying public-health orders (PHOs) have led to (potentially countervailing) changes in various risk factors for overdose. To assess whether the net effects of these factors varied geographically, we examined regional variation in the impact of the PHOs on counts of nonfatal overdoses, which have received less attention than fatal overdoses, despite their public health significance. Methods Data were collected from the Overdose Detection Mapping Application Program (ODMAP), which recorded suspected overdoses between July 1, 2018 and October 25, 2020. We used segmented regression models to assess the impact of PHOs on nonfatal-overdose trends in Washington DC and the five geographical regions of Maryland, using a historical control time series to adjust for normative changes in overdoses that occurred around mid-March (when the PHOs were issued). Results The mean level change in nonfatal opioid overdoses immediately after mid-March was not reliably different in the Covid-19 year versus the preceding control time series for any region. However, the rate of increase in nonfatal overdose was steeper after mid-March in the Covid-19 year versus the preceding year for Maryland as a whole (B = 2.36; 95% CI, 0.65 to 4.06; p = .007) and for certain subregions. No differences were observed for Washington DC. Conclusions The pandemic and its accompanying PHOs were associated with steeper increases in nonfatal opioid overdoses in most but not all of the regions we assessed, with a net effect that was deleterious for the Maryland region as a whole.
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Affiliation(s)
- Albert J. Burgess-Hull
- National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland, United States of America
- * E-mail:
| | - Kirsten E. Smith
- National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland, United States of America
| | - Leigh V. Panlilio
- National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland, United States of America
| | - Destiny Schriefer
- National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland, United States of America
| | - Kenzie L. Preston
- National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland, United States of America
| | - Aliese Alter
- Office of National Drug Control Policy, High Intensity Drug Trafficking Area, Washington, DC, United States of America
| | - Christopher Yeager
- Office of National Drug Control Policy, High Intensity Drug Trafficking Area, Washington, DC, United States of America
| | - Timothy Chizmar
- Maryland Institute for Emergency Medical Services Systems (MIEMSS), Baltimore, Maryland, United States of America
| | - Ted Delbridge
- Maryland Institute for Emergency Medical Services Systems (MIEMSS), Baltimore, Maryland, United States of America
| | - Kenan Zamore
- District of Columbia Department of Health, Washington, DC, United States of America
| | - Jeff Beeson
- Office of National Drug Control Policy, High Intensity Drug Trafficking Area, Washington, DC, United States of America
| | - David H. Epstein
- National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland, United States of America
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10
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Compton P, St Marie B. Coexisting Substance Use Disorder and Chronic Pain During COVID-19. Pain Manag Nurs 2022; 23:17-25. [PMID: 34620549 PMCID: PMC8418911 DOI: 10.1016/j.pmn.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/29/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Peggy Compton
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, 19104-4217.
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11
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DiMartini AF, Leggio L, Singal AK. Barriers to the management of alcohol use disorder and alcohol-associated liver disease: strategies to implement integrated care models. Lancet Gastroenterol Hepatol 2022; 7:186-195. [DOI: 10.1016/s2468-1253(21)00191-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 02/07/2023]
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12
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Shah N, Velez FF, Colman S, Kauffman L, Ruetsch C, Anastassopoulos K, Maricich Y. Real-World Reductions in Healthcare Resource Utilization over 6 Months in Patients with Substance Use Disorders Treated with a Prescription Digital Therapeutic. Adv Ther 2022; 39:4146-4156. [PMID: 35819569 PMCID: PMC9273919 DOI: 10.1007/s12325-022-02215-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/01/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS Substance use disorders (SUDs) affect approximately 40.3 million people in the USA, yet only approximately 19% receive evidence-based treatment each year. reSET® is a prescription digital therapeutic (PDT) and the only FDA-authorized treatment for patients with cocaine, cannabis, and stimulant use disorders. This study evaluated real-world healthcare resource utilization (HCRU) and associated costs 6 months after initiation of reSET in patients with SUD. METHODS A retrospective analysis of HealthVerity PrivateSource20 data compared the 6-month incidence of all-cause hospital facility encounters and clinician services in patients treated with reSET (re-SET cohort) before (pre-index period) and after (post-index period) reSET initiation (index). Incidence was compared using incidence rate ratios (IRR). HCRU-related costs were also assessed. RESULTS The sample included 101 patients (median age 37 years, 50.5% female, 54.5% Medicaid-insured). A statistically significant decrease of 50% was observed in overall hospital encounters from pre-index to post-index (IRR 0.50; 95% CI 0.37-0.67; P < 0.001), which included inpatient stays (56% decrease; IRR 0.44; 95% CI 0.26-0.76; P = 0.003), partial hospitalizations (57% decrease; IRR 0.43; 95% CI 0.21-0.88; P = 0.021), and emergency department visits (45% decrease; IRR 0.55; 95% CI 0.38-0.80; P < 0.004). Additionally, some clinician services declined significantly including pathology and laboratory services: other (54% decrease; IRR 0.46; 95% CI 0.28-0.76; P = 0.003); pathology and laboratory services: drug assays prior to opioid medication prescription (37% decrease; IRR 0.63; 95% CI 0.41-0.96; P = 0.031); and alcohol and drug abuse: medication services (46% decrease; IRR 0.54; 95% CI 0.41-0.70; P < 0.001). Reductions in facility-encounters drove 6-month reSET per-patient cost reductions of $3591 post-index compared to pre-index. CONCLUSIONS Use of reSET by patients with SUD is associated with durable reductions in HCRU and lower healthcare costs over 6 months compared to the 6 months before PDT treatment, after adjusting for covariates, providing an economic benefit to the healthcare system.
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Affiliation(s)
- Neel Shah
- grid.487063.ePear Therapeutics, Inc. (US), Boston, MA USA
| | | | - Samuel Colman
- Market Access Consulting, Labcorp Drug Development, Gaithersburg, MD USA
| | - Laura Kauffman
- Market Access Consulting, Labcorp Drug Development, Gaithersburg, MD USA
| | | | | | - Yuri Maricich
- grid.487063.ePear Therapeutics, Inc. (US), Boston, MA USA
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13
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Testino G, Vignoli T, Patussi V, Allosio P, Amendola MF, Aricò S, Baselice A, Balbinot P, Campanile V, Fanucchi T, Macciò L, Meneguzzi C, Mioni D, Parisi M, Renzetti D, Rossin R, Gandin C, Bottaro LC, Caio G, Lungaro L, Zoli G, Scafato E, Caputo F. Alcohol use disorder in the COVID-19 era: Position paper of the Italian Society on Alcohol (SIA). Addict Biol 2022; 27:e13090. [PMID: 34532923 PMCID: PMC8646667 DOI: 10.1111/adb.13090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 12/11/2022]
Abstract
Coronavirus disease 2019 (COVID‐19) first emerged in China in November 2019. Most governments have responded to the COVID‐19 pandemic by imposing a lockdown. Some evidence suggests that a period of isolation might have led to a spike in alcohol misuse, and in the case of patients with alcohol use disorder (AUD), social isolation can favour lapse and relapse. The aim of our position paper is to provide specialists in the alcohol addiction field, in psychopharmacology, gastroenterology and in internal medicine, with appropriate tools to better manage patients with AUD and COVID‐19,considering some important topics: (a) the susceptibility of AUD patients to infection; (b) the pharmacological interaction between medications used to treat AUD and to treat COVID‐19; (c) the reorganization of the Centre for Alcohol Addiction Treatment for the management of AUD patients in the COVID‐19 era (group activities, telemedicine, outpatients treatment, alcohol‐related liver disease and liver transplantation, collecting samples); (d) AUD and SARS‐CoV‐2 vaccination. Telemedicine/telehealth will undoubtedly be useful/practical tools even though it remains at an elementary level; the contribution of the family and of caregivers in the management of AUD patients will play a significant role; the multidisciplinary intervention involving experts in the treatment of AUD with specialists in the treatment of COVID‐19 disease will need implementation. Thus, the COVID‐19 pandemic is rapidly leading addiction specialists towards a new governance scenario of AUD, which necessarily needs an in‐depth reconsideration, focusing attention on a safe approach in combination with the efficacy of treatment.
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Affiliation(s)
- Gianni Testino
- Unit of Addiction and Hepatology, Regional Centre on Alcohol ASL3 San Martino Hospital Genoa Italy
| | - Teo Vignoli
- Unit of Addiction Treatment Lugo (Ravenna) Italy
| | | | | | | | - Sarino Aricò
- Gastroenterology Unit Mauriziano Hospital Torino Italy
| | | | - Patrizia Balbinot
- Unit of Addiction and Hepatology, Regional Centre on Alcohol ASL3 San Martino Hospital Genoa Italy
| | | | | | | | | | | | | | - Doda Renzetti
- Department of Internal Medicine Mater Dei Hospital Bari Italy
| | | | - Claudia Gandin
- National Observatory on Alcohol National Institute of Health Rome Italy
| | | | - Giacomo Caio
- Centre for the Study and Treatment of Alcohol‐Related Diseases Department of Translational Medicine, University of Ferrara Ferrara Italy
| | - Lisa Lungaro
- Centre for the Study and Treatment of Alcohol‐Related Diseases Department of Translational Medicine, University of Ferrara Ferrara Italy
| | - Giorgio Zoli
- Centre for the Study and Treatment of Alcohol‐Related Diseases Department of Translational Medicine, University of Ferrara Ferrara Italy
- Department of Internal Medicine, SS Annunziata Hospital, Cento (Ferrara) University of Ferrara Ferrara Italy
| | - Emanuele Scafato
- National Observatory on Alcohol National Institute of Health Rome Italy
| | - Fabio Caputo
- Centre for the Study and Treatment of Alcohol‐Related Diseases Department of Translational Medicine, University of Ferrara Ferrara Italy
- Department of Internal Medicine, SS Annunziata Hospital, Cento (Ferrara) University of Ferrara Ferrara Italy
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14
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de Vargas D, Pereira CF, Volpato RJ, Lima AVC, da Silva Ferreira R, de Oliveira SR, Aguilar TF. Strategies Adopted by Addiction Facilities during the Coronavirus Pandemic to Support Treatment for Individuals in Recovery or Struggling with a Substance Use Disorder: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212094. [PMID: 34831850 PMCID: PMC8624445 DOI: 10.3390/ijerph182212094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022]
Abstract
This review aimed to identify and synthesize strategies and actions adopted by addiction facilities to support and maintain treatment during the coronavirus disease 2019 (COVID-19) pandemic. A scoping review was conducted using the following information sources: Virtual Health Library, SCOPUS, Web of Science, PubMed, CINAHL, and Latin American and Caribbean Health Science Literature. From a total of 971 articles, 28 studies were included. The strategies to maintain the care offer were telehealth/telemedicine, counselling/screening, 24-h telephone, webinars, conducting group therapy and support among users, adaptation for electronic health records, increased methadone/naloxone dispensing, restriction in the number of medication dispensing/day, and electronic prescription and home delivery medications. These strategies can be used to support health professionals in addressing the impact of the pandemic on the treatment of those in recovery or struggling with a substance use disorder when in-person treatment is not possible.
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Affiliation(s)
- Divane de Vargas
- School of Nursing, São Paulo University, São Paulo 05403-000, Brazil; (C.F.P.); (R.J.V.); (A.V.C.L.); (S.R.d.O.); (T.F.A.)
- Nucleon of Addiction Nursing Research, School of Nursing (NEPEEA), University of São Paulo, São Paulo 05403-000, Brazil;
- Correspondence:
| | - Caroline Figueira Pereira
- School of Nursing, São Paulo University, São Paulo 05403-000, Brazil; (C.F.P.); (R.J.V.); (A.V.C.L.); (S.R.d.O.); (T.F.A.)
- Nucleon of Addiction Nursing Research, School of Nursing (NEPEEA), University of São Paulo, São Paulo 05403-000, Brazil;
| | - Rosa Jacinto Volpato
- School of Nursing, São Paulo University, São Paulo 05403-000, Brazil; (C.F.P.); (R.J.V.); (A.V.C.L.); (S.R.d.O.); (T.F.A.)
- Nucleon of Addiction Nursing Research, School of Nursing (NEPEEA), University of São Paulo, São Paulo 05403-000, Brazil;
| | - Ana Vitória Corrêa Lima
- School of Nursing, São Paulo University, São Paulo 05403-000, Brazil; (C.F.P.); (R.J.V.); (A.V.C.L.); (S.R.d.O.); (T.F.A.)
- Nucleon of Addiction Nursing Research, School of Nursing (NEPEEA), University of São Paulo, São Paulo 05403-000, Brazil;
| | - Rogério da Silva Ferreira
- Nucleon of Addiction Nursing Research, School of Nursing (NEPEEA), University of São Paulo, São Paulo 05403-000, Brazil;
| | - Sheila Ramos de Oliveira
- School of Nursing, São Paulo University, São Paulo 05403-000, Brazil; (C.F.P.); (R.J.V.); (A.V.C.L.); (S.R.d.O.); (T.F.A.)
- Nucleon of Addiction Nursing Research, School of Nursing (NEPEEA), University of São Paulo, São Paulo 05403-000, Brazil;
| | - Thiago Faustino Aguilar
- School of Nursing, São Paulo University, São Paulo 05403-000, Brazil; (C.F.P.); (R.J.V.); (A.V.C.L.); (S.R.d.O.); (T.F.A.)
- Nucleon of Addiction Nursing Research, School of Nursing (NEPEEA), University of São Paulo, São Paulo 05403-000, Brazil;
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15
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Hubach RD, O'Neil AM, Ernst C, Stowe M, Hickey M, Remondino M, Giano Z. Client perspectives on the accessibility and quality of substance use treatment during the COVID-19 pandemic. DRUG AND ALCOHOL DEPENDENCE REPORTS 2021; 1:100002. [PMID: 35156104 PMCID: PMC8606257 DOI: 10.1016/j.dadr.2021.100002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND People who use drugs have been particularly vulnerable during the COVID-19 pandemic because of their unique social, harm reduction, and treatment needs. These unique needs and challenges have significant influence on the severity of their substance use, mental health symptomatology, willingness to engage in treatment, and adherence to treatment options. This has included immense challenges related to the dissemination of COVID-19 messaging and the need for harm reduction and treatment service entities to adopt new formats to continue operation. METHODS In-depth interview data were collected people who use drugs (N=24) residing in Oklahoma from November 2020 through February 2021 to assess perspectives on (1) their access to harm reduction, substance use prevention, and treatment programs during the COVID-19 pandemic, (2) the perceived quality of such services and programs during this time, and (3) the perceived availability of tailored COVID-19 information. RESULTS Several factors emerged related to accessing and quality of substance use services during COVID-19, including poor accessibility (e.g., internet access), diminished quality (i.e., lack of social support), and lack of tailored COVID-19 prevention and treatment messaging. CONCLUSIONS Upticks in COVID-19 cases and deaths are expected to continue as new SARS-CoV-2 variants are introduced. The present findings highlight the need for tailored COVID-19 messaging (e.g., minimizing the sharing of substance use supplies that can spread COVID-19, mask wearing, COVID-19 vaccination), which is responsive to unique needs of substance using populations. Similarly, as prevention and treatment programs are delivered online, efforts are necessary to ensure equitable access and enhanced quality of services.
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Affiliation(s)
- Randolph D. Hubach
- Department of Public Health, Purdue University, West Lafayette, IN, USA,Corresponding Author: Randolph D. Hubach, Department of Public Health, Purdue University, 219 A Matthews Hall, West Lafayette, IN 47907
| | - Andrew M. O'Neil
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Campbell Ernst
- Center for Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Mollie Stowe
- Center for Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Mark Hickey
- Center for Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Molly Remondino
- Center for Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Zachary Giano
- Center for Innovating Design and Analysis, University of Colorado-Anschutz, Denver, CO USA
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16
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Go Greener, Less Risk: Access to Nature Is Associated with Lower Risk Taking in Different Domains during the COVID-19 Lockdown. SUSTAINABILITY 2021. [DOI: 10.3390/su131910807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Specific risk attitude and risky behavior had an important boost during the coronavirus disease 2019 (COVID-19) pandemic. In this contribution, we hypothesize that access to nature during home confinement will decrease both the tendency to passive risk taking and alcohol intake. To do so, we interviewed through an online survey two samples of Italian residents during the strict lockdown due to the first wave of the COVID-19 pandemic. Specifically, in Study 1, participants were 1519 Italian residents coming from different Italian regions, whilst in Study 2, participants were 182 students at a university of southern Italy who were monitored for one week. In Study 1, the hierarchical regression analysis attested that access to nature during the lockdown mitigated the tendency to passive risk taking, over and beyond the effect of socio-demographic variables and the psychological construct of impulsiveness, an important personality correlate of risk taking. In Study 2, the hierarchical regression showed that access to green was associated with fewer glasses of alcohol drunk in a week of lockdown. This effect held over and above the effect of socio-demographic variables and the drinking behavior before the outbreak of the COVID-19 pandemic. In both studies, findings confirmed the beneficial effect of access to nature in specific risk-taking domains. Theoretical future directions, as well as practical implications for the management of the COVID-19 emergency by policymakers, are discussed.
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17
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Pabst A, Bollen Z, Creupelandt C, Fontesse S, Maurage P. Alcohol consumption changes following COVID-19 lockdown among French-speaking Belgian individuals at risk for alcohol use disorder. Prog Neuropsychopharmacol Biol Psychiatry 2021; 110:110282. [PMID: 33587965 DOI: 10.1016/j.pnpbp.2021.110282] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/25/2021] [Accepted: 02/07/2021] [Indexed: 02/07/2023]
Abstract
We investigated changes in alcohol consumption following the COVID-19 lockdown among French-speaking Belgian individuals at risk for severe alcohol use disorder. Participants (N = 299) at risk for alcohol use disorder (AUD, i.e., score higher than 19 at the Alcohol Use Disorder Identification Test), and 299 moderate drinkers (MOD, i.e., score lower than 8) individually matched for age, gender and education provided self-reports of alcohol consumption changes (i.e., number of alcohol units consumed during a typical week before and during lockdown). AUD were more likely (91.31%) than MOD (71.57%) to modify their consumption following lockdown (p < 0.0001). They were more likely to decrease (65.89% vs. 35.12%, p < 0.0001) and less likely to increase (25.42% vs. 36.45%, p = 0.004) their consumption than MOD. Analyses of post-pre lockdown differences in alcohol consumption showed that AUD presented a stronger decrease than MOD (-13.97 units/week vs. -0.07, p < 0.0001). Among individuals who decreased consumption, AUD decreased more (-27.92 vs. -2.74, p < 0.0001) than MOD. Among those who increased consumption, AUD increased more (17.32 vs. 2.44, p < 0.0001) than MOD. We thus observed sharp consumption increases or conversely abrupt decreases in individuals at high risk of alcohol use disorder, underscoring the need to develop prophylactic interventions for this population during such sanitary crises, to avoid brutal changes of the alcohol consumption pattern. Efforts should be made to mitigate consumption increases but also to favor progressive rather than sudden decreases in order to prevent damaging withdrawal symptoms.
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Affiliation(s)
- Arthur Pabst
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium.
| | - Zoé Bollen
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium.
| | - Coralie Creupelandt
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium.
| | - Sullivan Fontesse
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium.
| | - Pierre Maurage
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium.
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18
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Abstract
PURPOSE OF REVIEW The COVID-19 pandemic and associated restrictions have uniquely and disproportionately affected vulnerable populations. This review summarizes recent evidence on the relationship between psychiatric disorders, substance use disorders and COVID-19, highlighting acute and long-term risks, pharmacotherapy interactions and implications regarding appropriate and timely evidence-based treatment. RECENT FINDINGS Evidence points to a complex relationship between psychiatric and substance use disorders and COVID-19. A range of risk factors associated with psychiatric and substance use disorders increases the risk of exposure to, and complications arising from, the COVID-19 virus. COVID-19 infection has been indicated as having acute and potential long-term impacts on both psychiatric and substance use disorders. Social disruption associated with restrictions imposed to curb transmission has also been identified as a risk factor for new onset of disorders and recurrence and exacerbation of existing conditions. SUMMARY Early recognition and intervention are key to preventing chronic disability associated with psychiatric disorders, substance use disorders, and their co-occurrence. It is critical that those most in need of services do not fall through the cracks of our healthcare systems. The pandemic has fast tracked the opportunity for widespread implementation of digital health interventions but ensuring these are accessible and available to all, including our most vulnerable, will be a critical task for our future health and social ecosystems.
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Affiliation(s)
- Christina Marel
- University of Sydney, Matilda Centre for Research in Mental Health and Substance Use, Sydney, New South Wales, Australia
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19
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Rutledge SM, Schiano TD, Florman S, Im GY. COVID-19 Aftershocks on Alcohol-Associated Liver Disease: An Early Cross-Sectional Report From the U.S. Epicenter. Hepatol Commun 2021; 5:1151-1155. [PMID: 34533000 PMCID: PMC8013370 DOI: 10.1002/hep4.1706] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/07/2021] [Accepted: 02/22/2021] [Indexed: 12/13/2022] Open
Abstract
Experts have forewarned about the coronavirus disease 2019 (COVID-19) pandemic environment fomenting the rising incidence of alcohol use disorder (AUD) and alcohol-associated liver disease (ALD). We performed a cross-sectional study of ALD at our liver transplantation (LT) center, located in the initial U.S. epicenter, New York City. Centered around the "stay at home" order date in New York state, March 22, 2020, we defined three time periods: "pre-COVID" (January 1, 2020-March 21, 2020), "COVID-quarantine" (March 22, 2020-April 22, 2020), and "declining-COVID" (April 23, 2020-August 25, 2020). We found a 62% increase in interhospital patient transfers for ALD from pre-COVID (20 of 93, 21%) to the declining-COVID period (43 of 127, 34%). Our inpatient liver census with ALD also increased: 38% pre-COVID, 45% COVID-quarantine, and 49% declining-COVID. Among 30 patients with severe alcoholic hepatitis (AH) not responding to medical therapy since March 22, 2020, 9 underwent early LT for AH (16% of the total number of early LT during our 8-year program). Three of 9 early-LT recipients reported specific COVID-related stressors. All 25 previous LT recipients with established abstinence pre-COVID maintained abstinence at follow-up visits during the declining-COVID period. Of the 6 recipients with sustained alcohol use within 6 months before March 22, 2020, half regained abstinence during the declining-COVID period. Our findings help confirm the predictions of rising AUD and ALD as an immediate consequence of the COVID-19 pandemic. This aftershock particularly affected ethnically diverse patients with ALD with high inpatient mortality, reflecting the disproportionate impact of COVID-19 on underserved and minority populations. Alcohol relapse did not occur in long-term early LT for AH recipients during the time of COVID-19. This lends further support to AH being a viable indication for LT, with recipients able to demonstrate ongoing resilience in the face of this unprecedented universal stressor.
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Affiliation(s)
- Stephanie M. Rutledge
- Division of Gastroenterology, Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Thomas D. Schiano
- Recanati/Miller Transplantation Institute, Division of Liver Diseases, Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Sander Florman
- Recanati/Miller Transplantation Institute, Division of Abdominal Transplantation, Department of SurgeryIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Gene Y. Im
- Recanati/Miller Transplantation Institute, Division of Liver Diseases, Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNYUSA
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20
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Media Exposure and Substance Use Increase during COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126318. [PMID: 34207964 PMCID: PMC8296128 DOI: 10.3390/ijerph18126318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/31/2021] [Accepted: 06/07/2021] [Indexed: 11/16/2022]
Abstract
Background: Lockdown measures because of COVID-19 are likely to result in deteriorating physical and mental health. In this study, our aim was to assess the impact of media exposure on increases in substance use during the COVID-19 pandemic. Methods: A nationally representative online survey of 1264 adults was collected during the pandemic in the United States. Logistic regression was used to explore the association between an increase in substance use since the beginning of the COVID-19 pandemic and exposure to cable news or social media together with COVID-19 knowledge, while controlling for covariates. Results: In the multivariable-adjusted models, participants with the highest exposure to social media (at least daily) and low knowledge of COVID-19 were 9.9 times more likely to experience an increase in substance use since the pandemic began (OR = 9.90, 95% CI = 4.27–23.06). Participants with the highest exposure to cable news and low knowledge of COVID-19 were over 11 times more likely to experience an increase in substance use (OR = 11.64, 95% CI = 4.01–24.45). Conclusion: Based on our findings, we recommend that media organizations should aim to reduce uncertainty and also provide positive coverage to counter the negative information associated with pandemics.
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Expressive Art Therapies for Treating People With Misuses of Alcohol, Licit, and Illicit Drugs in COVID-19 Outbreak. ADDICTIVE DISORDERS & THEIR TREATMENT 2021. [DOI: 10.1097/adt.0000000000000280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Beccegato E, Angiola F, Favretto D, Ruggeri A, Terranova C. Coronavirus lockdown: Excessive alcohol consumption and illicit substance use in DUI subjects. TRAFFIC INJURY PREVENTION 2021; 22:355-360. [PMID: 34037479 DOI: 10.1080/15389588.2021.1923701] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study investigates the consequences of the SarS-CoV-2 outbreak and of the resulting control measures on alcohol and illicit substance use in a high-risk population for substance-related disorders, utilizing an integrated medico-legal and toxicological approach. METHODS The research was structured as a retrospective case-control study of subjects found to be driving under the influence (DUI) of alcohol and/or other psychoactive substances who were examined for driver's license regranting. Alcohol and/or drug use was assessed by comparing cases examined in the period from May to August 2020 (immediately after the lockdown in Italy) to control subjects examined in the same period in 2019. DUI subjects were examined by an integrated approach, descriptive analyses were conducted, and significance was determined by chi-square and Mann-Whitney tests. Variables linked to the pandemic outbreak and resulting lockdown were investigated as predictive factors in determining unfitness to drive. RESULTS Cases (281) were significantly different from controls (261) concerning the judgment of unfitness to drive (p<.001) and had more subjects with chronic excessive alcohol use and/or illicit substance use. The two groups were rather homogeneous concerning the other variables, except for a difference in blood alcohol concentration (BAC) at the time of DUI (p = .027). No statistical association was found between the investigated variables linked to the lockdown and the judgment of unfitness to drive. CONCLUSIONS Chronic excessive alcohol consumption and illicit substance use were more frequently observed in cases, which suggests a possible correlation between the pandemic/lockdown restrictions and an increase in psychoactive substance misuse. While these potentially correlative factors are discussed in this article, they require further study. If confirmed, the results should be considered in forensic and clinical settings.
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Affiliation(s)
- Elena Beccegato
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy Padova
| | - Francesco Angiola
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy Padova
| | - Donata Favretto
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy Padova
| | - Angelo Ruggeri
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy Padova
| | - Claudio Terranova
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy Padova
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Navin K, Mahadevan J, Jain R, Moirangthem S. A Psychiatric-COVID Unit: The National Institute of Mental Health and Neuro Sciences (NIMHANS) Experience. Indian J Psychol Med 2021; 43:252-256. [PMID: 34345102 PMCID: PMC8287385 DOI: 10.1177/02537176211006324] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Karthick Navin
- Dept. of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Jayant Mahadevan
- Centre for Addiction Medicine, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Richa Jain
- Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sydney Moirangthem
- Dept. of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
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McGraw C, Salottolo K, Carrick M, Lieser M, Madayag R, Berg G, Banton K, Hamilton D, Bar-Or D. Patterns of alcohol and drug utilization in trauma patients during the COVID-19 pandemic at six trauma centers. Inj Epidemiol 2021; 8:24. [PMID: 33752758 PMCID: PMC7983106 DOI: 10.1186/s40621-021-00322-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/15/2021] [Indexed: 12/23/2022] Open
Abstract
Background Since the national stay-at-home order for COVID-19 was implemented, clinicians and public health authorities worldwide have expressed growing concern about the potential repercussions of drug and alcohol use due to social restrictions. We explored the impact of the national stay-at-home orders on alcohol or drug use and screenings among trauma admissions. Methods This was a retrospective cohort study at six Level I trauma centers across four states. Patients admitted during the period after the onset of the COVID-19 restrictions (defined as March 16, 2020-May 31, 2020) were compared with those admitted during the same time period in 2019. We compared 1) rate of urine drug screens and blood alcohol screens; 2) rate of positivity for drugs or alcohol (blood alcohol concentration ≥ 10 mg/dL); 3) characteristics of patients who were positive for drug or alcohol, by period using chi-squared tests or Fisher’s exact tests, as appropriate. Two-tailed tests with an alpha of p < 0.05 was used on all tests. Results There were 4762 trauma admissions across the study period; 2602 (55%) in 2019 and 2160 (45%) in 2020. From 2019 to 2020, there were statistically significant increases in alcohol screens (34% vs. 37%, p = 0.03) and drug screens (21% vs. 26%, p < 0.001). Overall, the rate of alcohol positive patients significantly increased from 2019 to 2020 (32% vs. 39%, p = 0.007), while the rate of drug positive patients was unchanged (57% vs. 52%, p = 0.13). Of the 1025 (22%) patients who were positive for alcohol or drugs, there were significant increases in a history of alcoholism (41% vs. 26%, p < 0.001), and substance abuse (11% vs. 23%, p < 0.001) in the 2020 period. No other statistically significant differences were identified among alcohol or drug positive patients during COVID-19 compared to the same period in 2019. Conclusions Our first wave of COVID-19 data suggests that trauma centers were admitting significantly more patients who were alcohol positive, as well those with substance use disorders, potentially due to the impact of social restrictions and guidelines. Further longitudinal research is warranted to assess the alcohol and drug positive rates of trauma patients over the COVID-19 pandemic.
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Affiliation(s)
- Constance McGraw
- Trauma Research Department, Injury Outcomes Network, Englewood, CO, USA
| | - Kristin Salottolo
- Trauma Research Department, Injury Outcomes Network, Englewood, CO, USA
| | - Matthew Carrick
- Trauma Services Department, Medical City Plano, Plano, TX, USA
| | - Mark Lieser
- Trauma Services Department, Research Medical Center, Kansas City, MO, USA
| | - Robert Madayag
- Trauma Services Department, St. Anthony Hospital, Lakewood, CO, USA
| | - Gina Berg
- Trauma Services Department, Wesley Medical Center, Wichita, KS, USA
| | - Kaysie Banton
- Trauma Services Department, Swedish Medical Center, Englewood, CO, USA
| | - David Hamilton
- Trauma Services Department, Penrose-St. Francis Health Services, Colorado Springs, CO, USA
| | - David Bar-Or
- Trauma Research Department, Injury Outcomes Network, Englewood, CO, USA.
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Boden M, Zimmerman L, Azevedo KJ, Ruzek JI, Gala S, Abdel Magid HS, Cohen N, Walser R, Mahtani ND, Hoggatt KJ, McLean CP. Addressing the mental health impact of COVID-19 through population health. Clin Psychol Rev 2021; 85:102006. [PMID: 33714167 PMCID: PMC7934657 DOI: 10.1016/j.cpr.2021.102006] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 12/17/2022]
Abstract
The COVID-19 pandemic has and will continue to result in negative mental health outcomes such as depression, anxiety and traumatic stress in people and populations throughout the world. A population mental health perspective informed by clinical psychology, psychiatry and dissemination and implementation science is ideally suited to address the broad, multi-faceted and long-lasting mental health impact of the pandemic. Informed by a systematic review of the burgeoning empirical research on the COVID-19 pandemic and research on prior coronavirus pandemics, we link pandemic risk factors, negative mental health outcomes and appropriate intervention strategies. We describe how social risk factors and pandemic stressors will contribute to negative mental health outcomes, especially among vulnerable populations. We evaluate the scalability of primary, secondary and tertiary interventions according to mental health target, population, modality, intensity and provider type to provide a unified strategy for meeting population mental health needs. Traditional models, in which evidence-based therapies delivered are delivered in-person, by a trained expert, at a specialty care location have proved difficult to scale. The use of non-traditional models, tailoring preventive interventions to populations based on their needs, and ongoing coordinated evaluation of intervention implementation and effectiveness will be critical to refining our efforts to increase reach.
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Affiliation(s)
- Matt Boden
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, United States of America.
| | - Lindsey Zimmerman
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Care Healthcare System, United States of America; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States of America; Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Kathryn J Azevedo
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Care Healthcare System, United States of America
| | - Josef I Ruzek
- Center for m2 Health, Palo Alto University, Palo Alto, CA, United States of America; Department of Psychology, University of Colorado, Colorado Springs, United States of America
| | - Sasha Gala
- Mission Rock Enterprise, LLC, United States of America
| | - Hoda S Abdel Magid
- Department of Epidemiology and Population Health, Stanford University, United States of America
| | - Nichole Cohen
- Department of Psychology, University of Kansas, United States of America
| | - Robyn Walser
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Care Healthcare System, United States of America; University of California, Berkeley, United States of America
| | - Naina D Mahtani
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, United States of America; School of Behavioral Health, Loma Linda University, United States of America
| | - Katherine J Hoggatt
- San Francisco VA Health Care System, United States of America; Department of Medicine, University of California, San Francisco, United States of America
| | - Carmen P McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Care Healthcare System, United States of America; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States of America
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Vahabi N, Salehi M, Duarte JD, Mollalo A, Michailidis G. County-level longitudinal clustering of COVID-19 mortality to incidence ratio in the United States. Sci Rep 2021; 11:3088. [PMID: 33542313 PMCID: PMC7862666 DOI: 10.1038/s41598-021-82384-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/18/2021] [Indexed: 01/30/2023] Open
Abstract
As of November 12, 2020, the mortality to incidence ratio (MIR) of COVID-19 was 5.8% in the US. A longitudinal model-based clustering system on the disease trajectories over time was used to identify "vulnerable" clusters of counties that would benefit from allocating additional resources by federal, state and county policymakers. County-level COVID-19 cases and deaths, together with a set of potential risk factors were collected for 3050 U.S. counties during the 1st wave of COVID-19 (Mar25-Jun3, 2020), followed by similar data for 1344 counties (in the "sunbelt" region of the country) during the 2nd wave (Jun4-Sep2, 2020), and finally for 1055 counties located broadly in the great plains region of the country during the 3rd wave (Sep3-Nov12, 2020). We used growth mixture models to identify clusters of counties exhibiting similar COVID-19 MIR growth trajectories and risk-factors over time. The analysis identifies "more vulnerable" clusters during the 1st, 2nd and 3rd waves of COVID-19. Further, tuberculosis (OR 1.3-2.1-3.2), drug use disorder (OR 1.1), hepatitis (OR 13.1), HIV/AIDS (OR 2.3), cardiomyopathy and myocarditis (OR 1.3), diabetes (OR 1.2), mesothelioma (OR 9.3) were significantly associated with increased odds of being in a more vulnerable cluster. Heart complications and cancer were the main risk factors increasing the COVID-19 MIR (range 0.08-0.52% MIR↑). We identified "more vulnerable" county-clusters exhibiting the highest COVID-19 MIR trajectories, indicating that enhancing the capacity and access to healthcare resources would be key to successfully manage COVID-19 in these clusters. These findings provide insights for public health policymakers on the groups of people and locations they need to pay particular attention while managing the COVID-19 epidemic.
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Affiliation(s)
- Nasim Vahabi
- Informatics Institute, University of Florida, Gainesville, FL, USA
| | - Masoud Salehi
- Department of Biostatistics, College of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Julio D Duarte
- Center for Pharmacogenomics, Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Abolfazl Mollalo
- Department of Public Health and Prevention Sciences, School of Health Sciences, Baldwin Wallace University, Berea, OH, USA
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Post LA, Benishay ET, Moss CB, Murphy RL, Achenbach CJ, Ison MG, Resnick D, Singh LN, White J, Chaudhury AS, Boctor MJ, Welch SB, Oehmke JF. Surveillance Metrics of SARS-CoV-2 Transmission in Central Asia: Longitudinal Trend Analysis. J Med Internet Res 2021; 23:e25799. [PMID: 33475513 PMCID: PMC7861038 DOI: 10.2196/25799] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/09/2020] [Accepted: 01/20/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND SARS-CoV-2, the virus that caused the global COVID-19 pandemic, has severely impacted Central Asia; in spring 2020, high numbers of cases and deaths were reported in this region. The second wave of the COVID-19 pandemic is currently breaching the borders of Central Asia. Public health surveillance is necessary to inform policy and guide leaders; however, existing surveillance explains past transmissions while obscuring shifts in the pandemic, increases in infection rates, and the persistence of the transmission of COVID-19. OBJECTIVE The goal of this study is to provide enhanced surveillance metrics for SARS-CoV-2 transmission that account for weekly shifts in the pandemic, including speed, acceleration, jerk, and persistence, to better understand the risk of explosive growth in each country and which countries are managing the pandemic successfully. METHODS Using a longitudinal trend analysis study design, we extracted 60 days of COVID-19-related data from public health registries. We used an empirical difference equation to measure the daily number of cases in the Central Asia region as a function of the prior number of cases, level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. RESULTS COVID-19 transmission rates were tracked for the weeks of September 30 to October 6 and October 7-13, 2020, in Central Asia. The region averaged 11,730 new cases per day for the first week and 14,514 for the second week. Infection rates increased across the region from 4.74 per 100,000 persons to 5.66. Russia and Turkey had the highest 7-day moving averages in the region, with 9836 and 1469, respectively, for the week of October 6 and 12,501 and 1603, respectively, for the week of October 13. Russia has the fourth highest speed in the region and continues to have positive acceleration, driving the negative trend for the entire region as the largest country by population. Armenia is experiencing explosive growth of COVID-19; its infection rate of 13.73 for the week of October 6 quickly jumped to 25.19, the highest in the region, the following week. The region overall is experiencing increases in its 7-day moving average of new cases, infection, rate, and speed, with continued positive acceleration and no sign of a reversal in sight. CONCLUSIONS The rapidly evolving COVID-19 pandemic requires novel dynamic surveillance metrics in addition to static metrics to effectively analyze the pandemic trajectory and control spread. Policy makers need to know the magnitude of transmission rates, how quickly they are accelerating, and how previous cases are impacting current caseload due to a lag effect. These metrics applied to Central Asia suggest that the region is trending negatively, primarily due to minimal restrictions in Russia.
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Affiliation(s)
- Lori Ann Post
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Elana T Benishay
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Charles B Moss
- Institute of Food and Agricultural Sciences, University of Florida, Gainsville, FL, United States
| | - Robert Leo Murphy
- Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Chad J Achenbach
- Divison of Infectious Disease, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Michael G Ison
- Divison of Infectious Disease, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Danielle Resnick
- International Food Policy Research Institute, Washington, DC, United States
| | - Lauren Nadya Singh
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Janine White
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Azraa S Chaudhury
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Michael J Boctor
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sarah B Welch
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - James Francis Oehmke
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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De Berardis D, Gianfelice G, Fornaro M, Vellante F, Ventriglio A, Marini G, Pettorruso M, Martinotti G, Fraticelli S, Di Giannantonio M. A Possible Next Covid-19 Pandemic: The Violence Against Women and Its Psychiatric Consequences. Front Psychiatry 2021; 12:650671. [PMID: 34248699 PMCID: PMC8267523 DOI: 10.3389/fpsyt.2021.650671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/28/2021] [Indexed: 12/21/2022] Open
Affiliation(s)
- Domenico De Berardis
- National Health Service, Department of Mental Health, Psychiatric Service for Diagnosis and Treatment, Hospital "G. Mazzini, " Azienda Sanitaria Locale 4, Teramo, Italy.,Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio" Chieti, Chieti, Italy
| | - Giulia Gianfelice
- National Health Service, Department of Mental Health, Psychiatric Service for Diagnosis and Treatment, Hospital "G. Mazzini, " Azienda Sanitaria Locale 4, Teramo, Italy
| | - Michele Fornaro
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio" Chieti, Chieti, Italy
| | | | | | - Gabriella Marini
- ANAAO Assomed Syndicate, Women Section, Hospice and Palliative Therapy Unit, ASL Teramo, Teramo, Italy
| | - Mauro Pettorruso
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio" Chieti, Chieti, Italy
| | - Giovanni Martinotti
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio" Chieti, Chieti, Italy
| | - Silvia Fraticelli
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio" Chieti, Chieti, Italy
| | - Massimo Di Giannantonio
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio" Chieti, Chieti, Italy
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Shapiro PA, Brahmbhatt K, Caravella R, Erickson J, Everly G, Giles K, Gopalan P, Greenspan H, Huijón RM, Key RG, Kroll D, Prince E, Rabinowitz T, Saad-Pendergrass D, Shalev D. Report of the Academy of Consultation-Liaison Psychiatry Task Force on Lessons Learned From the COVID-19 Pandemic: Executive Summary. J Acad Consult Liaison Psychiatry 2021; 62:377-386. [PMID: 34000470 PMCID: PMC8120806 DOI: 10.1016/j.jaclp.2021.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/06/2021] [Accepted: 05/09/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The COVID-19 pandemic forced consultation-liaison psychiatrists to adapt to unprecedented circumstances. The Academy of Consultation-Liaison Psychiatry (ACLP) recognized the need and opportunity to assess its response and convened a task force in mid-2020 to review the lessons learned from the initial experience of the COVID-19 pandemic. OBJECTIVE The aim of the study was to summarize experience and make recommendations to the ACLP Board of Directors about potential ACLP directions related to current and future pandemic response. METHODS In August-November 2020, the task force reviewed local experiences, ACLP list-serv contributions, and the published literature and generated recommendations for ACLP actions. RESULTS Recommendations addressed telepsychiatry, hospital staff wellness, support for consultation-liaison psychiatrists, the need for additional research on psychiatric and neuropsychiatric aspects of COVID-19, and the ACLP's role in advocacy and dissemination of information. The task force report was submitted to the ACLP Board of Directors in November 2020. CONCLUSIONS As the preeminent organization of consultation-liaison psychiatrists, the ACLP can implement actions related to pandemic awareness and preparedness for the benefit of consultation-liaison psychiatrists, other health care workers, patients, and the general population.
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Affiliation(s)
- Peter A. Shapiro
- Department of Psychiatry, Columbia University, New York, NY,Send correspondence and reprint requests to Peter A. Shapiro, MD, New York-Presbyterian Hospital, Columbia University Irving Medical Center, 622 W. 168 St Box 427, New York NY 10032
| | - Khyati Brahmbhatt
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
| | - Rachel Caravella
- Department of Psychiatry, New York University Langone Health, New York, NY
| | | | - George Everly
- Department of Psychiatry, Johns Hopkins University, Baltimore, MD
| | - Karen Giles
- Department of Psychiatry, Emory University, Atlanta, GA
| | - Priya Gopalan
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | | | | | - R. Garrett Key
- Department of Psychiatry, University of Texas-Austin, Austin, TX
| | - David Kroll
- Department of Psychiatry, Harvard University, Boston, MA
| | - Elizabeth Prince
- Department of Psychiatry, Johns Hopkins University, Baltimore, MD
| | | | | | - Daniel Shalev
- Department of Psychiatry, Columbia University, New York, NY
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Sharp decline in hospital and emergency department initiated buprenorphine for opioid use disorder during COVID-19 state of emergency in California. J Subst Abuse Treat 2020; 123:108260. [PMID: 33612194 PMCID: PMC7832157 DOI: 10.1016/j.jsat.2020.108260] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/06/2020] [Accepted: 12/15/2020] [Indexed: 11/22/2022]
Abstract
The California Bridge Program supports expansion of medications for opioid use disorder (MOUD) in emergency departments (EDs) and hospital inpatient units across the state. Here, we describe the change in activity before and after the coronavirus disease 2019 (COVID-19) California statewide shutdown. Of the 70 participating hospitals regionally distributed across California, 52 report MOUD-related activity monthly. We analyzed data on outcomes of OUD care and treatment: identification of OUD, acceptance of referral, receipt of buprenorphine prescription, administration of buprenorphine, and follow-up linkage to outpatient OUD treatment, from May 2019 to April 2020. In estimating the expected number of patients who met each outcome in April 2020, we found decreases in the expected to observed number of patients across all outcomes (all p-values<0.002): 37% (from 1053 to 667) decrease in the number of patients identified with OUD, 34% (from 632 to 420) decrease in the number of patients who accepted a referral, 48% (from 521 to 272) decrease in the number of patients who were prescribed buprenorphine, 53% (from 501 to 234) decrease in the number of patients who were administered buprenorphine, and 33% (from 416 to 277) decrease in the number of patients who attended at least one follow-up visit for addiction treatment. The COVID-19 California statewide shutdown was associated with an abrupt and large decrease in the progress toward expanded access to OUD treatment.
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Wilkinson R, Hines L, Holland A, Mandal S, Phipps E. Rapid evidence review of harm reduction interventions and messaging for people who inject drugs during pandemic events: implications for the ongoing COVID-19 response. Harm Reduct J 2020; 17:95. [PMID: 33261636 PMCID: PMC7705852 DOI: 10.1186/s12954-020-00445-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/20/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND People who inject drugs are at increased health risk in a pandemic due to their greater susceptibility to severe disease and as a consequence of the restrictions put in place to halt the spread of infection. Harm reduction (HR) services, which aim to reduce the negative effects of drug use on health, are likely to be diminished in a pandemic. However, innovative HR interventions and messaging may also develop in response to such a crisis. It is vital to understand the most effective ways to deliver HR in pandemic situations so that guidance can be provided for current and future disruptions to service provision. METHODS A rapid evidence review was conducted with the aim of exploring what HR interventions and messaging are most effective during a pandemic-type situation. Ten health databases were systematically searched using terms relevant to the research aim. A search was also made of grey literature, including a targeted search of HR messaging from key national and service provider websites. RESULTS In the initial search, 121 pieces of evidence were identified which, after screening and de-duplication, resulted in 60 for inclusion. The included evidence consists mainly of non-peer reviewed, pre-publication or expert opinion pieces. The rapid findings suggest that HR services should be deemed essential during a pandemic, with staff supported to work safely and social distancing adaptations implemented. Services should be encouraged to operate more flexibly; for instance, in deciding the amounts of take-home supplies of injecting equipment and medications. The evidence on HR communication was very limited but key messages on infection control, uncertain drug supply and accessing services were identified. CONCLUSIONS This rapid evidence review identifies implications for national policy makers, commissioners and HR service providers. A person-centred rather than disease-centred approach to HR delivered by collaborating partners, as well as prioritizing tailored HR messaging, is recommended. Further research evaluating the delivery of HR services and messaging, particularly focusing on health inequalities, is urgently needed.
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Affiliation(s)
- Rebecca Wilkinson
- Rebecca Wilkinson, Public Health Registrar, School of Primary Care, Population Sciences and Medical Education, Southampton General Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.
| | - Lindsey Hines
- Lindsey Hines, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Adam Holland
- Adam Holland Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sema Mandal
- Sema Mandal Blood Safety, Hepatitis, STI and HIV Division, National Infection Service, Public Health England, London, UK
| | - Emily Phipps
- Emily Phipps Blood Safety, Hepatitis, STI and HIV Division, National Infection Service, Public Health England, London, UK
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Affiliation(s)
- Ned H Kalin
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison
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Pajević I, Hasanović M, Avdibegović E, Džubur-Kulenović A, Burgić-Radmanović M, Babić D, Mehić-Basara N, Zivlak-Radulović N, Račetović G. Organization of mental healthcare in Bosnia and Herzegovina during coronavirus disease 2019 pandemic. Indian J Psychiatry 2020; 62:S479-S491. [PMID: 33227053 PMCID: PMC7659768 DOI: 10.4103/psychiatry.indianjpsychiatry_1044_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 08/31/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19), like any other pandemic, has imposed an unprecedented threat to physical and mental health to all nations, worldwide. There is no enough evidence in the literature in this area. The present study has been done to explore the organization of psychiatric services in Bosnia and Herzegovina (BH) to meet mental health needs of BH citizens during the particular restrictive measures caused by COVID-19 pandemic. MATERIALS This online survey has been done for BH psychiatric institutions. Data were collected from psychiatric institutions in the mental health network of BH. A total of 38 complete responses have been received. RESULTS Of 38 study participants, three were the departments of psychiatry in university clinical centers, two were psychiatric hospitals, four were psychiatric wards in general hospitals, 27 were community mental health centers, and two were institutes for alcoholism and drug addiction. During the pandemic, all services functioned on a reduced scale, adhering to measures to protect and self-protect both staff and service users. Protective equipment was provided to staff in some institutions in a timely and complete manner and in some in an untimely and incomplete manner. Consultative psychiatric examinations were mainly performed through telephone and online, where it exists as a standard patient monitoring protocol. The application of long-acting antipsychotics was continuous with adherence to restricted and protective measures. In opiate addiction replacement therapy services, substitution therapy was provided for a longer period to reduce frequent contacts between staff and patients. Individual and group psychotherapy continued in reduced number using online technologies, although this type of service was not administratively regulated. An initiative has been given to regulate and administratively recognize telepsychiatry by health insurance funds in the country. A number of psychological problems associated with restrictive measures and fear of illness have been reported by patients as well as by the professionals in mental healthcare teams. There were no COVID-19-positive patients seeking help from institutions that responded to the questionnaire. In one center, infected people with COVID-19 from abroad sought help through the phone. Only one involuntary hospitalization was reported. The involvement of mental health professionals in the work of crisis headquarters during the design of the COVID-19 pandemic control measures varies from satisfactory to insufficient. Education of staff, patients, and citizens was regular with direct instructions through meetings, press, and electronic media. CONCLUSIONS During the COVID-19 pandemic in BH, all psychiatric services functioned on a reduced scale, adhering to measures to protect and self-protect staff and service users. All patients who asked for help have been adequately treated in direct inpatient or outpatient mental healthcare or online, despite telepsychiatric services not being recognized in health system in BH. There were neither infected patients nor staff with COVID-19 in the psychiatric institutions who responded in this research. A large-scale, multicenter study needs to be performed to get a broader picture and to guide us for future better service planning and delivery.
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Affiliation(s)
- Izet Pajević
- Department of Psychiatry, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Mevludin Hasanović
- Department of Psychiatry, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Esmina Avdibegović
- Department of Psychiatry, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Alma Džubur-Kulenović
- Department of Psychiatry, Clinical Center of University Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Marija Burgić-Radmanović
- Department of Psychiatry, University Clinical Center of Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Dragan Babić
- Department of Psychiatry, University Clinical Hospital of Mostar, Mostar, Bosnia and Herzegovina
| | - Nermana Mehić-Basara
- Public Institute for Addiction Disorders of Canton Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nera Zivlak-Radulović
- Department of Psychiatry, University Clinical Center of Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Goran Račetović
- Community Mental Health Center, Health Center Prijedor, Prijedor, Bosnia and Herzegovina
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