Treatment Of Chronic Medical Conditions Research Articles

Sources of nonmedically used prescription psychotherapeutic drugs using real-world data from adolescents and adults assessed for substance use treatment--2014-2022

BackgroundNonmedical use (NMU) of prescription psychotherapeutic drugs (PPD) may increase risk for significant morbidity and mortality in the overdose crisis. ObjectiveThis study examines sources of PPD using real-world data from adolescents and adults reporting past 30-day NMU of PPDs. MethodsA convenience sample of individuals aged ≥10 years assessed for substance use disorders (SUD) treatment was analyzed using the 2014–2022 National Addictions Vigilance Intervention and Prevention Program datasets. PPD include prescription opioids, prescription tranquilizers/sedatives, and prescription stimulants. ResultsOverall, among assessments of adolescents aged 10–18 years (N = 1991) and young adults aged 19–24 years (N = 15,166), “family/friend” (46.08–47.41 %) and “dealer” (33.82–42.71 %) were the most common sources. Among assessments of adults aged ≥25 years (N = 89,225), “own prescription” was the most common source and increased in frequency as age increased. Across all age groups, “family/friend” was the most frequent source for all drug classes (41.96–48.76 %) except for nonmedically used buprenorphine/methadone, for which “own prescription” was the most common source (51.85 %) among adults. ConclusionsOur study demonstrates heterogeneity in sources of nonmedically used PPD across age groups. Tailored prevention strategies for different age groups and improving timely access to medical care to ensure proper treatment of chronic medical conditions including SUD are needed.

Preference for Telehealth Sustained Over Three Months at an Outpatient Center for Integrative Medicine.

BackgroundIntegrative medicine is a key framework for the treatment of chronic medical conditions, particularly chronic pain conditions. The COVID-19 pandemic prompted rapid implementation of telehealth services.ObjectiveWe present outcomes of a complete and rapid transition to telehealth visits at an outpatient integrative medicine center in the Southeastern United States.MethodPatients and administrative staff took surveys comparing telehealth to in-person visits within four weeks of our clinic's transition to telehealth and three months later. Beginning four weeks after the clinic’s telehealth conversion in March 2020, patients who had a telehealth visit at the center completed a survey about their telehealth experience and another survey three months later.ResultsPatient quality judgements significantly favored telehealth at baseline, B = .77 [0.29 – 1.25], SE = .25, t(712) = 3.15, p = .002, and increased at three months, B = .27 [–0.03 – 0.57], SE = .15, t(712) = 1.76, p = .079. Telehealth technology usability and distance from the center predicted patient ratings of telehealth favorability. Providers favored in-person visits more than patients, B = –1.00 [–1.56 – –0.44], SE = .29, t(799) = –3.48, p < .001, though did not favor either in-person or telehealth more than the other. Patient discrete choice between telehealth and in-person visits was split at baseline (in-person: n = 86 [54%]; telehealth: n = 73 [46%]), but favored telehealth at three months (in-person: n = 17 [40%]; telehealth: n = 26 [60%]). Overall, discrete choice favored telehealth at follow-up across providers and patients, OR = 2.69 [.1.18 – 6.14], z = 2.36, p = .018. Major qualitative themes highlight telehealth as acceptable and convenient, with some challenges including technological issues. Some felt a loss of interpersonal connection during telehealth visits, while others felt the opposite.ConclusionWe report converging mixed-method data on the successful and sustained implementation of telehealth with associated policy and clinical implications during and beyond the COVID-19 pandemic.

Diagnosis and Treatment of Chronic Medical Conditions Among Trauma Patients at a Level 1 Trauma Center.

Diabetes mellitus (DM) and hypertension (HTN) are increasing in prevalence in the population. Level 1 trauma facilities are often faced with managing these chronic conditions. Recent studies indicated that 12-44% of patients presenting traumas are found to have incidental findings by imaging representing undiagnosed medical conditions, with 10% reported requiring further management [Surendran A, Mori A, Varma DK, Gruen RL. Systematic review of the benefits and harms of whole-body computed tomography in the early management of multitrauma patients: Are we getting the whole picture? J Trauma and Acute Care Surg. 2014;76(4):1122-1130]. Between 2015 and 2016, 852 patients seen at a level 1 trauma center were analyzed. Patients were evaluated who received a new diagnosis of HTN or DM, or had preexisting diagnosis of HTN or DM whose management was changed. Uncontrolled HTN or DM was defined as a need for either a change in medication or primary care optimization prior to discharge. Among the patients evaluated, 6.3% and 3.0% received new diagnoses of HTN and DM, respectively. Additionally, 34.4% and 35.3% of patients were found to have uncontrolled HTN and DM and required medical optimization, respectively. The high prevalence of undiagnosed or suboptimal management for chronic conditions indicates that more research is warranted for defining, screening for, and treating surgical patients with poorly controlled medical conditions with these comorbidities.

An update on maternal medication-related embryopathies.

There is a general perception that any exposure to medication during pregnancy poses a potential risk to the fetus. Most available data about teratogenic drugs is derived from animal studies, case reports, or cohort studies. As a result, counseling women and their partners about the safety of drugs during pregnancy can be difficult due to limited information about efficacy, pharmacokinetics, and teratogenicity of some drugs. However, this should always be done in the context of weighing up potential teratogenic risks with the perinatal risks of an untreated medical or psychiatric condition. Ideally, this counseling should occur prior to a planned pregnancy so that medications and treatment of chronic medical conditions can be optimized. It is important that clinicians providing antenatal care are able to confidently manage women including utilizing appropriate resources. This paper aims at reviewing a selected (non-exhaustive) list of the most commonly prescribed medications considered significant human teratogens and provides recommendations for pre-conception and antenatal counseling.

Using Electronic Medical Record Data to Better Understand Obesity in Hispanic Neighborhoods in El Paso, Texas.

The prevalence of obesity has been persistent amongst Hispanics over the last 20 years. Socioeconomic inequities have led to delayed diagnosis and treatment of chronic medical conditions related to obesity. Factors contributing include lack of insurance and insufficient health education. It is well-documented that obesity amongst Hispanics is higher in comparison to non-Hispanics, but it is not well-understood how the socioeconomic context along with Hispanic ethnic concentration impact the prevalence of obesity within a community. Specifically studying obesity within Hispanic dominant regions of the United States, along the Texas–Mexico border will aid in understanding this relationship. El Paso, Texas is predominantly Mexican-origin Hispanic, making up 83% of the county’s total population. Through the use of electronic medical records, BMI averages along with obesity prevalence were analyzed for 161 census tracts in the El Paso County. Geographic weighted regression and Hot Spot technology were used to analyze the data. This study did identify a positive association between Hispanic ethnic concentration and obesity prevalence within the El Paso County. Median income did have a direct effect on obesity prevalence while evidence demonstrates that higher education is protective for health.

Stem Cell Therapies: A Way to Promising Cures.

Stem cells carry the remarkable ability to differentiate into different cell types while retaining the capability to self-replicate and maintain the characteristics of their parent cells, referred to as potency. Stem cells have been studied extensively to better understand human development and organogenesis. Because of advances in stem cell-based therapies, regenerative medicine has seen significant growth. Ophthalmic conditions, some of which are leading causes of blindness worldwide, are being treated with stem cell therapies. Great results have also been obtained in the treatment of oral and maxillofacial defects. Stem-cell-based therapies have great potential in the treatment of chronic medical conditions like diabetes and cardiomyopathy. The unique property of stem cells to migrate towards cancer cells makes them excellent vectors for the transportation of bioactive agents or for targeting cancer cells, both primary and metastatic.While these therapeutic strategies are extremely promising, they are not without limitations. Failure to completely eradicate the tumor and tumor relapse are some of those concerns. Stem cells share some characteristics with cancer stem cells, raising concerns for increasing the risk of cancer occurrence. Ethical concerns due to the fetal origin of stem cells and cost are other major obstacles in the large-scale implementation of such therapies.

Determinants of sickness absence rate among Finnish municipal employees

Objective: In addition to acute health problems, various aspects of health behavior, work-related and sociodemographic factors have been shown to influence the rate of sickness absence. The aim of this study was to concomitantly examine factors known to have an association with absenteeism. We hypothesized the prevalence of chronic diseases being the most important factor associated with sickness absence.Design: A cross-sectional study.Setting: Occupational health care in the region of Pori, Finland.Subjects: 671 municipal employees (89% females) with a mean age of 49 (SD 10) years. Information about the study subjects was gathered from medical records, by physical examination and questionnaires containing information about physical and mental health, health behavior, work-related and sociodemographic factors. The number of sickness absence days was obtained from the records of the city of Pori.Main outcome measures: The relationship of absenteeism rate with sociodemographic, health- and work-related risk factors.Results: In the multivariate analysis, the mean number of chronic diseases (IRR 1.24, 95% CI 1.13 to 1.36), work ability (IRR 0.83, 95% CI 0.76 to 0.91), and length of years in education (IRR 0.90, 95% CI 0.85 to 0.95) remained as independent factors associated with absenteeism.Conclusion: According to our results, chronic diseases, self-perceived work ability and length of years in education are the most important determinants of the rate of sickness absence. This implies that among working-aged people the treatment of chronic medical conditions is also worth prioritizing, not only to prevent complications, but also to avoid sickness absences.KEY POINTSVarious sociodemographic, health- and work- related risk factors have been shown to influence sickness absence.The study aimed to find the most important determinants of absenteeism among several known risk factors in Finnish municipal employees.Chronic diseases, self-perceived work ability and education years remained as the most important determinants of sickness absence rates.Treatment of chronic medical conditions should be prioritized in order to reduce sickness absence rate.

Who is Taking Care of the Caregiver?

In neurology practices, the patient's caregiver is often overlooked, but it is essential to understand the importance of the caregiver in the management of a chronic neurological condition. Caring for a loved one with a chronic condition can often be profoundly fulfilling, as many times individuals move closer together when challenges arise; however it can also become overwhelming, physically and emotionally challenging, and isolating. At times, it can be thought of as a burden. Caregivers must learn to take care of themselves physically and emotionally. The multidisciplinary care model used in the treatment of chronic medical conditions is important not only for the patient or care recipient, but also for the caregiver. This care model allows for several practitioners to interact with the caregiver to assess and determine the optional interventions. The purpose of this article is to review common caregiver challenges and to determine how, as providers, we can address and help caregivers more effectively care for themselves while maintaining their responsibility to the patient or care recipient.

Liposuction: A Surgical Tool to Improve the Quality of Life after Morbid Medical Conditions: Review of Literature

Introduction: The purpose of this literature review is to conduct a systematic review of the clinical applicability and safety of the liposuction technique and to familiarize the reader with the scope of non-cosmetic indications. The procedure of liposuction used not only as a tool of rejuvenation but also used to improve the quality of life after many disabling medical conditions such as: Lipomatosis syndromes, Adipose tissue diseases, chronic lymphedema of the extremities, fasciocutaneous, and myocutaneous bulky Flaps, subcutaneous lipomas, axillary Hyperhydrosis, post ablative surgery and Radio dermatitis. Methods: An online search of the Cochrane Library, MEDLINE, Embase and SciELO was conducted. Studies included in the review were 47 original articles reported from 1982 to February 2014. The articles included the use of liposuction for treatment of non-cosmetic and disabling medical conditions, with description of clinical applications and complications. The criteria used for papers selection were: papers with large size of samples, papers with significant statistics, and original papers. The case reports were excluded. Results: There was a broad agreement in the reviewed literature about the applicability and the efficacy of the liposuction for treatment of these chronic medical conditions. Literatures review confirmed that this technique has provided significant and stable cure. Conclusion: Liposuction is the most frequent aesthetic procedure world-wide for adipose tissue reduction and treatment of lipedema. Apart from aesthetic indications, liposuction also is suitable for treatment of chronic medical diseases and non-cosmetic conditions. It alternates some of surgical procedures like debulking of flaps, undermining the subcutaneous tissues. It is an adjuvant tool for breast reconstruction. Liposuction is not a simple procedure but requires extensive knowledge and experience to prevent irreversible medical or aesthetic complications.

Family functioning and caregiver burden in Alzheimer’s disease

Changes in morbidity and the lengthening of life expectancy have encouraged an increasing interest in the treatment of chronic medical conditions and in those diseases whose typical onset happens in late adulthood. Alzheimer’s is probably one of the most relevant, in terms of complexity of treatment and of costs for health care systems. Several studies highlight how the effects of this neurological disease weigh down patients, caregivers, families and society, and probably more complex options of treatment have to be arranged in order to prevent the negative outcomes that are indirectly but strictly related to the disease. In this respect, it is suggested to pay special attention to the consequences on caregivers’ health due to their intense and prolonged assistance. Given that most caregivers are relatives of patients affected by Alzheimer’s, their burden of care should be properly contextualised in the relational context in which it takes place. Theoretical and clinical models of family functioning migh...

Treatment of bipolarity + medical comorbidity = costability

This issue of the Acta Psychiatrica Scandinavica reports from an open-label follow-up of 3766 research subjects of the STEP-Bipolar project. At least one medical comorbid condition was found in 58.8%. Baseline data from subjects with bipolar-spectrum disorder and schizoaffective disorder, bipolar type, were analyzed retrospectively to determine the association of historical variables with medical comorbidity (1). A strong linear-by-linear association was noted between the following historical variables and prevalence of any medical comorbidity: More than 10 previous mood episodes; Childhood onset; Smoking; Lifetime of anxiety and substance use disorder. In summary, this study (1) adds support to the notion that medical comorbidity may be a central aspect of the pathophysiology of the bipolar affective disorder spectrum, rather than the result of lifestyle and/or psychotropic medication. This is consistent with prior research that suggests a diathesis toward medical comorbidity in bipolar disorder (2). Pirraglia et al. (2) found that the outcome of bipolar affective disorder correlated with stress and the experience of burden of total physical illness over time – rather than with a simple count of current medical diseases. The authors of the current study (1) offer their interpretation that recurrent severe mood episodes may: Promote additive allostatic stress leading to increased prevalence of medical illness and/or; Share an underlying physiological pathway with chronic medical illness, thereby increasing risk of both psychiatric and medical morbidity. This research (1) has clinical implications that extend beyond what its title suggests. Because the diagnosis of schizoaffective disorder, bipolar type, was included in the study population, the findings may apply to other affective psychiatric conditions. Similar results have been found for other affective disorders. One study, for example, reported that endocrine/metabolic illness was associated with greater depressive symptom severity and poorer treatment outcomes. Therefore, the take-home message, especially relevant to psychiatric and primary care providers, is to pay attention to three easily-overlooked areas of practice. These clinical domains have the potential to improve the outcome of, and/or minimize the severity of, medical conditions that may accompany exacerbations of chronic, recurring affective disorders: Compliance: Non-adherence to medications for bipolar affective disorder and related affective conditions has been found to contribute – albeit at a barely significant level – to greater physical comorbidity in bipolar patients, as measured by the PCS (Physical Component Scale) (3). Providers should encourage implementation and maintenance of systems of medication delivery which ensure compliance in patients with bipolar-spectrum affective disorders. Early intervention: Untreated or poorly treated affective disorders may contribute to the recurrence of, and/or chronicity of, medical comorbid conditions and vice versa. For example, medical conditions were more prevalent in a group of primary care patients with a recurrent depressive episode than in a group with a first episode of depressive disorder. Early medical intervention and consultation from specialists may, for affective disorder patients with medical comorbidities, help prevent worsening and recurrence of both conditions. Prescribing practices: The geriatric proportion of the total population is growing, along with a concomitant increased burden of comorbid medical and psychiatric conditions. Risks inherent in prescribing medication combinations to the aged are obvious. As a result, there has been increased attention in the professional literature to pharmacokinetic/pharmacodynamic principles, parsimonious use of medications, and vigilance toward drug–drug interaction for the geriatric patient (4). Related issues have been raised in a recent article advocating more conservative prescribing principles (5). In sum, the paper reviewed here has inherent recommendations that have the potential to improve the treatment of chronic medical conditions in affective disorders beyond the bipolar patient.

Psychotherapy for Psychological Injury: A Biopsychosocial and Forensic Perspective

This article reviews the predominant psychological approaches to therapy and other treatments in the field of psychological injury. Mostly, they concern cognitive behavior therapy and its variants. However, because of the simultaneous physical injuries or physiological effects that accompany these types of injury, practitioners should adopt an integrated biopsychosocial approach in treatment (Sperry, L., Treatment of chronic medical conditions: Cognitive-behavioral therapy strategies and integrative treatment protocols. Washington, DC: American Psychological Association, 2006; Treatment of chronic medical conditions: Cognitive-behavioral therapy strategies and integrative treatment protocols. Washington, DC: American Psychological Association, 2009). The paper presents a componential model of therapy that integrates the cognitive-behavioral, biopsychosocial, and forensic approaches. More research needs to be undertaken that takes into account the difficulties of conducting therapy with individuals who are expressing psychological injury. This will help in the quest to formulate evidence-based but flexible practice guidelines. The paper concludes with a model that may serve to scaffold the numerous psychotherapies that are available into a more coherent framework.

Interventions to Enhance Medication Adherence in Chronic Medical Conditions

Approximately 20% to 50% of patients are not adherent to medical therapy. This review was performed to summarize, categorize, and estimate the effect size (ES) of interventions to improve medication adherence in chronic medical conditions. Randomized controlled trials published from January 1967 to September 2004 were eligible if they described 1 or more unconfounded interventions intended to enhance adherence with self-administered medications in the treatment of chronic medical conditions. Trials that reported at least 1 measure of medication adherence and 1 clinical outcome, with at least 80% follow-up during 6 months, were included. Study characteristics and results for adherence and clinical outcomes were extracted. In addition, ES was calculated for each outcome. Among 37 eligible trials (including 12 informational, 10 behavioral, and 15 combined informational, behavioral, and/or social investigations), 20 studies reported a significant improvement in at least 1 adherence measure. Adherence increased most consistently with behavioral interventions that reduced dosing demands (3 of 3 studies, large ES [0.89-1.20]) and those involving monitoring and feedback (3 of 4 studies, small to large ES [0.27-0.81]). Adherence also improved in 6 multisession informational trials (small to large ES [0.35-1.13]) and 8 combined interventions (small to large ES [absolute value, 0.43-1.20]). Eleven studies (4 informational, 3 behavioral, and 4 combined) demonstrated improvement in at least 1 clinical outcome, but effects were variable (very small to large ES [0.17-3.41]) and not consistently related to changes in adherence. Several types of interventions are effective in improving medication adherence in chronic medical conditions, but few significantly affected clinical outcomes.

The Health Compliance Model-II.

The Health Compliance Model-II (HCM-II) is posited to address the multivariate, dynamic, and idiosyncratic nature of predicting adherence to health behaviors. The HCM-II advances upon the original Model (E.M. Heiby & J.C. Carlson, 1986) by emphasizing emotional causal variables indicated by a psychological behaviorism framework (A.W. Staats, 1996). The HCM-II also adds causal variables from the empirical support of eclectic cognitive-behavioral models: Social Cognitive Theory (A. Bandura, 1991); Modified Social Learning Theory (K.A. Wallston, 1992); Health Belief Model (I.M. Rosenstock, 1991); and Theories of Reasoned Action/ Planned Behavior (M. Fishbein & I. Ajzen, 1975). Preliminary development of an assessment instrument derived from the proposed HCM-II is described and implications for treatment and prevention of noncompliance are discussed. Keywords: health compliance model-ii, psychological behaviorism, adherence, health behaviors. ********** Noncompliance or nonadherence to common healthy life-style recommendations has been subject to intense scrutiny by the behavioral health research community in recent years. Now that medical advances of the 20th century have brought many formerly fatal, acute illnesses under control (Myers & Midence, 1998), public health attentions focus more closely upon the promotion of self-controlled prevention and treatment of chronic medical conditions. However, after more than 30 years of research and intervention, poor compliance statistics with mainstream health behavior recommendations is cause for national concern (Conner & Norman, 1996). This predicament is reflective of shortcomings within popular theoretical models used to explain and predict compliance to heath behaviors. Despite a large empirical literature, there is still no consensus as to the superiority of any theory or model, or even that particular variables are more useful than others for understanding the determinants of compliance within discrete behavioral health domains (Weinstein, 1993). One exception is an operant behavioral analysis that for decades has been shown to effectively guide treatment in environments where discriminative stimuli and contingent reinforcement can be controlled (e.g., daCosta, Rapoff, Lemanek, & Goldstein, 1997; Haynes, Sackett, Gobson, Taylor, Hackett, Roberts, & Johnson, 1976). Given that environmental engineering is usually not feasible, most compliance enhancement theories focus on an eclectic variety of cognitive-behavioral health compliance competency variables. We describe the Health Compliance Model-II (Frank, 2000; Heiby & Frank, 2003; Heiby & Lukens, in press) as an attempt to move toward a unification and expansion of the operant behavioral and cognitive-behavioral theoretical and empirical compliance enhancement literatures. [FIGURE 1 OMITTED] There are several reviews of cognitive-behavioral compliance theories (e.g., Horne & Weinman, 1998; Myers & Midence, 1998; Norman & Conner, 1996; Weinstein, 1993). In Figure 1, we summarize the variables proposed in these theories that enjoy substantial empirical support, so not all posited variables in each theory are listed. The transtheoretical or stages of change theories have not been included in Figure 1 because they describe the options of change rather than the posit conditions and skills involved in acquiring behavioral health regimens (e.g., as suggested by DiClemente, 1993, p. 105). The theories are presented in approximate chronological order from right to left. While the number of empirically supported variables included in theories increase over time, it is apparent that no theory has fully integrated the contributions of prior theories. Weinstein (1993) argued that a more comprehensive theory of compliance is needed, and issued the following appeal to the research community for ongoing model development: Because these theories contain at least a grain of truth, empirical tests typically yield some degree of confirmation, enough to keep the theory under scrutiny from being rejected . …