Improve Recovery Outcomes Research Articles

Research progress of ferroptosis in brain injury

Ferroptosis, a regulated form of cell death characterized by iron-dependent lipid peroxidation, has emerged as a key contributor to neuronal damage in various types of brain injury, including traumatic brain injury (TBI) and ischemic brain injury caused by brian ischemia (BI). This review summarizes the underlying mechanisms of ferroptosis in brain injuries and highlights its role in exacerbating neuronal loss, inflammation, and secondary damage. After TBI, the release of free iron and oxidative stress after injury triggers ferroptosis, contributing to long-term neurological deficits. Similarly, in BI, ferroptosis is initiated by the accumulation of reactive oxygen species (ROS) and mitochondrial dysfunction during ischemia and reperfusion, further amplifying neuronal damage. The current review provides a comprehensive overview of the interplay between ferroptosis and brain injury, with an emphasis on the potential of targeting ferroptosis to improve recovery outcomes in patients. Future research directions include the development of novel ferroptosis inhibitors and the integration of ferroptosis-targeting strategies with existing treatment modalities.

Perioperative nutrition in older patients: what are the priorities?

This review aimed to synthesize recent literature on perioperative nutritional interventions for older patients. This review underscores the role of comprehensive preoperative optimization, strategic use of nutritional supplements focusing on calorie, protein, and fluid intake, and active involvement of health consumers in co-designing solutions. Tools like the Geriatric Nutritional Risk Index offer a prediction value for nutrition-related complications in preoperative patients, guiding management strategies. Oral nutritional supplements, particularly those rich in protein and carbohydrates, prevent weight loss and improve functional outcomes postsurgery. However, patient satisfaction with these interventions is inconsistent and often unmeasured. Evidence suggests that prolonged fluid deprivation is harmful and preoperative hydration protocols reduce surgical stress and improve recovery outcomes. Yet, the benefit of preoperative hydration remains under-researched. Multimodal interventions for frail older adults are increasingly considered more effective than single-aspect interventions, which involve combining prehabilitation programs targeting malnutrition with smoking cessation and stabilization of preexisting conditions. Comprehensive preoperative nutritional assessment, evidence-based interventions, and health consumer involvement are crucial for improving perioperative care for elderly patients. Implementing multimodal interventions, including nutritional support and proper hydration, can enhance recovery, reduce complications, and improve the quality of life for older surgical patients.

Return to Play Guidelines in Pediatric Concussion: A Systematic Review of Current Literature.

Pediatric concussions, particularly in youth sports, are a significant public health concern, with up to 18% of children experiencing one by age 17. Return-to-play (RTP) guidelines aim to protect athletes from the adverse effects of repeated injuries, but these protocols vary widely based on factors such as age, sport, and geography. This review synthesizes current literature on RTP guidelines for pediatric concussions to provide evidence-based recommendations. A systematic search of PubMed was conducted using Medical Subject Headings (MeSH) terms "return to play," "pediatric concussion," and "mild traumatic brain injury." Studies published between January 2000 and December 2023 were included if they focused on RTP protocols for children aged 5 to 17. After screening 60 articles, 45 were selected for review. Study quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. RTP protocols showed significant variability influenced by age, gender, and sport type. Common themes included initial rest followed by a gradual return to activity. Female athletes generally required longer recovery periods. Multidisciplinary care and early therapeutic interventions, such as vestibular therapy, were associated with better outcomes and faster recovery. There is a need for standardized, evidence-based RTP guidelines to address inconsistencies in concussion management. Future research should focus on creating universally applicable protocols, with attention to gender, sport-specific factors, and early intervention to improve recovery outcomes for young athletes.

Integrating oral health in stroke care: a critical necessity.

To highlight the critical role of integrating oral health assessments into routine stroke care for better patient outcomes. The Eto et al. study utilizes the modified oral assessment grade (mOAG) to evaluate the oral health of acute ischemic stroke patients upon admission and its predictive value for functional outcomes and hospital-acquired pneumonia (HAP). Evidence from Eto et al. study shows that mOAG scores at admission significantly predict 3-month functional outcomes and the incidence of HAP, emphasizing the need for comprehensive oral evaluations. Integrating oral health assessments into stroke care protocols can improve recovery outcomes, reduce HAP incidence, and lower healthcare costs through preventive oral care. Routine oral health evaluations for stroke patients are crucial for better recovery and overall health outcomes, advocating for policy changes and multidisciplinary approaches to patient care.

Role of Hypoperfusion Intensity Ratio in Vessel Occlusions: A Review on Safety and Clinical Outcomes.

The hypoperfusion intensity ratio (HIR) is a quantitative metric used in vascular occlusion imaging to evaluate the extent of brain tissue at risk due to hypoperfusion. Defined as the ratio of tissue volume with a time-to-maximum (Tmax) of >10 seconds to that of >6 seconds, HIR assists in differentiating between the salvageable penumbra and the irreversibly injured core infarct. This review explores the role of HIR in assessing clinical outcomes and guiding treatment strategies, including mechanical thrombectomy and thrombolytic therapy, for patients with large vessel occlusions (LVOs). Evidence suggests that higher HIR values are associated with worse clinical outcomes, indicating more severe tissue damage and reduced potential for salvage through reperfusion. Additionally, HIR demonstrates predictive accuracy regarding infarct growth, collateral flow, and the risk of reperfusion hemorrhage. It has shown superiority over traditional metrics, such as core infarct volume, in predicting functional outcomes. HIR offers valuable insights for risk stratification and treatment planning in patients with LVOs and distal medium vessel occlusions (DMVOs). Incorporating HIR into clinical practice enhances patient care by improving decision-making processes, promoting timely interventions, and optimizing post-intervention management to minimize complications and improve recovery outcomes.

Recovery From Severe Mental Illnesses: The Influence of Personal and Psychosocial Factors in Community Settings.

Severe mental illnesses (SMIs) represent a significant public health challenge with substantial personal, economic and societal burdens. Despite treatment advances, recovery outcomes for SMI patients remain variable. This study aimed to investigate the influence of personal and psychosocial factors on recovery among SMI patients in community health settings. This cross-sectional study was conducted in 23 community health service centres in Nanjing, China. We recruited 924 participants diagnosed with SMIs, using a random sampling method. The relationships between individual, psychosocial factors and patients' recovery status were analysed by multiple linear regression. The mediation effect of medication adherence was further tested by the Sobel test with bootstrapping. The mean score of the Morningside Rehabilitation Status Scale (MRSS) of 924 patients with SMIs was 49.82 ± 41.52. The main influencing personal factors of recovery status were age, marital status, education, average annual income and duration of illness. Patients who were accepted by their families tended to have better recovery outcomes, while stigma and social impairment may hinder recovery. Medication adherence played a mediating role between psychosocial factors and recovery status. This study highlights the crucial role of psychosocial factors in the treatment and recovery of SMI patients. Furthermore, medication adherence emerged as a mediating factor. Implementing targeted interventions and policies addressing identified psychosocial barriers can offer promising avenues for improving recovery outcomes for SMI patients in community settings.

Comparative Analysis of Oral Clonidine Versus Oral Gabapentin on Subarachnoid Block Duration and Postoperative Analgesic Needs.

Pain, an inherently subjective experience, plays a pivotal role in the body's defence mechanism by signalling tissue damage or potential harm. Thus, optimal postoperative pain management is a cornerstone of modern surgical practice, essential for improving recovery outcomes and overall patient well-being. In this study, a total of 60 patients were randomly assigned to two groups of 30 each: Group C (clonidine) and Group G (gabapentin). Group C received oral clonidine 100 mcg and Group G received oral gabapentin600 mg one hour prior to the subarachnoid block. Duration of sensory and motor block, hemodynamic parameters, Visual Analog Scale (VAS) scores, time to rescue analgesia and any side effect of both drugs were assessed in both groups. The duration of motor and sensory blockade, as well as intraoperative hemodynamics and respiratory rates, were comparable between the two groups. Group G exhibited significantly lower VAS scores from 150 minutes postoperatively up to 12 hours (p < 0.001). Additionally, Group G experienced longer duration of postoperative analgesia (16.8±3.9 hours) compared to Group C (9.27±1.7 hours). About 26.6% of the patients in Group C and 6.7% of the patients in Group G presented with postoperative nausea and vomiting (PONV). Oral gabapentin at a dosage of 600 mg demonstrates superior efficacy as a premedication compared to oral clonidine 100 mcg for patients undergoing lower abdominal and lower limb surgeries under spinal anesthesia. Group G demonstrated extended postoperative analgesia, lower VASscores, and a reduced incidence of PONV, indicating its superiority over clonidine as an analgesic adjunct.

Recovery from alcohol use disorder: Reinforcer pathology theory, measurement, and methods.

Recovery from alcohol use disorder (AUD) is a dynamic process that often entails periods of drinking but has been defined primarily by abstinence. Recently, a broader interpretation of recovery was developed, including meeting the Diagnostic and Statistical Manual of Mental Disorders (DSM) remission criteria and improved psychosocial functioning. This new understanding of recovery has facilitated the development of novel theories and methodologies. This paper reviews a new theoretical perspective of recovery, Reinforcer Pathology, and two novel methodological approaches in light of this broader view of recovery. Using this theoretical framework as a foundation, we propose an alternative perspective to explain the recovery process as it relates to environmental factors and valuation of the future; we suggest that changing the environment in which substances are available (e.g., increasing non-alcohol-related activities) and extending one's temporal window are associated with improved recovery outcomes (e.g., remission and quality of life). In this review, we discuss two novel methodological approaches. The first uses latent profile analysis to show that using a measure of Relative Reinforcement Value of Alcohol-Free Activities is associated with a greater likelihood of belonging to a high functioning/infrequent heavy drinking recovery profile. The second developed an online national sample and used an accelerated longitudinal design to study longer-term recovery of up to 12 years over a 5-year study period. Reinforcer Pathology theory, novel methods, and measures may further our understanding of recovery and begin to address critical questions for future studies. Subsequent randomized clinical trials should examine whether the suggested targets and interventions based on the theoretical model improve recovery outcomes prospectively. Measuring and promoting alcohol-free activity engagement may facilitate improved recovery outcomes, while novel methodologies permit an understanding of returning to use or remission across different recovery durations.

Effect of kinesiophobia on postoperative rehabilitation outcomes in patients with cervical spondylotic myelopathy: a cross-sectional study

ObjectiveThis study aims to investigate the occurrence of postoperative kinesiophobia in patients with CSM and compare the postoperative recovery of patients with and without kinesiophobia to understand its influence on clinical outcomes in CSM.MethodsBetween November 2020 and November 2022, surgical treatment was performed in the neurosurgical wards of 2 Grade III Class A general public hospitals in the Fujian Province. The demographic and disease data of the patients were collected, and patients were divided into a kinesiophobia group and non-kinesiophobia group according to the Tampa kinesiophobia Scale (TSK). The cervical dysfunction index, cervical Japanese Orthopaedic Association (JOA) rating, self-anxiety rating, and activity of daily living rating scales were collected three months postoperatively. The influence of postoperative kinesiophobia on early rehabilitation was also analysed.ResultsA total of 122 patients were an average age of (55.2 ± 10.3) years included in this study. The average score of kinesophobia after surgery was 41.2 ± 4.5, with an incidence of 75.4%. Multivariate logistic regression analysis showed that age (OR = 1.105, 95% CI = 1.014–1.204), neck disability index (NDI) (OR = 1.268, 95% CI = 1.108–1.451), diabetes mellitus (OR = 0.026, 95% CI = 0.001–0.477), and Japanese Orthopaedic Association (JOA) score (OR = 0.698, 95% CI = 0.526–0.927) were associated with the occurren.ConclusionDoctors should be aware of kinesiophobia in patients with CSM. Education regarding kinesiophobia, strategies to avoid it, and treatment strategies using a multidisciplinary approach can improve recovery outcomes.

Pharmacological Insights of Ropivacaine and Clinical Applications: A Narrative Review.

This review focuses on ropivacaine, a long-acting amide local anaesthetic, detailing its pharmacology and clinical applications. The article highlights its applications in providing analgesia, prolonging pain relief, and improving recovery outcomes in surgical settings. Ropivacaine is particularly effective for epidural labor analgesia in obstetrics, promoting stable hemodynamics and rapid onset when used with adjuvants. Its prolonged anesthetic effects reduce the need for postoperative opioids in peripheral nerve blocks. Intrathecal administration may enhance functional recovery and postoperative analgesia in various surgical procedures. While effective in treating acute pain, its role in chronic pain management remains unclear, indicating a need for further research. The review underscores the versatility and efficacy of ropivacaine in acute pain management and the importance of exploring its potential in chronic pain treatment.

A smartphone app-based mindfulness intervention to enhance recovery from substance use disorders: Protocol for a pilot feasibility randomized controlled trial

BackgroundPoor long-term recovery outcomes after treatment (e.g., readmission to inpatient treatment) are common among individuals with substance use disorders (SUDs). In-person mindfulness-based treatments (MBTs) are efficacious for SUDs and may improve recovery outcomes. However, existing MBTs for SUD have limited public health reach, and thus scalable delivery methods are needed. A digitally-delivered MBT for SUDs may hold promise. MethodsWe recently developed Mindful Journey, a smartphone app-based adjunctive MBT for improving long-term recovery outcomes. In this paper, we present details on the app and describe the protocol for a single-site pilot feasibility randomized controlled trial of Mindful Journey. In this trial, individuals (n = 34) in an early phase of outpatient treatment for SUDs will be randomized to either treatment-as-usual (TAU) plus Mindful Journey, or TAU only. The trial will focus on testing the feasibility (e.g., engagement) and acceptability of the app (e.g., perceived usability and helpfulness for recovery), as well as feasibility of study procedures (e.g., assessment completion). The trial will incorporate ecological momentary assessment before and after treatment to assess mechanisms in real-time, including mindfulness, craving, difficulties with negative emotion regulation, and savoring. To examine the sensitivity to change of outcomes (substance use, substance-related problems, and psychological distress) and mechanism variables (noted above), we will test within-treatment-condition changes over time. DiscussionThe proposed pilot trial will provide important preliminary data on whether Mindful Journey is feasible and acceptable among individuals with SUDs. Trial registrationClinicalTrials.gov NCT05109507.

A - 41 Relationship between Fear-Avoidance Behavior, Clinical Outcomes, and Recovery Time in Adults Following Concussion

Abstract Purpose To examine the relationship between fear-avoidance behavior, clinical outcomes, and recovery time in adults following concussion. Method This prospective study included patients aged 18–50 years who presented to a specialty clinic 5–30 days post-concussion. Participants completed a clinical intake (e.g., demographics/medical history), multidomain clinical assessment (Clinical Profile Screen [CP-Screen], Immediate Post-concussion Cognitive Testing [ImPACT], Vestibular/Ocular Motor Screen [VOMS], Patient Health Questionnaire-9 [PHQ-9], Generalized Anxiety Disorder-7 [GAD-7]), and the Fear-Avoidance Components Scale (FACS). Recovery time was ascertained at a subsequent visit(s). Fear-avoidant (FA) and non-fear-avoidant (NFA) groups were classified using cutoffs from the FACS (FA = 41–100; NFA = 0–40) and compared using independent samples t-tests, X2 tests, and analyses of covariance. Results Seventy-two participants (M = 28.7¬ ± 8.5 years, 69.4% female) were included: 37 (51.4%) in the FA and 35 (48.6%) in the NFA group. Groups did not differ on demographics, medical history, injury characteristics, or CP-Screen. A greater proportion of the FA group had the anxiety/mood profile (62.2% vs 31.4%, p &amp;lt; 0.01). The FA group had worse ImPACT reaction time (t(68) = −2.7, p &amp;lt; 0.01, d = −0.7), VOMS visual motion sensitivity (t(67) = −2.3, p = 0.03, d = −0.5), GAD-7 (t(70) = −3.9, p &amp;lt; 0.01, d = −0.9), and PHQ-9 (t(69) = −2.8, p &amp;lt; 0.01, d = −0.7) scores, and longer recovery (t(24) = −2.8, p = 0.01, d = −0.9), even when controlling for age and time to clinic (F[1, 22] = 4.6, p = 0.04, ηp2 = 0.17). Conclusions Adults who reported high fear-avoidance (e.g., avoiding activity, catastrophizing) had worse clinical outcomes and longer recovery following concussion compared to non-fear-avoidant adults, despite no differences in demographics, medical history, injury characteristics, or symptoms. Clinicians should screen for and counsel adults post-concussion against engaging in fear-avoidance behaviors to improve recovery outcomes.

Jenna's Project: Preventing Overdose and Improving Recovery Outcomes for Women Leaving Incarcerated Settings During Pregnancy and Postpartum Periods.

For people with opioid use disorder (OUD), transitioning from pregnancy to postpartum and from incarceration to the community is a time of increased risk for opioid overdose. This prospective project evaluated the extent of Jenna's Project's success in preventing overdoses and improving recovery outcomes by coordinating postrelease care in incarcerated OUD perinatal patients. Participants (N = 132) were pregnant or postpartum (1 year postdelivery) with OUD during incarceration and self-referred for postrelease services. From March 2020 to October 2021, participants could receive up to 6 months of postincarceration care coordination services (eg, regular communication, transportation, emergency housing, SUD treatment), medication to treat OUD (MOUD) and other treatment services. Outcomes included verified overdose (fatal), self-reported nonfatal overdose, reincarceration, active Medicaid, receipt of MOUD, presence of children living with participants, open Child Protective Services cases, and number of referrals for services. There were 0 nonfatal and 0 fatal overdoses at both 1 and 6 months postrelease, and 3 of 132 (2%) returned to incarceration. Significantly fewer participants had Medicaid at release (36%) and at 6 months postrelease (60%) than before incarceration (87%) ( P < 0.001 for all 3 pairwise comparisons). At 6 months postrelease, significantly more participants reported MOUD receipt (51%) compared with before incarceration (39%) ( P < 0.001). There was no significant change in the number of open Child Protective Services cases. Referrals for childcare or parenting services were the most common referrals provided. Immediate postrelease care coordination for pregnant and postpartum women with OUD was feasible and effective in preventing overdose, reincarceration, and promoting recovery outcomes.

Cognitive remediation for schizophrenia: Clinician perspectives on implementation barriers and facilitators.

Neurocognitive deficits in schizophrenia have a major impact on functioning; however, they remain poorly targeted by available treatment offerings. Cognitive remediation (CR) is effective in improving neurocognition and functioning. Despite clinical guidelines for schizophrenia recommending CR, it is still not readily available in clinical services and sizeable attrition rates are reported in clinical trials. To elucidate the barriers and facilitators of CR access and engagement, we conducted a mixed methods qualitative-dominant study with 12 clinicians in Australia, in 2021, with 1 hr interviews and additional rating scales completed. Thematic analysis highlighted four themes (cognitive symptoms, CR intervention, motivation and engagement in CR, and CR implementation), and 14 subthemes. Clinicians emphasized the broad impact of cognitive deficits and outlined pros and cons of different CR approaches. Several factors were suggested as impacting engagement, including motivation assessments/techniques, neurocognitive insight, illness, and demographic factors. Lack of routine implementation in Australia was unanimously espoused and partly explained by a need for cost-effectiveness analyses, remote and flexible delivery, and increasing service resource provision and staff training in CR. This study offers key insights into CR access, while recommending methods for optimizing CR implementation and dissemination to improve recovery outcomes of people diagnosed with schizophrenia. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Brain functional connectivity alterations in patients with anterior cruciate ligament injury

Recent advancements in neuroimaging have illustrated that anterior cruciate ligament (ACL) injuries could impact the central nervous system (CNS), causing neuroplastic changes in the brain beyond the traditionally understood biomechanical consequences. While most of previous functional magnetic resonance imaging (fMRI) studies have focused on localized cortical activity changes post-injury, emerging research has suggested disruptions in functional connectivity across the brain. However, these prior investigations, albeit pioneering, have been constrained by two limitations: a reliance on small-sample participant cohorts, often limited to two to three patients, potentially limiting the generalizability of findings, and an adherence to region of interest based analysis, which may overlook broader network interactions. To address these limitations, our study employed resting-state fMRI to assess whole-brain functional connectivity in 15 ACL-injured patients, comparing them to matched controls using two distinct network analysis methods. Using Network-Based Statistics, we identified widespread reductions in connectivity that spanned across multiple brain regions. Further modular connectivity analysis showed significant decreases in inter-modular connectivity between the sensorimotor and cerebellar modules, and intra-modular connectivity within the default-mode network in ACL-injured patients. Our results thus highlight a shift from localized disruptions to network-wide dysfunctions, suggesting that ACL injuries induce widespread CNS changes. This enhanced understanding has the potential to stimulate the development of strategies aiming to restore functional connectivity and improve recovery outcomes.

Patient-centered evaluation of an expectation-focused intervention for patients undergoing heart valve surgery: a qualitative study.

Randomized controlled trials demonstrate the effectiveness of expectation-focused interventions in improving recovery outcomes following cardiac surgery. For dissemination in routine health care, it is important to capture the perspective of affected individuals. This qualitative study explores the perceived benefits and intervention-specific needs of patients who received expectation-focused intervention in the context of heart valve surgery. In addition, it explores potential barriers and adverse effects. As part of an Enhanced Recovery After Surgery (ERAS) program within a multicentered randomized controlled trial, patients undergoing minimally invasive heart valve surgery received an intervention focused on their expectations. Six weeks after the intervention, semi-structured interviews were conducted with 18 patients to assess its feasibility, acceptance, barriers, benefits, and side effects. The transcribed interviews were analyzed using qualitative content analysis. The results indicate that both the intervention and the role of the patient and psychologist are key aspects in evaluating the expectation-focused intervention. Five key themes emerged from the patients' perspective: personal needs, expectations and emotions, relationship, communication, and individuality. Patients valued the preparation for surgery and recovery and the space for emotions. Establishing a trustful relationship and addressing stigmatization were identified as primary challenges within the intervention. Overall, patients experienced the expectation-focused intervention as helpful and no adverse effects were reported. Perceived benefits included enhanced personal control throughout the surgery and recovery, while the potential barrier of stigmatization towards a psychologist may complicate establishing a trustful relationship. Addressing personal needs, as a relevant topic to the patients, could be achieved through additional research to identify the specific needs of different patient subgroups. Enhancing the expectation-focused intervention could involve the implementation of a modular concept to address individual needs better.

Public Sector Learning Health Care Systems—Improving Patient Experience, Workforce Well-Being, and Recovery Outcomes

This Viewpoint discusses the need for integrating basic, clinical, and epidemiological science into behavioral health care delivery to develop more scalable and sustainable learning health care systems and improve population health and patient experience, reduce costs, and promote the well-being of the health care workforce.

Guidelines for treating spinal cord injury without radiological abnormalities in children

Spinal cord injury without radiological abnormality (SCIWORA) is a rare condition that predominantly affects children. The enigmatic nature of SCIWORA poses significant challenges in terms of diagnosis, treatment, and achieving full recovery. Various factors, such as different injury mechanisms, delayed symptom onset, normal magnetic resonance imaging findings in certain cases, and complex management decisions, contribute to the challenges of dealing with SCIWORA. Attaining a significant outcome and complete recovery through a single-treatment approach is difficult. Therefore, a multifaceted treatment strategy is proposed to yield more favorable results. This paper comprehensively addresses the assessment and management, examination and diagnosis procedures, treatment methods, rehabilitation techniques, and potential complications associated with SCIWORA in children. The paper provides therapeutic guidance for physicians and medical staff, with the aim of enhancing survival rates and improving recovery outcomes. Moreover, it offers suggestions for restoring neurological functions in pediatric patients suffering from SCIWORA.

Perceptions of Addiction Medications Within Collegiate Recovery Communities.

Addiction medications (AM) are effective in improving recovery outcomes, but many barriers still exist that reduce their implementation among young adults. While the perception of AM has been explored within clinicians and counselors in many settings, it has not yet been documented within collegiate recovery communities (CRC). The aim of this brief report is to assess the acceptability and intent to use AM among students in recovery, and to evaluate the effect of attitudes, perceived AM effectiveness, and social norms on these outcomes. Using the Theory of Planned Behavior, CRC students (N = 162; 44% female) within the United States completed an online survey. Results from a hierarchical linear model indicated that the perceived acceptance of AM use by important others was significantly related to the intent to use AM ( β = 0.47, P < 0.01) and encourage others to use AM ( β = 0.16, P < 0.05). Positive attitudes about AM predicted acceptability of AM use ( β = 0.42, P < 0.01) and encouraging other CRC students to use AM ( β = 0.38, P < 0.01). Perceived AM effectiveness was positively associated with acceptability ( β = 0.36, P < 0.01) and encouragement of others ( β = 0.27, P < 0.01). Results highlight the importance of promoting effectiveness, improving attitudes, and tapping social networks to increase AM use and acceptability among CRC students. Implications for CRC policy and programming are discussed.

Situational Confidence and Recovery Capital Among Recovery Residents Taking Medications for Opioid Use Disorder in Texas.

Situational confidence, that is, confidence to resist substance use in high-risk situations, and recovery capital (RC) are resources that individuals can draw upon to initiate and sustain their recovery from opioid use disorder. We assessed the associations between total, social, and personal RC and situational confidence among recovery residents taking medications for opioid use disorder. Cross-sectional associations between the Brief Situational Confidence Questionnaire and Assessment of Recovery Capital scores were assessed among participants (N = 267) enrolled in a longitudinal study in 13 recovery homes for persons taking medications for opioid use disorder in Texas using χ 2 tests and multivariable logistic regression. Most participants were 35 years or older (51.7%), male (59.4%), non-Hispanic White (71.5%), and unemployed (66.0%); used more than one substance (77.9%); and had higher educational levels (53.8%). The majority had high situational confidence (66.7%), social (63.7%), physical (67.0%), and total (64.8%) RC. Education (model 1: adjusted odds ratio [aOR], 1.96; confidence interval [CI], 1.13-3.40; model 2: aOR, 2.03; CI, 1.17-3.51) and social (aOR, 2.08; CI, 1.11-3.92), personal (aOR, 2.06; CI, 1.08-3.93), and total (aOR, 2.98; CI, 1.71-5.20) RC were associated with situational confidence. Our findings highlight the need for recovery housing operators to be trained on the relevance of RC and situational confidence to practice to improve recovery outcomes among residents with opioid use disorder. Health planners, recovery housing administrators, and policymakers should strengthen recovery residence-based services and systems to improve individual RC and situational confidence.