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Bali B, Tuan WJ, Scott A, Bollampally P, Groff D, Leong SL, King VL, Bone C. Assessing men with opioid use disorder for testosterone deficiency after the development of symptoms. J Addict Dis 2024:1-7. [PMID: 38619057 DOI: 10.1080/10550887.2024.2327751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Individuals with opioid use disorder (OUD) have reduced life expectancy and inferior outcomes when treated for depression, diabetes, and fractures. Their elevated risk of testosterone deficiency may contribute to all of these relationships, however few individuals prescribed opioids are evaluated with testosterone assays. The purpose of this study is to determine whether patients with opioid use disorder are evaluated for testosterone deficiency after development of a symptom that may merit investigation, such as erectile dysfunction (ED). METHOD We conducted a retrospective longitudinal cohort study that utilized data from a national database called TriNetX. Patients were eligible for inclusion if they were 20 to 90 years of age, male, and diagnosed with erectile dysfunction. We utilized descriptive statistics and logistic regression to address study aims. RESULTS Testosterone testing was uncommon for all patients with ED. Among 20,658 patients, it was assessed in 11.2% with OUD and 15.1% without OUD. Among those screened, 40% individuals with OUD and ED had testosterone deficiency. Odds of screening those with OUD were lower than matched controls (RR 0.74). CONCLUSIONS Individuals with OUD are at increased risk of testosterone deficiency than the general population, but nearly 90% are not evaluated for this condition even after development symptoms. That 40% of individuals assessed were classified as testosterone deficient suggests endocrine disorders may be contributing to increased fracture risk, chronic pain, and severe depression commonly encountered in patients with OUD. Addressing this care gap may reduce morbidity and mortality associated with opioid use disorder.
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Affiliation(s)
- Bhavna Bali
- Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Wen Jan Tuan
- Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Alyssa Scott
- University of Maryland Medical Center, Baltimore, Maryland, USA
| | | | - Destin Groff
- Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Shou Ling Leong
- Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Van L King
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Curtis Bone
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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2
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Groff D, Freedman Z, Gilles A, Bone C, Johnson TS. Development of Opioid Use Disorder After Breast Reconstruction: Effects of Nicotine Exposure. Ann Plast Surg 2024; 92:S241-S244. [PMID: 38556681 DOI: 10.1097/sap.0000000000003793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
INTRODUCTION After undergoing breast reconstructive surgery, patients are typically prescribed opioids. Smoking tobacco increases rate of opioid metabolism and is associated with development of opioid use disorder (OUD). The aim of this study was to determine whether patients who smoke have an increased risk of OUD after breast reconstructive surgery. Given that OUD is a known risk factor for injection drug use and intravenous drug use increases risk of acquiring blood-borne diseases including human immunodeficiency virus (HIV) and hepatitis, the secondary aim was to determine if these patients are also at increased risk of acquiring these communicable diseases associated with OUD. METHODS A retrospective analysis was conducted using TriNetX, a multi-institutional deidentified database. Individuals included underwent a breast reconstructive surgery and received postoperative opioid treatment. The exposed group included patients who smoke. The control group did not smoke. Risk of developing OUD, hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV from 12 to 36 months after surgery was compared between groups. Patients with preexisting OUD or associated diseases were excluded. Cohorts were matched to control for confounding factors including age, sex, race, mental health history, and concomitant substance use. RESULTS There were 8648 patients included in the analysis. After matching, 4324 patients comprised the exposure group, and 4324 patients remained in the control group. Preoperative smoking was significantly associated with increased risk of OUD at 12, 24, and 36 months after breast reconstruction (36 months: odds ratio [OR], 2.722; confidence interval [CI], 2.268-6.375). Smoking was also associated with increased risk of HIV and HCV at all time points after surgery (36 months HIV: OR, 2.614; CI, 1.977-3.458; 36 months HCV: OR, 3.718; CI, 2.268-6.375) and increased risk of HBV beginning at 24 months after surgery (36 months HBV: OR, 2.722; CI, 1.502-4.935). CONCLUSIONS Individuals who smoke have an increased risk of developing OUD, HIV, HCV, and HBV after breast reconstructive surgery. This risk persists for at least 3 years after surgery. Additional research and clinical interventions focusing on early identification of OUD, prevention efforts, and harm reduction strategies for patients who smoke or have nicotine dependence undergoing breast reconstruction are warranted.
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Affiliation(s)
| | | | - Ambroise Gilles
- Division of Plastic and Reconstructive Surgery, Pennsylvania State Hershey Medical Center, Hershey, PA
| | | | - Timothy Shane Johnson
- Division of Plastic and Reconstructive Surgery, Pennsylvania State Hershey Medical Center, Hershey, PA
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Takada S, Seamans MJ, Javanbakht M, Bone C, Ijadi-Maghsoodi R, Shoptaw S, Gelberg L. Nativity and the risk of opioid use disorder among Hispanic/Latinx women in primary care in Los Angeles, CA. J Ethn Subst Abuse 2024:1-15. [PMID: 38327151 DOI: 10.1080/15332640.2023.2297392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND While rates of opioid use disorder (OUD) are lower among women compared to men, nativity may have disproportionate impacts on OUD risk among Hispanic/Latinx women but remain understudied. OBJECTIVE To assess the association between country of birth and reported OUD risk among low-income Hispanic/Latinx women in primary care in Los Angeles, CA. METHODS This was a cross-sectional study of 1189 non-pregnant, Hispanic/Latinx women attending two federally qualified health centers in Los Angeles between March and July 2013. OUD risk was assessed using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), and moderate-to-high risk was defined as ASSIST score ≥ 4. RESULTS Overall, 4.2% of women (n = 49) were at moderate-to-high risk for OUD. Risk for OUD was higher among US-born women compared to foreign-born women (6.7 vs. 1.7%; p < .01), those who reported 2+ chronic medical conditions (p < .01), and those who were at moderate-to-high risk for other substance use disorders (p < .01). In multivariable logistic regression analyses, being U.S.-born was independently associated with being at moderate-to-high risk for OUD among Hispanic/Latinx women as compared to those who were foreign-born (AOR = 2.8; 95% CI 1.2-6.8). CONCLUSION Among low-income Hispanic/Latinx women presenting to primary care, one in twenty patients is at-risk for OUD. The odds of moderate-high risk of OUD were three times as high in US-born compared to foreign-born women, and higher among those with chronic medical conditions and those at risk of other substance use disorders. Gender-specific and culturally-tailored screening for OUD may inform overdose prevention interventions for US-born Hispanic/Latinx women.
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Affiliation(s)
- Sae Takada
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Marissa J Seamans
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California
| | - Curtis Bone
- Department of Family and Community Medicine, Penn State Milton Hershey Medical Center, Hershey, Pennsylvania
| | - Roya Ijadi-Maghsoodi
- Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, California
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Shafeek P, Clegg T, Kawmi N, Luciano S, Bone C, Graziane N. The temporal relationship between antibiotic and opioid prescription on the risk of developing an opioid use disorder: A national database study. J Addict Dis 2023; 41:274-281. [PMID: 35938745 DOI: 10.1080/10550887.2022.2108364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: Previously, we discovered that subjects co-prescribed both antibiotics and opioids on the same day in a hospital setting displayed an increased risk of developing an opioid use disorder (OUD) 12 months following hospital discharge. The goal of this study was to examine whether prescribing antibiotics in the inpatient or emergency department setting at various time points before or after an opioid prescription impacted the risk OUD.Methods: A propensity score matched cohort study was conducted to identify subjects (18-65 years old) with no previous history of OUD. Two cohorts were defined: subjects who were prescribed antibiotics 0-1, 2-4, 5-7, 8-10, 11-12 months before or after the date of an opioid prescription while in the emergency department or inpatient setting, from the years 2010-2019. The diagnosis of an Opioid Related Disorder (F11.10-F11.20) 12 months following discharge from the emergency department or inpatient unit was then observed.Results: Primary analysis showed that subjects prescribed an antibiotic 0-1 month or 8-10 months before an opioid prescription showed a modest risk of developing an OUD 12 months following an opioid prescription (0.04% and 0.20%, respectively). Similarly, subjects prescribed an antibiotic 0-1 month, 5-7 months, or 8-10 months after an opioid prescription displayed a modest risk of developing OUD 12 months after an opioid prescription (0.02% risk, 0.14% risk, and 0.16% risk, respectively).Conclusions: These findings suggest that there is little to no effect on the risk of developing OUD when antibiotics are prescribed at various time points before or after opioid prescription.
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Affiliation(s)
- Peter Shafeek
- Doctor of Medicine Program, Penn State College of Medicine, Hershey, PA, USA
| | - Taylor Clegg
- Doctor of Medicine Program, Penn State College of Medicine, Hershey, PA, USA
| | - Noor Kawmi
- Doctor of Medicine Program, Penn State College of Medicine, Hershey, PA, USA
| | | | - Curtis Bone
- Departments of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Nicholas Graziane
- Departments of Anesthesiology and Perioperative Medicine and Pharmacology, Penn State College of Medicine, Hershey, PA, USA
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5
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Latronica JR, Tuan WJ, Clegg TJ, Silvis ML, Bone C. Cardiovascular Outcomes Among Older Individuals With Depression Prescribed Amphetamines: A Retrospective Cohort Study. J Gerontol A Biol Sci Med Sci 2022; 77:2459-2463. [PMID: 35137053 DOI: 10.1093/gerona/glac033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Prescription amphetamines are utilized for treatment of depression in older adults, yet cardiovascular risks in this population are not well described. The purpose of this study is to evaluate risk of cardiovascular events among adults aged 65 and older with depression who were prescribed amphetamines. METHODS We conducted a retrospective matched cohort study utilizing the TriNetx database and statistical software. The 1:1 propensity score matching technique was performed using logistic regression to balance the baseline characteristics of the population. Inclusion criteria were a diagnosis of depression and age 65 years and older. We excluded individuals with an adverse cardiovascular event or diagnosis of attention deficit and hyperactivity disorder prior to enrollment. Individuals were followed from January 1, 2018 to December 31, 2020. Those prescribed an amphetamine were considered exposed and others served as controls. We used descriptive statistics and calculated risk ratios to assess the relationship between amphetamine prescriptions and cardiovascular events in these cohorts. RESULTS There were 4 434 included in the exposed cohort and 4 434 matched controls in the unexposed group. The cohort exposed to amphetamines had higher high-density lipoprotein along with lower low-density lipoprotein, total cholesterol, hemoglobin A1C, systolic blood pressure, and body mass index than the control group, but increased risk of cardiovascular events (risk ratio: 8.9; 95% confidence interval: 6.39, 12.48). CONCLUSIONS Amphetamines offer potential benefits to people with depression; however, these data suggest increased risk of cardiovascular events among older individuals. Additional research is warranted to fully characterize risk among subpopulations of older adults and inform patient-provider decision making.
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Affiliation(s)
- James R Latronica
- Department of Psychiatry and Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Wen Jan Tuan
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Taylor J Clegg
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Matthew L Silvis
- Penn State Milton S. Hershey Medical Center, Department of Family and Community Medicine; Department of Orthopedics and Rehabilitation, Hershey, Pennsylvania, USA
| | - Curtis Bone
- Penn State Milton S. Hershey Medical Center, Department of Family and Community Medicine, Hershey, Pennsylvania, USA
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Messner E, Parascando JA, La Gamma C, Bone C, Clebak KT, Riley TD. Effects of Early COVID-19 Restrictions on Resident Well-being and Burnout. Fam Med 2022; 54:708-712. [DOI: 10.22454/fammed.2022.233405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background and Objectives: The COVID-19 pandemic has contributed to burnout among residents, a population already at increased risk for heightened stress and work-related fatigue. Residency programs were also forced to alter schedules and educational objectives. We assessed how social distancing restrictions (specifically self-isolation) enacted early in the COVID-19 pandemic affected family medicine (FM) resident well-being and burnout. Our FM department created a 2-week reserve rotation as a response to the need to socially distance and protect the residents. We explored how the reserve rotations impacted their experiences.
Methods: A purposive sample of FM residents were recruited in May and June of 2020. Qualitative interviews explored well-being and burnout, changes in education and provision of patient care, and overall adaptation to the pandemic. We employed interpretative phenomenology to analyze the interviews.
Results: We interviewed six out of 24 residents before saturation was reached. Qualitative analysis revealed themes related to positive and negative consequences of the pandemic, including uncertainty/fear of the unknown, schedule/life changes, communication, and adapting to a new routine.
Conclusions: The COVID-19 pandemic placed an additional burden on residents, a group already at increased risk for burnout. While uncertainty and disruptions in work and home life were significant stressors, this cohort demonstrated adaptability and resilience that was facilitated by peer support and effective communication. These factors, along with the reserve rotation with decreased clinical responsibilities, led to an improved sense of well-being and decreased feelings of burnout.
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Affiliation(s)
- Eric Messner
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA
| | - Jessica A. Parascando
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA
| | | | - Curtis Bone
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA
| | - Karl T. Clebak
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Timothy D. Riley
- Department of Family and Community Medicine, Penn State Health Hershey Medical Center
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7
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Brumbaugh S, Tuan WJ, Scott A, Latronica JR, Bone C. Trends in characteristics of the recipients of new prescription stimulants between years 2010 and 2020 in the United States: An observational cohort study. EClinicalMedicine 2022; 50:101524. [PMID: 35812998 PMCID: PMC9257326 DOI: 10.1016/j.eclinm.2022.101524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/18/2022] [Accepted: 05/31/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Stimulant prescriptions increased by 250% in the United States from 2006-2016 while diagnoses for ADHD minimally increased. There is insufficient data regarding who may be the recipients of these new stimulant prescriptions and safety of stimulants have come under scrutiny in some populations. We aim to describe trends in stimulant prescriptions across biopsychosocial patient level factors between 2010 and 2020. METHODS We applied a retrospective observational cohort design utilizing electronic health records from 52 healthcare organizations sourced from the TriNetX research network database in the United States. We assessed new stimulant prescriptions across biopsychosocial variables for recipients of prescriptions. We utilized linear regression to assess longitudinal trends of all participants and also conducted an age stratified logistic regression analysis. FINDINGS There was an increase in stimulants to people categorized as white (OR 1.24 CI 1.20-1.28), female (OR 1.28 CI 1.23-1.31), and to those with diagnosed anxiety disorders (OR 1.39 CI 1.35-1.44) as well as obesity (OR 1.34 CI 1.28-1.41). The average age of recipients increased throughout the study, and among people sixty-five and older, there was an increase in prescriptions to people with multiple cardiovascular risk factors. INTERPRETATION Prescription stimulant dispensing may have liberalized during the study period in some demographics as a greater number of new prescriptions were dispensed to individuals with risk of adverse outcomes (i.e. older individuals, obese individuals, and geriatric patients with CV risk factors) between 2010 and 2020. Similar trends in prescription medications were witnessed through the opioid epidemic and warrant attention given concerning trends with illicit stimulants. Additional research that investigates patient and provider motivation for stimulant prescriptions, as well as risk perception of stimulants, may be warranted. FUNDING This study was made possible by institutional resources at Penn State Hershey Medical Center.
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Affiliation(s)
- Shannon Brumbaugh
- Penn State Hershey Medical Center, College of Medicine, Hershey, PA, USA
| | - Wen Jan Tuan
- Penn State Hershey Medical Center, Department of Family and Community Medicine, Hershey, PA, USA
| | - Alyssa Scott
- Penn State Hershey Medical Center, College of Medicine, Hershey, PA, USA
| | - James R. Latronica
- University of Pittsburgh School of Medicine, Department of Psychiatry and Department of Family Medicine, Pittsburgh, PA, USA
- Corresponding author at: University of Pittsburgh School of Medicine, Department of Psychiatry, Department of Family Medicine, 3501 Forbes Ave., Suite 860, Pittsburgh, PA 15213, USA.
| | - Curtis Bone
- Penn State Hershey Medical Center, Department of Family and Community Medicine, Hershey, PA, USA
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8
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Smith RA, Bone C, Visco A, Calo WA, Wright J, Groff D, Lennon RP. Skeptical Health Mavens May Limit COVID-19 Vaccine Diffusion: Using the Innovation Diffusion Cycle to Interpret Results of a Cross-sectional Survey among People Who are Socially Vulnerable. J Health Commun 2022; 27:375-381. [PMID: 35983888 DOI: 10.1080/10810730.2022.2111619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
We sought to identify barriers to COVID-19 vaccine uptake among persons who are socially vulnerable in light of the natural cycle of innovation diffusion. Widespread adoption of a health innovation requires a cadre of opinion leaders to build on successes experienced by early adopters. One type of opinion leader in healthcare are health mavens: members of a community who maintain up-to-date health knowledge and share their knowledge others. We surveyed 139 persons who are socially vulnerable regarding their COVID-19 vaccination intention, and evaluated their responses based on psychological traits captured by two scales: innovativeness and health mavenism. Health mavenism was not strongly correlated with COVID-19 vaccine intention. Health mavens often relied on their own healthcare providers (n = 46) and health agency websites (n = 42) for vaccine information. Those who relied on their faith leaders (n = 4) reported a lower likelihood of getting vaccinated (31.5% vs. 76.0%, p < .05). The observed lack of support by health mavens represents a critical barrier to COVID-19 vaccine uptake; targeting campaigns to health mavens may increase COVID-19 vaccine uptake in socially vulnerable communities.
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Affiliation(s)
- Rachel A Smith
- Department of Communication Arts and Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Curtis Bone
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Ashley Visco
- Community Relations Department, Penn State Health, Hershey, Pennsylvania, USA
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jessica Wright
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Destin Groff
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Robert P Lennon
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
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Bone C, Wendel N, Leong SL, Snyder B, Costigan H, Bowen J, Sell J, Kawasaki S, Giampetro D, Dissinger D, Milchak B, Reedy-Cooper A, Stuckey H. Preparing for the future of medical education: A case series of traditional and virtual clinical rotations in addiction medicine spanning the COVID pandemic. Subst Abus 2022; 43:884-891. [PMID: 35179457 DOI: 10.1080/08897077.2022.2028702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Substance use accounts for more than 400,000 deaths annually in the United States and overdose rates surged during the COVID pandemic. While the pandemic created increased pressure for better prepared providers, it simultaneously placed restrictions on medical training programs. The purpose of this educational case series is to assess the feasibility of a virtual addiction medicine training program and conduct a qualitative evaluation of medical student attitudes toward caring for people with substance use disorders, both before and after their addiction medicine training experience. Methods: We conducted a qualitative analysis related to course content focused on strengths and limitations of in-person and virtual training modalities. Individual quotes were evaluated and content themes were developed after a thorough review of all codes and detailed examination of interviewee quotes. Results: The primary themes that emerged were (1) Addiction medicine content is important to improve care of patients with substance disorders and is not fully addressed in undergraduate medical education (2) In-person and virtual training contain unique strengths and weaknesses and (3) Students perceived that both experiences provided positive and needed training in addiction medicine that shifted perspective and enhanced confidence to practice. Conclusions: Remote training via virtual lectures and patient visits may enhance training opportunities for students with limited exposure to addiction medicine patients and faculty with addiction medicine expertise. There is a need to further refine virtual care for patients with SUDs and virtual training to meet the needs of patients and learners across the country.
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Affiliation(s)
- Curtis Bone
- Penn State Hershey Medical Center, 500 University Drive, Hershey, Pennsylvania, USA
| | - Nils Wendel
- Penn State Hershey Medical Center, 500 University Drive, Hershey, Pennsylvania, USA
| | - Shou Ling Leong
- Penn State Hershey Medical Center, 500 University Drive, Hershey, Pennsylvania, USA
| | - Bethany Snyder
- Penn State Hershey Medical Center, 500 University Drive, Hershey, Pennsylvania, USA
| | - Heather Costigan
- Penn State Hershey Medical Center, 500 University Drive, Hershey, Pennsylvania, USA
| | - Joy Bowen
- Penn State Hershey Medical Center, 500 University Drive, Hershey, Pennsylvania, USA
| | - Jarrett Sell
- Penn State Hershey Medical Center, 500 University Drive, Hershey, Pennsylvania, USA
| | - Sarah Kawasaki
- Penn State Hershey Medical Center, 500 University Drive, Hershey, Pennsylvania, USA
| | - David Giampetro
- Penn State Hershey Medical Center, 500 University Drive, Hershey, Pennsylvania, USA
| | - Don Dissinger
- Penn State Hershey Medical Center, 500 University Drive, Hershey, Pennsylvania, USA
| | - Bill Milchak
- Penn State Hershey Medical Center, 500 University Drive, Hershey, Pennsylvania, USA
| | - Alexis Reedy-Cooper
- Penn State Hershey Medical Center, 500 University Drive, Hershey, Pennsylvania, USA
| | - Heather Stuckey
- Penn State Hershey Medical Center, 500 University Drive, Hershey, Pennsylvania, USA
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10
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Groff D, Stuckey H, Philpott C, Van Dyke E, Silvis M, Leong SL, Bone C. Kratom use disorder: a primer for primary care physicians. J Addict Dis 2021; 40:131-141. [PMID: 34281482 DOI: 10.1080/10550887.2021.1950263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Kratom is a substance similar to opioids that is often used for its euphoric effects, however it can be obtained legally in most of the United States. The substance is often not assessed on routine urine drug screen, however it is estimated that millions of people engage in kratom use each year and level of use is rising. Given the increasing prevalence of kratom use, and its potentially lethal consequences, it is imperative that primary care physicians be familiar with this substance and have a framework to approach identification and treatment of individuals with kratom use disorder. This manuscript offers a review of the epidemiology and pharmacology of kratom, along with guidance for care of individuals with kratom use disorder in the primary care setting.
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Affiliation(s)
- Destin Groff
- Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Heather Stuckey
- Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Carolyn Philpott
- UC Health: University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Erika Van Dyke
- Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Matthew Silvis
- Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Shou Ling Leong
- Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Curtis Bone
- Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
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11
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Bone C, Lou Y, Squires J. PSVII-34 The Characterization of Androstenone Binding to Plasma Proteins in Boars. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Bone
- University of Guelph,Guelph, ON, Canada
| | - Y Lou
- University of Guelph,Guelph, ON, Canada
| | - J Squires
- University of Guelph,Guelph, ON, Canada
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12
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Goodfellow A, Bone C, Gelberg L. They Didn't Believe Her Pain: My Education in Interpersonal Violence. Ann Fam Med 2018; 16:361-363. [PMID: 29987088 PMCID: PMC6037522 DOI: 10.1370/afm.2266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 03/07/2018] [Accepted: 04/04/2018] [Indexed: 12/15/2022] Open
Abstract
In my first year of medical school, I began to care for patients who were survivors of interpersonal violence. As I transitioned from didactics to clinical experiences, I was struck by how common the hidden threads of physical and sexual violence were in my patients' stories of chronic pain, depression, and poor health outcomes. Their symptoms often seemed intangible and challenging to treat, unable to fit neatly into typical diagnostic and therapeutic algorithms. In response, I saw clinicians become frustrated and dissatisfied with their ability to treat these patients. Better care for survivors may begin simply with believing our patients' pain.
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Affiliation(s)
| | - Curtis Bone
- Yale University School of Medicine, New Haven, Connecticut.,VA Connecticut Healthcare System, West Haven, Connecticut
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.,Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California
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13
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Bone C, Eysenbach L, Bell K, Barry DT. Our Ethical Obligation to Treat Opioid Use Disorder in Prisons: A Patient and Physician's Perspective. J Law Med Ethics 2018; 46:268-271. [PMID: 30146992 DOI: 10.1177/1073110518782933] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The opioid epidemic has claimed the lives of more than 183,000 individuals since 1999 and is now the leading cause of accidental death in the United States. Meanwhile, rates of incarceration have quadrupled in recent decades, and drug use is the leading cause of incarceration. Medication-assisted treatment or MAT (i.e. methadone, buprenorphine) is the gold standard for treatment of opioid use disorder. Incarcerated individuals with opioid use disorder treated with methadone or buprenorphine have a lower risk of overdose, lower rates of hepatitis C transmission, and lower rates of re-incarceration. Despite evidence of improved outcomes, many jails and prisons do not offer MAT to individuals with opioid use disorder. This seems partly due to a scientifically unjustified preference for an abstinence-only treatment approach. The absence of MAT in prisons and jails results in poor outcomes for individuals and poses a public health threat to communities. Furthermore, it disproportionately harms poor communities and communities of color. Health care providers in prisons and jails have an ethical obligation to offer MAT to individuals with opioid use disorder to mitigate risk of infectious diseases, opioid overdose and health disparities associated with incarceration.
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Affiliation(s)
- Curtis Bone
- Curtis Bone, M.D., M.H.S., is an addiction medicine research fellow at the Yale University School of Medicine and West Haven VA. Lindsay Eysenbach, B.A., is currently a medical student at the Yale University School of Medicine and co-founder of the Yale Addiction Medicine Collaborative. Kristen Bell, J.D., Ph.D., is currently a Lecturer in Law, Associate Research Scholar in Law, and Senior Liman Fellow in Residence at Yale Law School. Declan T. Barry, Ph.D., is a psychologist and an associate professor of psychiatry at the Yale University School of Medicine. He is also the director of research at the APT foundation, a non-profit substance abuse treatment facility in Connecticut
| | - Lindsay Eysenbach
- Curtis Bone, M.D., M.H.S., is an addiction medicine research fellow at the Yale University School of Medicine and West Haven VA. Lindsay Eysenbach, B.A., is currently a medical student at the Yale University School of Medicine and co-founder of the Yale Addiction Medicine Collaborative. Kristen Bell, J.D., Ph.D., is currently a Lecturer in Law, Associate Research Scholar in Law, and Senior Liman Fellow in Residence at Yale Law School. Declan T. Barry, Ph.D., is a psychologist and an associate professor of psychiatry at the Yale University School of Medicine. He is also the director of research at the APT foundation, a non-profit substance abuse treatment facility in Connecticut
| | - Kristen Bell
- Curtis Bone, M.D., M.H.S., is an addiction medicine research fellow at the Yale University School of Medicine and West Haven VA. Lindsay Eysenbach, B.A., is currently a medical student at the Yale University School of Medicine and co-founder of the Yale Addiction Medicine Collaborative. Kristen Bell, J.D., Ph.D., is currently a Lecturer in Law, Associate Research Scholar in Law, and Senior Liman Fellow in Residence at Yale Law School. Declan T. Barry, Ph.D., is a psychologist and an associate professor of psychiatry at the Yale University School of Medicine. He is also the director of research at the APT foundation, a non-profit substance abuse treatment facility in Connecticut
| | - Declan T Barry
- Curtis Bone, M.D., M.H.S., is an addiction medicine research fellow at the Yale University School of Medicine and West Haven VA. Lindsay Eysenbach, B.A., is currently a medical student at the Yale University School of Medicine and co-founder of the Yale Addiction Medicine Collaborative. Kristen Bell, J.D., Ph.D., is currently a Lecturer in Law, Associate Research Scholar in Law, and Senior Liman Fellow in Residence at Yale Law School. Declan T. Barry, Ph.D., is a psychologist and an associate professor of psychiatry at the Yale University School of Medicine. He is also the director of research at the APT foundation, a non-profit substance abuse treatment facility in Connecticut
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Linden M, Marullo S, Bone C, Barry DT, Bell K. Prisoners as Patients: The Opioid Epidemic, Medication-Assisted Treatment, and the Eighth Amendment. J Law Med Ethics 2018; 46:252-267. [PMID: 30146987 DOI: 10.1177/1073110518782926] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This article argues that correctional institutions violate the Eighth Amendment when they refuse to establish MAT programs and prevent doctors from exercising medical judgment to properly treat incarcerated people with OUD.
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Affiliation(s)
- Michael Linden
- Michael Linden is a member of the class of 2019 at Yale Law School. Sam Marullo is a member of the class of 2020 at Yale Law School. Curtis Bone, M.D., M.H.S., completed medical school at the Johns Hopkins School of Medicine and a masters degree in epidemiology at the Johns Hopkins School of Public Health. He is currently an addiction medicine research fellow at the Yale University School of Medicine and West Haven VA. Declan T. Barry, Ph.D., is a psychologist and an associate professor of psychiatry at the Yale University School of Medicine. Dr. Barry is also the director of research at the APT foundation, a non-profit substance abuse treatment facility in Connecticut. Kristen Bell J.D., Ph.D., is a graduate of Stanford Law School and earned her Ph.D. in legal and moral philosophy at UNC-Chapel Hill. She is currently a Lecturer in Law, Associate Research Scholar in Law, and Senior Liman Fellow in Residence at Yale Law School
| | - Sam Marullo
- Michael Linden is a member of the class of 2019 at Yale Law School. Sam Marullo is a member of the class of 2020 at Yale Law School. Curtis Bone, M.D., M.H.S., completed medical school at the Johns Hopkins School of Medicine and a masters degree in epidemiology at the Johns Hopkins School of Public Health. He is currently an addiction medicine research fellow at the Yale University School of Medicine and West Haven VA. Declan T. Barry, Ph.D., is a psychologist and an associate professor of psychiatry at the Yale University School of Medicine. Dr. Barry is also the director of research at the APT foundation, a non-profit substance abuse treatment facility in Connecticut. Kristen Bell J.D., Ph.D., is a graduate of Stanford Law School and earned her Ph.D. in legal and moral philosophy at UNC-Chapel Hill. She is currently a Lecturer in Law, Associate Research Scholar in Law, and Senior Liman Fellow in Residence at Yale Law School
| | - Curtis Bone
- Michael Linden is a member of the class of 2019 at Yale Law School. Sam Marullo is a member of the class of 2020 at Yale Law School. Curtis Bone, M.D., M.H.S., completed medical school at the Johns Hopkins School of Medicine and a masters degree in epidemiology at the Johns Hopkins School of Public Health. He is currently an addiction medicine research fellow at the Yale University School of Medicine and West Haven VA. Declan T. Barry, Ph.D., is a psychologist and an associate professor of psychiatry at the Yale University School of Medicine. Dr. Barry is also the director of research at the APT foundation, a non-profit substance abuse treatment facility in Connecticut. Kristen Bell J.D., Ph.D., is a graduate of Stanford Law School and earned her Ph.D. in legal and moral philosophy at UNC-Chapel Hill. She is currently a Lecturer in Law, Associate Research Scholar in Law, and Senior Liman Fellow in Residence at Yale Law School
| | - Declan T Barry
- Michael Linden is a member of the class of 2019 at Yale Law School. Sam Marullo is a member of the class of 2020 at Yale Law School. Curtis Bone, M.D., M.H.S., completed medical school at the Johns Hopkins School of Medicine and a masters degree in epidemiology at the Johns Hopkins School of Public Health. He is currently an addiction medicine research fellow at the Yale University School of Medicine and West Haven VA. Declan T. Barry, Ph.D., is a psychologist and an associate professor of psychiatry at the Yale University School of Medicine. Dr. Barry is also the director of research at the APT foundation, a non-profit substance abuse treatment facility in Connecticut. Kristen Bell J.D., Ph.D., is a graduate of Stanford Law School and earned her Ph.D. in legal and moral philosophy at UNC-Chapel Hill. She is currently a Lecturer in Law, Associate Research Scholar in Law, and Senior Liman Fellow in Residence at Yale Law School
| | - Kristen Bell
- Michael Linden is a member of the class of 2019 at Yale Law School. Sam Marullo is a member of the class of 2020 at Yale Law School. Curtis Bone, M.D., M.H.S., completed medical school at the Johns Hopkins School of Medicine and a masters degree in epidemiology at the Johns Hopkins School of Public Health. He is currently an addiction medicine research fellow at the Yale University School of Medicine and West Haven VA. Declan T. Barry, Ph.D., is a psychologist and an associate professor of psychiatry at the Yale University School of Medicine. Dr. Barry is also the director of research at the APT foundation, a non-profit substance abuse treatment facility in Connecticut. Kristen Bell J.D., Ph.D., is a graduate of Stanford Law School and earned her Ph.D. in legal and moral philosophy at UNC-Chapel Hill. She is currently a Lecturer in Law, Associate Research Scholar in Law, and Senior Liman Fellow in Residence at Yale Law School
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Butner JL, Bone C, Ponce Martinez CC, Kwon G, Beitel M, Madden LM, Bono MH, Eller A, Barry DT. Training addiction counselors to deliver a brief psychoeducational intervention for chronic pain among patients in opioid agonist treatment: A pilot investigation. Subst Abus 2018. [DOI: 10.1080/08897077.2018.1449052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Jenna L. Butner
- Yale School of Medicine, New Haven, Connecticut, USA
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
| | - Curtis Bone
- Yale School of Medicine, New Haven, Connecticut, USA
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
| | - Caridad C. Ponce Martinez
- Yale School of Medicine, New Haven, Connecticut, USA
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
| | - Grace Kwon
- Yale School of Medicine, New Haven, Connecticut, USA
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
| | - Mark Beitel
- Yale School of Medicine, New Haven, Connecticut, USA
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
| | - Lynn M. Madden
- Yale School of Medicine, New Haven, Connecticut, USA
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
| | - Madeline H. Bono
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
- New York University, Department of Psychology, New York, New York, USA
| | - Anthony Eller
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Declan T. Barry
- Yale School of Medicine, New Haven, Connecticut, USA
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
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Xu T, Fan J, Levy L, Zhuang Y, Bone C, Huo J, Gomez D, Liao Z, Hu Y. Predictive Value of Serum Hepcidin for Disease Outcome in Non-Small Cell Lung Cancer Patients Received Definitive Radio(chemo)therapy. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Goodfellow A, Ulloa JG, Dowling PT, Talamantes E, Chheda S, Bone C, Moreno G. Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States: A Systematic Literature Review. Acad Med 2016; 91:1313-21. [PMID: 27119328 PMCID: PMC5007145 DOI: 10.1097/acm.0000000000001203] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PURPOSE The authors conducted a systematic review of the medical literature to determine the factors most strongly associated with localizing primary care physicians (PCPs) in underserved urban or rural areas of the United States. METHOD In November 2015, the authors searched databases (MEDLINE, ERIC, SCOPUS) and Google Scholar to identify published peer-reviewed studies that focused on PCPs and reported practice location outcomes that included U.S. underserved urban or rural areas. Studies focusing on practice intentions, nonphysicians, patient panel composition, or retention/turnover were excluded. They screened 4,130 titles and reviewed 284 full-text articles. RESULTS Seventy-two observational or case-control studies met inclusion criteria. These were categorized into four broad themes aligned with prior literature: 19 studies focused on physician characteristics, 13 on financial factors, 20 on medical school curricula/programs, and 20 on graduate medical education (GME) programs. Studies found significant relationships between physician race/ethnicity and language and practice in underserved areas. Multiple studies demonstrated significant associations between financial factors (e.g., debt or incentives) and underserved or rural practice, independent of preexisting trainee characteristics. There was also evidence that medical school and GME programs were effective in training PCPs who locate in underserved areas. CONCLUSIONS Both financial incentives and special training programs could be used to support trainees with the personal characteristics associated with practicing in underserved or rural areas. Expanding and replicating medical school curricula and programs proven to produce clinicians who practice in underserved urban or rural areas should be a strategic investment for medical education and future research.
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Affiliation(s)
- Amelia Goodfellow
- A. Goodfellow is a medical student, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California. J.G. Ulloa is a VA/Robert Wood Johnson Foundation Clinical Scholar, UCLA, Los Angeles, California and Surgery Resident, Department of Surgery, University of California, San Francisco, San Francisco, California. P.T. Dowling is professor and chair, Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. E. Talamantes at the time of this research was primary care research fellow, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, and is now assistant professor, Division of General Internal Medicine, Department of Internal Medicine, University of California, Davis, School of Medicine, Sacramento, California. S. Chheda is research assistant, Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. C. Bone at the time of this research was a third-year resident physician, Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. G. Moreno is assistant professor, Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
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Koloski NA, Jones M, Weltman M, Kalantar J, Bone C, Gowryshankar A, Walker MM, Talley NJ. Identification of early environmental risk factors for irritable bowel syndrome and dyspepsia. Neurogastroenterol Motil 2015. [PMID: 26202154 DOI: 10.1111/nmo.12626] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The role of childhood environment including exposure to infection via siblings and pets in irritable bowel syndrome (IBS) and dyspepsia is relatively unknown. We assessed proxy measures of microbial exposure in early childhood to assess if these are associated with IBS and functional dyspepsia in later life. METHODS Participants (n = 767, response rate = 53%) were a random population sample from Sydney, Australia who previously responded to a validated survey. IBS and functional dyspepsia were defined using Rome III criteria. Early environmental risk factors assessed included type of birth delivery, premature birth, breastfeeding, bedroom sharing, and pet exposure (the latter two then combined as early hygiene factors) up to 5 years of age. Post infectious IBS (PI-IBS) was assessed by development of IBS following gastroenteritis. KEY RESULTS In this sample, in adult life 17% developed IBS (of which 20% had PI-IBS) and 12% functional dyspepsia. Development of IBS was associated with childhood factors-a shorter duration of breastfeeding (odds ratios [OR] = 0.87, 95% CI: 0.78-0.97, p = 0.01), sharing a bedroom (OR = 1.89, 95% CI: 1.73-3.08, p = 0.01), exposure to a herbivore pet (OR = 1.65 (1.10, 2.48), p = 0.02), and hygiene factors (OR = 4.39; 95% CI: 1.89-10.21, p = 0.001). The sole factor associated with functional dyspepsia was exposure to a herbivore pet (1.79; 95% CI: 1.19-2.87, p = 0.02). CONCLUSIONS & INFERENCES Childhood environment factors, particularly bedroom sharing and pet exposure, combined with subsequent risk of microbial exposure are a risk factor for IBS in later life. These associations however need confirmation to rule out any risk of a type I error.
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Affiliation(s)
- N A Koloski
- Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - M Jones
- Department of Psychology, Macquarie University, North Ryde, NSW, Australia
| | - M Weltman
- Department of Gastroenterology & Hepatology, Nepean Hospital, Penrith, NSW, Australia
| | - J Kalantar
- Department of Gastroenterology & Hepatology, Nepean Hospital, Penrith, NSW, Australia
| | - C Bone
- Department of Gastroenterology & Hepatology, Nepean Hospital, Penrith, NSW, Australia
| | - A Gowryshankar
- Department of Gastroenterology & Hepatology, Nepean Hospital, Penrith, NSW, Australia
| | - M M Walker
- Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - N J Talley
- Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
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Bone C, O'Reilly M, Karim K, Vostanis P. 'They're not witches. …' Young children and their parents' perceptions and experiences of Child and Adolescent Mental Health Services. Child Care Health Dev 2015; 41:450-8. [PMID: 24898825 DOI: 10.1111/cch.12161] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent initiatives have emphasized the ongoing need to include children in healthcare research, which is relevant to the development of both paediatric and mental healthcare services. Our aim was to contribute children and their parents' perceptions and experiences of Child and Adolescent Mental Health Services (CAMHS), with the objective of providing guidance for those wishing to improve inclusivity and empowerment. METHOD We performed a thematic analysis of interview data taken from 11 children (9 boys, 2 girls, aged 8-12) and their parents (12 mothers, 2 fathers), who had recently been referred to CAMHS for mental health and educational problems. RESULTS Three core themes emerged from the data. Fear of the unknown refers to emotional apprehension due to uncertainty of what happens in CAMHS. However children also provided useful reassurances for future service users. Therapeutic engagement refers to the importance of being listened to and building up good relationships with professionals. Finally making services acceptable was discussed in terms of issues of accessibility, session tolerances and suggestions for the development of child-centred services. CONCLUSIONS Children were able to provide potentially useful opinions of CAMHS. In a time of limited resources it is imperative that the voices of children and their parents are acknowledged in order to improve accessibility and experiences within CAMHS.
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Affiliation(s)
- C Bone
- The Greenwood Institute, University of Leicester, Leicester, UK
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Abstract
We investigated the efficacy of aerobic exercise alongside antidepressant medication as an adjuvant maintenance treatment for depression. Fifty patients in remission were randomly assigned to either medication only or medication plus exercise. Assessment of psychopathology was made at 6-weekly intervals (for 24 weeks) using the Hamilton Rating Scale for Depression. The medication-plus-exercise group showed significantly more improvement at 12 and 24 weeks than the medication-only group. This study adds to a growing evidence base that suggests aerobic exercise is worthy of further development in the treatment of depressive disorders.
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Affiliation(s)
- P Majumder
- Clinical Lecturer, Greenwood Institute of Child Health, School of Psychology, University of Leicester, Leicester, UK
| | - I Sharma
- Professor, Department of Psychiatry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - P Vostanis
- Professor, University of Leicester, Greenwood Institute of Child Health, Leicester, UK, email
| | - C Bone
- Research Assistant, Greenwood Institute of Child Health, School of Psychology, University of Leicester, Leicester, UK
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Brothers N, Bone C. The response of burrow-nesting petrels and other vulnerable bird species to vertebrate pest management and climate change on sub-Antarctic Macquarie Island. ACTA ACUST UNITED AC 2008. [DOI: 10.26749/rstpp.142.1.123] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
OBJECTIVES To determine the feasibility and acceptability of minilaparotomy-assisted vaginal hysterectomy. METHODS A prospective pilot study in a general hospital was conducted. Twenty patients who were on the waiting list for abdominal hysterectomy were included in the study. All these patients had one or more relative contraindications to vaginal hysterectomy. The hysterectomy procedure was started vaginally in all cases. A minilaparotomy incision was performed to complete the procedure if vaginal hysterectomy was not feasible. Results were analyzed on the intention to treat basis. RESULTS The procedure was successfully completed as intended in 19/20 patients (95%). Six patients had the procedure completed vaginally (30%). Thirteen patients had the procedure completed with minilaparotomy assistance (65%). The mean operative time was 63+/-24.8 min (+/-S.D.). The median estimated blood loss was 155 ml (range: 20-800). One bladder injury occurred. The overall post-operative complication rate was 35% (7/20). This included urinary retention necessitating catheterization for 24 h (n=3), urinary infection (n=2), vaginal infection (n=1) and wound hematoma (n=1). The mean post-operative pain score on a scale from 1 to 10 was 3.1. The overall patient satisfaction based on a scale from 1 to 10 was 9.23 (range: 8-10). CONCLUSIONS Minilaparotomy-assisted vaginal hysterectomy is a feasible and safe procedure. Our results suggest that this approach is potentially useful in increasing the proportion of hysterectomies performed vaginally.
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Affiliation(s)
- A A Ahmed
- Obstetrics and Gynecology Department, Queen Elizabeth Hospital, King's Lynn, UK.
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Bone C. A simplified guide to veterinary compounding. Int J Pharm Compd 2001; 5:104. [PMID: 23981831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- C Bone
- People's Custom Rx and clinical Care Center, Memphis, Tennessee
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Borland K, Bone C, Harlow M, Parker MN, Platou T. Collaborating to develop a student intern program. Nurs Manag (Harrow) 1991; 22:56-9. [PMID: 1923133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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McIntosh N, Bone C. Dilemmas of perinatal intensive care. Br J Hosp Med (Lond) 1984; 31:145-8. [PMID: 6697052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Christie G, Bone C. Intensive and coronary care units. Nurs Times 1981; 77:419-21. [PMID: 6907886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Bone C, Camplejohn RS. Proceedings: Immunological mechanisms in control of malignant disease. Br J Cancer 1974; 29:95-6. [PMID: 4820959 PMCID: PMC2009156 DOI: 10.1038/bjc.1974.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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