Treatment Barriers Research Articles

Natural Polyphenol Delivered Methylprednisolone Achieve Targeted Enrichment for Acute Spinal Cord Injury Therapy.

The strong anti-inflammatory effect of methylprednisolone (MP) is a necessary treatment for various severe cases including acute spinal cord injury (SCI). However, concerns have been raised regarding adverse effects from MP, which also severely limits its clinical application. Natural polyphenols, due to their rich phenolic hydroxyl chemical properties, can form dynamic structures without additional modification, achieving targeted enrichment and drug release at the disease lesion, making them a highly promising carrier. Considering the clinical application challenges of MP, a natural polyphenolic platform is employed for targeted and efficient delivery of MP, reducing its systemic side effects. Both in vitro and SCI models demonstrated polyphenols have multiple advantages as carriers for delivering MP: (1) Achieved maximum enrichment at the injured site in 2 h post-administration, which met the desires of early treatment for diseases; (2) Traceless release of MP; (3) Reducing its side effects; (4) Endowed treatment system with new antioxidative properties, which is also an aspect that needs to be addressed for diseases treatment. This study highlighted a promising prospect of the robust delivery system based on natural polyphenols can successfully overcome the barrier of MP treatment, providing the possibility for its widespread clinical application.

Challenges associated with follow-up care after implementation of an HPV screen-and-treat program with ablative therapy for cervical cancer prevention

BackgroundCervical cancer is a preventable cancer; however, decreasing its prevalence requires early detection and treatment strategies that reduce rates of loss to follow-up. This study explores factors associated with loss to follow-up among HPV-positive women after implementation of a new HPV-based screen-and-treat approach for cervical cancer prevention in Iquitos, Peru.MethodsWe conducted semi-structured interviews with “obstetras” (i.e., midwives) (n = 15) working in cervical cancer prevention and women (n = 24) who were recorded as lost to follow-up after positive HPV results. We used the Health Care Access Barriers Model to guide analyses. We utilized manifest content analysis to describe barriers to follow-up according to the obstetras and thematic analysis to report themes from the women’s perspectives. We also report the steps and time taken to contact women.ResultsWe found an incomplete and fragmented patient monitoring system. This incomplete system, in conjunction with challenges in contacting some of the women, led to structural barriers for the obstetras when attempting to deliver positive results. Women in this study expressed a desire to receive treatment, however, faced cognitive barriers including a lack of understanding about HPV results and treatment procedures, fear or anxiety about HPV or treatment, and confusion about the follow-up process. Women also reported having important work matters as a barrier and reported frequently using natural medicine. Reported financial barriers were minimal.ConclusionThis study highlights the barriers to follow-up after implementation of a primary-level HPV-based screen-and-treat approach. While some barriers that have previously been associated with loss to follow-up were not as prominently observed in this study (e.g., financial), we emphasize the need for screen-and-treat programs to focus on strategies that can address incomplete registry systems, structural challenges in results delivery, cognitive barriers in understanding results and treatment, and work-related barriers.

Racial and ethnic differences in self-reported barriers to substance use treatment among emergency department patients.

As overdose rates rise among non-White Americans, understanding barriers to substance use disorder (SUD) treatment access by race and ethnicity is important. This study explores self-reported barriers to SUD treatment by race and ethnicity in emergency department (ED) populations. We conducted a secondary, exploratory analysis of a randomized trial of patients not seeking SUD treatment who endorsed active drug use at six academic EDs. Responses to the Barriers to Treatment Inventory were compared by race, ethnicity, and drug severity, using χ2 tests (N = 858), followed by adjusted logistic regression models. Absence of a perceived drug problem (39% non-Hispanic Black, 38% Hispanic, 50% non-Hispanic White; p ≤ .001) was the most prevalent barrier to SUD treatment. Non-Hispanic Black participants were less likely to state that they could handle their drug use on their own (OR = 0.69, CI = 0.50-0.95), and were more likely to report disliking personal questions than non-Hispanic White participants (OR = 1.49, CI = 1.07-2.09). Non-Hispanic Black participants were less likely than Hispanic participants to agree that treatment availability (OR = 0.46, CI = 0.28-0.76) and family disapproval (OR = 0.38, CI = 0.16-0.91) were treatment barriers. Screening and counseling may help address the barrier, common to all groups, that drug use was not seen as problematic. Expanding access to diverse treatment options may also address the range of barriers reported by our study population. Our study is one of the first in the U.S. to examine both individual and structural barriers to accessing treatment and to examine the association with drug use severity by race/ethnicity.

A qualitative exploration of the pathway to diagnosis and treatment of cutaneous squamous cell carcinoma of the head and neck with perineural spread.

Perineural spread (PNS) is associated with a poor prognosis in cutaneous squamous cell carcinoma of the head and neck (cSCCHN). Hence, investigating facilitators and barriers of early diagnosis and treatment of PNS in cSCCHN may improve outcomes. Patients were recruited from an institutional database. Semi-structured interviews were conducted according to the Model of Pathways to Treatment. Thematic analysis was based on the four main intervals in the framework using a data-driven analytical method. Seventeen participants were interviewed. Facilitators included patients' past experiences, symptom progression, trust in healthcare professionals (HCPs), and capacity to leverage relationships. Barriers included difficult diagnoses, limited access to cancer services, lack of care coordination, and lack of awareness of PNS among primary health care providers. These findings emphasise the complexity early diagnosis and treatment of PNS. Interventions like clinical practice guidelines, education for HCPs, and telehealth could facilitate timely detection and management.

Scoping review of barriers to mental health service utilization among medical students and residents

Background: Undergraduate medical students and resident doctors face high rates of anxiety, depression, and psychological distress. Despite these issues, their mental health service utilization is very low; this can be attributed to various structural and attitudinal factors. The current research aims to highlight such barriers to accessing mental health care and bridge the existing research gap. Methods: A literature search on barriers to mental health treatment for medical students was conducted involving PubMed, Web of Science and Scopus databases, along with bibliographic search, from inception till 30th April 2023 to identify relevant English records with full-text available. Studies not involving medical students or not assessing treatment barriers, and non-original papers were excluded. Results: Our comprehensive literature search yielded 12 articles. We identified six key themes concerning barriers to accessing mental health services: stigmatization, attitudinal barriers, confidentiality concerns, time constraints, lack of knowledge, and access to services. Discussion: Stigmatization was found to be a prominent barrier, while attitudinal barriers included beliefs that mental health problems are a sign of weakness and should be managed independently. Medical students and residents also worried about breaches in confidentiality affecting their interpersonal relationships and career prospects. Time constraints due to demanding academic and clinical responsibilities also posed challenges in seeking mental health care. These critical barriers to mental health service utilization among medical students and residents can be addressed through mental health awareness campaigns in college campuses, universal mental health screening in medical schools, providing internet-based services and collaborative programs with local mental health professionals to widen the treatment options.

Disparities in adolescent controller medication adherence, treatment barriers, and asthma control.

Disparities in asthma persist despite advances in interventions. Adherence and self-management behaviors are critical yet challenging during adolescence. Treatment barriers include individual factors as well as structural and social determinants of health. To determine differences in controller medication adherence, asthma control, and treatment barriers by race, income, and insurance and whether racial disparities persist when controlling for income and insurance. Associations between adherence, barriers, and control were also examined. Adolescents completed measures of treatment barriers and asthma control. Controller medication adherence was measured electronically. Descriptive statistics, means comparisons, and analyses of covariance were conducted. One hundred twenty-five adolescents participated (Mage = 14.55, SD = 2.01, 37.6% Black or African American, 55.2% White). Black or African American adolescents had significantly lower adherence than White adolescents, t(105) = 2.79, p = .006, Cohen's d = .55. This difference was not significant when controlling for income and insurance (p > .05). There was a significant difference in asthma control, F(1,86) = 4.07, p = .047, ηp 2 = .045, where Black or African American adolescents had better asthma control scores than White adolescents. Feeling tired of living with asthma was the most common barrier among all adolescents (62.4%). More Black or African American adolescents endorsed difficulty getting to the pharmacy than White adolescents, X2 (1, N = 116) = 4.86, p = .027. Racial disparities in asthma may be partially driven by income, insurance, and pharmacy access. Asthma burnout may be important to address for all adolescents with asthma.

The impact of an enhanced recovery after surgery protocol for major head and neck oncologic surgery on postoperative complications and adjuvant treatment delivery.

The Commission on Cancer (CoC) recently introduced a quality metric to optimize time between major head and neck surgery and adjuvant treatment (TAT) ≤6 weeks, as TAT delay adversely impacts patient survival. This study evaluates whether enhanced recovery after surgery (ERAS) for this population reduces the rate of postoperative complications, length of stay (LOS), and TAT. Patients undergoing larynx or oral cavity resection with free flap reconstruction, ERAS, and adjuvant treatment after 2018 were compared to a historical pre-ERAS cohort. Patients underwent surgery at a single-institution tertiary referral center for complex head and neck oncology. Differences between groups were compared by chi-square, Fisher's exact, or Wilcoxon rank-sum test. TAT >6 weeks was evaluated with univariate and multivariable logistic regression. Thirty-nine pre-ERAS patients were compared to 39 ERAS patients. No demographic differences existed between groups. LOS was improved with ERAS (p = 0.005). ERAS patients were discharged to home and returned to their activities of daily living (ADL) earlier (p = 0.004, 0.001). ADL recovery was associated with on-time TAT ≤42 days on univariate analysis (OR 1.36, 95% CI 1.13-1.63, p = 0.001). TAT delay was less frequent with ERAS (51.3% vs. 69.2%), but this was not significant after multivariable logistic regression (p = 0.11). ERAS decreases LOS and returns advanced head and neck cancer patients to their ADL sooner. Postoperative ADL recovery independently predicts on-time adjuvant treatment. Still, compliance beyond 50% with the TAT ≤6 weeks CoC quality metric remains a major treatment barrier.

Barriers and risk factors associated with non-treatment-seeking for suicidality onset during the COVID-19 pandemic among young adults

IntroductionResearchers predict long-term increases in suicide deaths following the COVID-19 pandemic. Little is known about risk factors for suicidal ideation (SI) and suicidal attempts (SA) or treatment barriers and promoters during the pandemic. We examine these factors in a young adult sample. MethodsAnalyses used a 2022 cross-sectional survey dataset (N = 1,956). Logistic regression identified factors associated with pandemic suicidality (i.e., SI, SA). Non-treatment seekers reported barriers to seeking treatment. Logistic regression identified promotive factors associated with treatment-seeking. Results28.6 % of our sample developed suicidality during the pandemic, of whom 49.6 % did not seek treatment. Asian race and sexual minority status were strongly associated with increased odds of pandemic suicidality. Among SI non-treatment-seekers, barriers were primarily attitudinal (e.g., “symptoms are not serious enough for treatment”); among non-treatment-seekers with SA, barriers were mostly structural (e.g., insufficient funds). Previous depression treatment was strongly associated with increased odds of treatment-seeking. ConclusionAsian American individuals were at increased risk for pandemic suicidality, which may reflect interpersonal risks related to COVID-19-related anti-Asian racism. Our findings point to a “foot-in-the-door” effect: past treatment-seeking was positively associated with future treatment-seeking. To promote this effect and decrease barriers, we suggest integrated mental health screening and referrals in primary care.

Qualitative insights into mental health treatment through telemedicine during the COVID-19 crisis: a natural experiment in community mental health centers

BackgroundThe COVID-19 pandemic exacerbated existing mental health challenges and introduced new ones, particularly among vulnerable populations such as individuals within the criminal justice system, who disproportionately experienced employment, financial, and housing issues. As mandatory lockdowns and social distancing mandates were implemented, the United States saw unprecedented interruptions to treatment. Telemedicine emerged as a transformative tool in alleviating new and existing treatment barriers. Yet, limited empirical research has examined the impact and implications of telemedicine on mental health treatment in criminal justice populations.MethodsThe timing of this study’s data collection overlapped with the spread of COVID-19 in the United States and provided a unique opportunity to examine the impact of telemedicine as part of a natural experiment. Utilizing interviews with 61 community mental health center service providers, this study qualitatively examined service providers’ experiences in treating criminal justice-involved individuals with serious mental illness who were receiving mental health treatment through telemedicine.ResultsService providers expressed satisfaction with telemedicine in addressing client transportation and childcare barriers while increasing engagement. Service providers voiced new concerns regarding clients’ confidentiality, digital literacy, and limitations to gathering non-verbal client information during virtual treatment.ConclusionsMental health treatment offered through telemedicine mitigates barriers to treatment that disproportionately affect criminal justice clients. Despite its benefits, challenges like access to reliable internet and to internet-enabled devices, confidentiality concerns, and information gathering must be addressed to achieve optimal and equitable mental health treatment through telemedicine. The findings support the continued use of telemedicine in mental health treatment delivery for this population.

Perceptions of Women in Opioid Recovery Regarding Policies and Laws on Sexual and Reproductive Health

ObjectiveTo explore perceptions of policies and laws on sexual and reproductive health among women in recovery from opioid use disorder (OUD). DesignQualitative descriptive. SettingTelephone interviews conducted in a midsized urban area in the midwestern region of the United States. ParticipantsTwenty-two women ages 18 to 49 years who self-identified as being in recovery from OUD. MethodsWe conducted individual, semistructured telephone interviews and analyzed the data using reflexive thematic analysis. ResultsWe identified three themes: Barriers to OUD Treatment and Recovery, Pregnancy as a Gateway to Treatment and Recovery, and The Dobbs Effect. Participants described OUD treatment barriers such as inadequate recovery resources for women and the criminalization of drug use. Many participants described pregnancy as a gateway to recovery because of improved access to treatment services and enhanced motivation for engaging in recovery. Participants described unintended pregnancy as a threat to recovery that made them seek woman-controlled contraceptive methods they could use without negotiating with a partner (e.g., intrauterine devices) after the Supreme Court overturned constitutionally protected access to abortion. ConclusionOpioid use disorder is a public and mental health crisis in the United States that affects reproductive-age women. Participants in our study closely connected recovery from OUD with sexual and reproductive health policy and laws. There is a need for regulation to support the unique needs of women in OUD treatment. The recent Supreme Court decision that overturned constitutionally protected abortion creates challenges for women in recovery from OUD. Nurses are ideally positioned to advocate for recovery and sexual and reproductive health policies and laws that improve the physical and mental health of women in recovery.

Beliefs about mental health treatment, treatment initiation, and suicidal behaviors among veterans and service members at-risk for suicide and not in treatment.

Previous research has identified a variety of barriers to mental health care among military personnel and veterans, despite high rates of mental health symptoms. The current study is the first to examine beliefs about mental health treatment barriers among post-9/11 military personnel and veterans at elevated suicide risk not involved in treatment and whether these beliefs are associated with treatment initiation, engagement, or suicidal behaviors. Four hundred and twenty-two participants reported on beliefs about treatment during a cognitive behavioral treatment session and responded to follow-up questionnaires on mental health treatment initiation, engagement, and suicidal behaviors over 12 months. Beliefs identified in the therapy session were coded thematically, and rates of treatment initiation, engagement, and suicidal behavior were examined by belief category. Nine belief themes emerged. Participants reporting logistical barriers and preferences about treatment type were least likely to initiate mental health treatment and participated in the fewest number of sessions, respectively. Participants endorsing beliefs about stigma or using other ways to cope were most likely to engage in suicidal behavior. The current findings point to specific beliefs that may identify individuals who would benefit from systemic and individual interventions for mental health treatment engagement.

Barriers, facilitators and referral patterns of general practitioners, physiotherapists, and people with osteoarthritis to exercise

BackgroundBarriers and facilitators of general practitioners (GPs), physiotherapists (PTs), and people with hip and knee osteoarthritis (PwOA) may influence uptake of and referral to guideline-based exercise treatments for OA. ObjectiveTo identify barriers and facilitators of GPs, PTs and PwOA to uptake of and referral to exercise treatments for OA. MethodsAn online survey was circulated to GPs, PTs, and PwOA in Ireland from March to September 2021. Data were collected on demographics, barriers and facilitators, and referral patterns to exercise treatments for OA. Frequency distributions were used to illustrate demographics, barriers and facilitators, and referral patterns to exercise treatments for OA. Results388 stakeholders responded (GPs = 148; PTs = 154; PwOA = 86). Barriers and facilitators were related to (1) stakeholder (e.g., patient tiredness and fatigue), (2) healthcare setting (e.g., appropriate referrals from GP or other sources), and (3) treatment (e.g., low-cost community-based exercise programmes) factors. While 91% of GPs would refer PwOA to physiotherapy if no barriers existed, only 60% would in their current practice. Only 33% of PwOA reported receiving a GP referral to physiotherapy. ConclusionStakeholder, healthcare setting and treatment barriers and facilitators of GPs, PTs, and PwOA influence uptake of and referral to exercise treatments for OA. Future strategies Future strategies addressing these factors may improve implementation of guideline-based management for OA. Contribution of the Paper•Despite an established evidence-based consensus, uptake of and referral to exercise as a first-line treatment for OA is suboptimal, partly influenced by the barriers and facilitators of stakeholders (e.g., GPs, PTs, and PwOA).•Barriers and facilitators that influence uptake of and referral to exercise treatments for OA are related to stakeholder, healthcare setting, and treatment factors.•Majority of PwOA are not receiving GP referrals to physiotherapy, and a mismatch between GPs intentions to and actual referrals to physiotherapy exists, primarily due to long waitlists to access services.•These findings may be adapted to inform strategies for the successful implementation of exercise treatments that are effective in encouraging guideline-based management of OA.

Quantifying microbial risk from drinking water production process under changing climate and socio-economic conditions

Consumption of drinking water containing pathogenic microorganisms may pose serious health risks from waterborne diseases. Quantifying such risks is essential for guiding interventions and policy decisions. Quantitative microbial risk assessment (QMRA) is a very useful method to estimate the public's risk of infection from disease-causing microorganisms in water sources. QMRA of drinking water production process is limited worldwide and so far no such QMRA study has been conducted in Bangladesh. Moreover, climate and socio-economic changes may impact waterborne pathogens and associated health risks, but to what extent remains unclear, because comprehensive QMRA by taking into account combined impact of climatic and socio-economic factors has never been done worldwide so far. In this study, the Swedish QMRA tool was applied to evaluate public health risk from drinking water production process in Dhaka, Bangladesh as a case study. At first, current risk was quantified, and then the potential future risk was projected by taking into account climate and socio-economic factors. The results revealed that the annual infection risks at the current (2020s) baseline condition were below the acceptable risk threshold 10–4 infections per person per year (as proposed by several USEPA scientists) for all three pathogens Salmonella, norovirus and Giardia. However, after extreme events with sewer overflow and agricultural runoff, norovirus violates the acceptable risk thresholds, and the risks for Salmonella and Giardia are in borderline. The selected sustainable future scenario showed some improvement in terms of annual infection risks, while the uncontrolled scenario resulted in substantially higher infection risks both in the near and far future compared to the current scenarios. installment of a UV treatment step as an additional treatment barrier resulted in significant infection risk reduction. According to the sensitivity analysis results, socio-economic factors such as human population, livestock, and pathogen removal in wastewater were found to have greater influence on the infection risks, compared to climate change. The study can help policy makers and water managers to identify interventions to reduce the burden of disease on the population. The tool can be used to assess the health risk associated with drinking water production process in other areas of the world with similar characteristics.

Expert Opinion on Optimising Type2 Diabetes Treatment Using Fixed-Ratio Combination of Basal Insulin and GLP-1RA for Treatment Intensification and Simplification.

The management of type2 diabetes (T2D) often necessitates treatment intensification, and sometimes simplification to achieve glycaemic targets and mitigate complications. This expert opinion paper evaluates the use and positioning of the fixed-ratio combinations (FRCs) of basal insulin (BI) and glucagon-like peptide1 receptor agonists (GLP-1RAs) in optimising T2D management. On the basis of the evidence presented and discussions, these FRCs offer a promising approach for both treatment intensification and simplification in people with suboptimal glucose control despite receiving various therapies. In treatment intensification, FRCs provide a synergistic effect by addressing multiple pathophysiological defects contributing to hyperglycaemia. These FRCs effectively control both fasting and postprandial glucose (PPG) excursions, offering significantly improved glycaemic control with a lower hypoglycaemia risk and weight neutrality compared to traditional or complex insulin regimens. Moreover, the reduced injection frequency (once daily) and flexibility in the dosing schedule (with any major meal of the day) help mitigate patient resistance to insulin initiation or titration. This further reduces treatment burden, facilitating treatment adherence and enhancing patient convenience. These key benefits of FRCs over complex insulin regimens play a crucial role in long-term glycaemic management and overall treatment outcomes. Hence, the timely use of FRCs in the treatment algorithm for people with T2D represents a valuable strategy for optimising glycaemic control, addressing treatment barriers and enhancing patient-reported outcomes.

Health behavior and psychological treatment utilization in adults with avoidant/restrictive food intake disorder symptoms

BackgroundAvoidant/restrictive food intake disorder (ARFID), an eating disorder not associated with weight and shape concerns, results in nutrient or energy deficiencies related with further health consequences and a pronounced need for specialized treatment. These interventions need to be tailored to individual health behavior. However, research about health behavior and treatment utilization in ARFID is scarce, particularly in adults, as ARFID is more common in children despite occurring across the lifespan. One important aspect of health behavior is the individual’s health regulatory focus (i.e., health prevention and health promotion). Additionally, symptoms of eating disorders have generally been associated with various health risk behaviors, such as smoking, drinking, or unhealthy physical (in)activity. Therefore, the present study aimed to investigate health behavior and psychological treatment utilization in adults with symptoms of ARFID.MethodsA representative adult population sample (N = 2415) completed several self-report questionnaires assessing symptoms of eating disorders and health behavior. Differences between groups (symptoms of ARFID vs. no symptoms of ARFID) were tested with analysis of variance, Mann-Whitney-U-tests, and binary logistic regression.ResultsIndividuals with symptoms of ARFID (n = 20) did not differ in their health regulatory focus, smoking status, physical activity or psychological treatment utilization from individuals without symptoms of ARFID (n = 2395). However, they reported higher alcohol misuse than individuals without symptoms of ARFID.ConclusionThe findings suggest a relevance of further exploration of the relationship between alcohol misuse and ARFID, given the preliminary nature of these results. This exploration could inform treatment strategies for addressing potential comorbid substance misuse. Furthermore, the low psychological treatment utilization in adults with symptoms of ARFID suggest a need for more specialized psychological treatment services, public education about ARFID being an indication for psychological treatment, and further research about treatment barriers.

The role of psychiatric symptoms, sociodemographic factors, and baseline sleep variables on pediatric insomnia treatment outcomes in a clinically referred population.

The current study aimed to examine clinically relevant psychiatric and sociodemographic predictors of insomnia treatment outcomes in pediatric patients clinically referred for insomnia. Pediatric patients (N = 1428; ages 1.5 - 18 years), presenting for insomnia evaluation in a medical/sleep center-based behavioral sleep clinic were followed for treatment as clinically indicated. According to patient age, parent/patients completed validated measures of insomnia severity, psychiatric symptoms, and sociodemographic measures. Patients were also categorized by treatment outcome status (i.e., not recommended to follow-up after initial evaluation and treatment session, successful treatment completion, lost to follow-up after initial evaluation and treatment session, and early termination) according to the clinically indicated treatment recommended and dose of treatment received. Youth had elevated scores on psychiatric screening indexes with affective problems being highest for all age groups. Other co-morbid sleep disorders were present in nearly 25% of insomnia patients and use of sleep aids (melatonin; hypnotics) was commonplace. Baseline insomnia severity significantly predicted sleep treatment trajectories and post-treatment insomnia severity with large effects for all age groups. Other clinically relevant predictors of insomnia treatment outcomes included medication use and externalizing mental health concerns in younger patients and internalizing mental health concerns and chronological age in older patients. Lack of treatment follow-up and premature treatment termination was observed for patients with the worst insomnia symptoms at time of initial evaluation. Pediatric health providers delivering insomnia treatment should take a developmentally sensitive approach that is proactive with regards to managing treatment barriers that are likely influenced by severity of insomnia and co-morbid mental health concerns.

User perspectives on outreach opioid substitution treatment among street-entrenched people who use drugs in Denmark

Background The COVID-19 pandemic had many serious consequences for vulnerable populations, but it also gave rise to innovations and changes of established ways of providing services for such populations. In Copenhagen, Denmark outreach opioid agonist therapy (OAT) was such an innovation. Methods Based on qualitative interviews with 15 individuals who received outreach OAT this article describes this new service and presents OAT clients’ experiences of previous OAT and outreach OAT. Analytically the article draws on literature about people who use drugs’ experiences of barriers when wanting to access drug treatment and other services. Results The participants had experienced significant systemic and social barriers in relation to outreach OAT. Outreach OAT helped to minimize both types of barriers. It also created new opportunities for providing care because treatment took place in participants’ own environments. Conclusion Outreach OAT has the potential to minimize treatment barriers for some of the most vulnerable people who use drugs. It is however also important to review and possibly change system design, guidelines, and practices of the existing system to better accommodate the program to the needs of vulnerable people.

DIPG-89. ENHANCEMENT OF BLOOD-BRAIN BARRIER PENETRATION AND TUMOR TARGETED DRUG DELIVERY FOR DMG USING A P-SELECTIN TARGETED NANOMEDICINE APPROACH

Abstract The blood-brain barrier (BBB) is one of the greatest barriers for the effective treatment of brain tumors, including H3K27-altered diffuse midline glioma (DMG), a near universally fatal childhood brain cancer. The BBB typically requires drugs to be given at maximally tolerated doses that are limited by systemic toxicities, particularly in settings of combination therapy. We have developed a clinically compatible fucoidan nanoparticle (Fi-NP) that homes to P-selectin on tumor vasculature after low-dose radiation (RT) to breach the BBB through an active caveolin-1-dependent mechanism and deliver several classes of targeted therapies. In non-CNS cancer xenograft models and a transgenic mouse model of SHH-driven medulloblastoma with an intact BBB, this approach improved survival while eliminating on-target systemic toxicities. We have now applied this approach to both brainstem and non-brainstem RCAS-TVA mouse models of DMG with an intact BBB. Specifically, we have found that DMG tumor vasculature expresses P-selectin, and that a single low-dose 2 Gy fraction of ionizing radiation further enhances it in a time-dependent manner up to 24 hours post-treatment. Importantly, we have also found that this P-selectin targeted drug delivery approach facilitates DMG tumor localization of Fi-NP encapsulated EZH2 inhibitor tazemetostat (EPZ-6438) as well as larger macromolecules including the PROTAC BET degrader dBET6, two promising targeted therapies for DMG limited by extremely poor BBB-penetration, while sparing drug delivery to non-tumor healthy brain regions. Work to measure PK, biodistribution, survival benefit, and drug target inhibition is ongoing. Our findings will provide the foundation for this P-selectin targeted Fi-NP approach to be evaluated in clinical trials for children with this lethal cancer.

Blues-based stigma songwriting with adults on an acute mental health inpatient unit: A cluster-randomized trial and reflection

Self-stigma often functions as a treatment barrier for adults with mental health conditions and can hinder recovery. Blues-based stigma songwriting may constitute an empowering and engaging medium to educate people with mental health conditions about self-stigma, identify it as an oppressive social construct, and encourage treatments to augment the likelihood of recovery. The purpose of this cluster-randomized effectiveness study was to determine whether a single group music therapy songwriting intervention can impact self-stigma with adults on an acute mental health unit. Participants ( N = 131) were cluster-randomized to a single session of blues-based stigma songwriting or a control group. Experimental participants completed the Internalized Stigma of Mental Illness Inventory (ISMI) at posttest only while control participants completed the ISMI at pretest only. Although there were tendencies for the experimental group to have slightly lower mean self-stigma scores on the alienation, stereotype, discrimination, and resistance subscales as well as total self-stigma, there was no significant between-group difference. Mental health stigma is an important recovery-oriented construct and blues-based songwriting may constitute an empowering and engaging way to address this challenging topic. As educational interventions for stigma can lead to increases in self-stigma for adults with mental health conditions, larger treatment doses may be necessary to reduce it. Implications for clinical practice, limitations, and suggestions for future inquiry are provided.

Testing an Innovative Approach to Improve Hypertension Management at a Federally Qualified Health Center.

Despite the availability of effective treatments, hypertension control rates remain inadequate in the United States and locally in Los Angeles County. To address this health condition, QueensCare Health Centers developed and launched a team-based hypertension management program that was led by clinical pharmacists and designed to mitigate treatment barriers encountered at the system, provider, and patient levels. System- and provider-focused strategies included incorporating self-monitored blood pressure values into the electronic health record and retraining clinicians to regularly review these values; adding a community health worker to the disease management team; and utilizing clinical pharmacists to assess and titrate medications. Patient-focused strategies included tailoring education materials to reduce literacy and linguistic barriers; providing tailored one-on-one education and support; and providing blood pressure cuffs and pedometers. This multilevel intervention serves as a practical example of how team-based care can be optimized at a Federally Qualified Health Center.