Treatment Program Research Articles

Group dynamics and therapy outcome of multimodal pain therapies: A prospective observational trial

AbstractBackgroundFor the treatment of chronic pain, interdisciplinary treatment programs are recommended. Despite continuous adaptation and optimization of this cost‐ and time‐intensive and comprehensive form of therapy, it is not successful in some patients. As personality disorders have an important influence on social interaction and behaviour, the aim of our study was to identify the possible impact of patients with personality disorders on group dynamics and to analyse the influence of group dynamics on individual therapy outcomes.MethodsWe conducted a prospective observational study in patients with chronic pain (N = 104) who participated in a 5‐week interdisciplinary treatment program. The main outcome parameters were psychological state and pain intensity before and after the program.ResultsIn contrast to our clinical assumption, we found that neither the type nor the number of patients with personality accentuation or personality disorders had a clinically relevant influence on group dynamics and that even a negative group dynamic did not negatively influence the individual therapy outcome.DiscussionThis trial analysed the connection between group dynamics and therapy outcome of multimodal pain therapies in chronic pain patients considering the factor of personality disorders. Our data demonstrated that neither the type nor the number of patients with personality disorders had a clinically relevant influence on group dynamics and that even a negative group dynamic did not negatively influence the individual therapy outcome. Hence, clinicians should not be afraid to include patients with personality disorders in their treatment programs.Significance StatementThe study emphasizes that clinicians may include patients with personality disorders in multimodal pain treatment programs and groups, provided that the maintenance of a close therapeutic bond with the patient and within the interdisciplinary team is given.

A Randomized Controlled Trial of a Virtually Delivered Group Parent Training for Parents of Children with ADHD During an Intensive Summer Treatment Program

ABSTRACT Background Behavioral Parent Training (BPT) is a widely implemented evidence-based treatment for youth with Attention-Deficit/Hyperactivity Disorder (ADHD) and related behavioral problems. During the COVID-19 pandemic, BPT was rapidly scaled for remote delivery via video conferencing platforms to enhance reach and engagement among families in need. Objective The purpose of the present study was to conduct a randomized controlled trial of a remotely delivered group-based BPT implemented in tandem with the Summer Treatment Program (STP) during the summer of 2021, the first year our clinic returned to in-person services following initial pandemic-related lockdowns. Method Children ranged in age from 6 to 12 years (M = 8.23, SD = 1.51) and were primarily male (93%) and Hispanic/Latine (74.4%). Families were randomly assigned to either receive the virtually delivered BPT during the summer (N = 23) or to a wait-list control group (N = 20), who received virtually delivered BPT in the fall. Results All families reported significant improvements in ADHD symptoms, related impairments, negative parenting behaviors, and knowledge of effective parenting skills from pre- to post-STP. Parents in the BPT group demonstrated additional improvements in managing difficult home situations. Conclusions Results of the study suggest that participating in BPT alongside the STP produces unique benefits for families above the standard behavioral treatment. Additionally, this study demonstrates the feasibility and utility of virtual group-based BPT to reduce burden associated with in-person services while providing evidence-based care in an inclusive manner.

Using a combination of cognitive behavioral therapy, case management and eHealth components for patients with depression or panic disorders in primary care practices in Hesse, Germany: an exploration of healthcare professionals’ lived experiences

BackgroundDepression and panic disorders have high prevalence rates in primary care. Given the crucial role of general practitioners in diagnosing and treating mental disorders, the two-arm cluster-randomized, controlled PREMA trial was designed. PREMA was aimed at investigating a new intervention combining cognitive behavioral therapy, case management and eHealth components for patients with depression and/or panic disorder with or without agoraphobia in primary care practices in Germany. This qualitative study, embedded in the PREMA trial, explores primary healthcare professionals’ lived experiences in using the new treatment program. Using a qualitative design, we conducted eleven interviews with general practitioners and medical assistants from Hesse, Germany, between July 2021 and March 2022. For both groups we relied on a semi-structured interview guide covering the following subjects: study procedures, implementation, practicality, and individual components of the treatment program. Interviews were audio-recorded, transcribed verbatim and analyzed by two researchers using content analysis. A deductive-inductive approach was used for the analysis according to Kuckartz.ResultsWe narratively summarized the facilitators and barriers from two different stakeholders across five key themes regarding experiences of feasibility and practicability of the new treatment program: study instruction materials, individual components of the treatment program, practicality, target population, and benefits of the treatment program. Facilitators to become familiar with the study include study instruction materials that are easy to understand and not too complex, considering the limited time resources available; barriers included text-heavy instruction materials, lack of collegial exchange, and issues especially with digital materials also involved access and log-in difficulties on the online platform. Facilitators for using the treatment program include the combination of face-to-face consultations and the use of an online platform, enabling a structured approach and regularity; barriers included patients feeling unsupported in performing anxiety exercises independently at home. For practicality, the professional skills of medical assistants and their central role as points of contact for patients facilitated the implementation; barriers included time-intensive organization and planning of monitoring phone calls and consultations. Regarding the target population, general practitioners and medical assistants state that the treatment program would be most appropriate for patients with mild to moderate depression and for those waiting for psychotherapeutic treatment; it would be less suitable for older patients, and those with negative attitudes towards technological tools. For benefits of the program, facilitating factors included free and low-threshold access to the online platform and strengthening the relationship between medical assistants and patients; barriers included a preference for in-person conversations and the inability of some people to use online applications.ConclusionsThe complexity of the new treatment program and the associated high workload underline the need for further adjustments to the treatment approach. Team-based care and the expanded responsibilities of medical assistants demonstrated promising results.Trial registrationThe study was registered in the German Clinical Trials Register (DRKS00016622) on February 22, 2019.

Efficacy of combined exercise training during different menstrual phases in young students with primary dysmenorrhoea

AbstractObjectivesThe objective of the study was to compare the effectiveness of combined exercise training during different menstrual phases on pain, quality of life and menstrual symptoms.MethodsA total of 72 participants for the study were randomly assigned into three groups: Group 1 (N = 24), Group 2 (N = 24) and Group 3 (N = 24) which had undergone combined exercise training during the follicular, luteal and bleeding phases of their menstrual cycle, respectively. The treatment programme included combined exercise training involving deep breathing exercises, Kegel exercises, core strengthening exercises and stretching exercises. Exercises were repeated 5 times with hold duration of 15 s with total of 30–40 min session with 5–10 min of warm‐up and cooldown sessions. Demographic data and outcome measures (Visual Analogue Scale [VAS], Menstrual Symptom Questionnaire [MSQ], and Working ability, Location, Intensity, Days, Duration [WaLIDD]) were assessed at baseline and assessed again during the first menstrual cycle after the completion of the treatment programme. One‐way ANOVA was used for between‐group comparisons of the normally distributed data.ResultsWithin‐group comparison of the outcome variables except VAS in group 3 showed a statistically significant difference in all groups. Comparison of post‐intervention results of the outcome measures of all the groups revealed a statistically significant difference for the VAS, while there was no statistically significant difference for in between the comparison of the WaLIDD and MSQ scoring.ConclusionCombined exercise training is effective in reducing pain only when performed during follicular and luteal phases and significantly improve quality of life and menstrual symptoms in all phases of the menstrual cycle.

Supplemental Material for Individualized Assessment and Treatment Program (IATP) for Alcohol Use Disorder: Comparison With Conventional Cognitive-Behavioral Treatment and Examination of Coping Skills as a Mediator of Treatment

Supplemental Material for Individualized Assessment and Treatment Program (IATP) for Alcohol Use Disorder: Comparison With Conventional Cognitive-Behavioral Treatment and Examination of Coping Skills as a Mediator of Treatment

Examining Change in Callous-Unemotional Behaviors in Young Children with Attention-Deficit/hyperactivity Disorder (ADHD) and Comorbid Disruptive Behavior Disorders: Impact of the Summer Treatment Program for Pre-Kindergarteners (STP-PreK)

ABSTRACT Background Young children with attention-deficit/hyperactivity disorder (ADHD) and comorbid disruptive behavior disorders (DBD) exhibit significant impairments across functional domains, which are compounded by co-occurring callous-unemotional (CU) behaviors. Objective This study examined the impact of the Summer Treatment Program for pre-kindergartners (STP-PreK) on reducing callous-unemotional (CU) behaviors in children with and without ADHD and DBD. Method This study utilized a multi-informant approach to examine the change in CU behaviors in response to the STP-PreK via parent and teacher report across three time points. The current sample included three groups based on diagnostic status (68.7% boys; mean age = 5.47, SD = 0.77, 81.4% Latinx): ADHD Only (n = 46), ADHD+DBD (n = 129), and typically developing (TD; n = 148). Results Linear mixed models revealed significant initial differences in CU scores, with ADHD+DBD displaying higher CU scores, followed by ADHD Only, and then TD. Per teacher report, both ADHD groups experienced substantial decrease in CU behaviors over time, with moderate effect sizes (Cohen’s d = .67-.71). At the 1-year follow-up, children in the ADHD Only group no longer significantly differed from TD peers, while the ADHD+DBD group continued to exhibit significantly higher CU scores. Conclusion The findings suggest that the STP-PreK has a positive impact on reducing CU behaviors in children with ADHD during the transition to kindergarten or first grade. Understanding and addressing CU traits in early childhood may contribute to improved treatment outcomes and long-term social-emotional development.

Strategies for minimizing muscle loss during use of incretin-mimetic drugs for treatment of obesity.

The rapid and widespread clinical adoption of highly effective incretin-mimetic drugs (IMDs), particularly semaglutide and tirzepatide, for the treatment of obesity has outpaced the updating of clinical practice guidelines. Consequently, many patients may be at risk for adverse effects and uncertain long-term outcomes related to the use of these drugs. Of emerging concern is the loss of skeletal muscle mass and function that can accompany rapid substantial weight reduction; such losses can lead to reduced functional and metabolic health, weight cycling, compromised quality of life, and other adverse outcomes. Available evidence suggests that clinical trial participants receiving IMDs for the treatment of obesity lost 10% or more of their muscle mass during the 68- to 72-week interventions, approximately equivalent to 20 years of age-related muscle loss. The ability to maintain muscle mass during caloric restriction-induced weight reduction is influenced by two key factors: nutrition and physical exercise. Nutrition therapy should ensure adequate intake and absorption of high-quality protein and micronutrients, which may require the use of oral nutritional supplements. Additionally, concurrent physical activity, especially resistance training, has been shown to effectively minimize loss of muscle mass and function during weight reduction therapy. All patients receiving IMDs for obesity should participate in comprehensive treatment programs emphasizing adequate protein and micronutrient intakes, as well as resistance training, to preserve muscle mass and function, maximize the benefit of IMD therapy, and minimize potential risks.

An Archival Study of the Relationship Between Treatment Duration, Functioning, and Out-of-Home Placement for Youth with Serious Emotional Disturbance in a State-Wide Intensive In-Home Family Treatment Program

AbstractThe main aim of this study was to evaluate the effectiveness of Pennsylvania’s state-wide intensive in-home treatment for youth with serious emotional disturbance (SED), EcoSystemic Structural Family Therapy-Family Based Mental Health Services (ESFT-FBMHS). Despite its long history of implementation, the program remains empirically under-evaluated. In this archival study, out-of-home placement and youth functioning outcomes were compared across four tiers of length of stay. Given the high-risk population treated in ESFT-FBMHS, it was hypothesized that the families and youth who completed the full duration of treatment (169–224 days) would have better outcomes than those who stopped treatment after 168 days or less. We utilized an ex post facto quantitative research design analyzing archived medical claims data of 2251 youth treated between 2018 and 2022 to assess out-of-home placement rates and analyzed archived data from six domains of the Child and Adolescent Needs and Strengths (CANS; Problem Presentation, Risk Behaviors, Functioning, Child Safety, Caregiver Needs, and Child Strengths) to assess changes in youth functioning post-discharge (90 and 180 days). An analysis using generalized estimating equations (GEE), controlling for potential confounding variables such as demographics and clinical features, suggest that length of stay in ESFT-FBMHS was significantly associated with out-of-home placement and youth improvement on the CANS at both 90- and 180-days post-discharge. As a group, youth with SED who did not complete the full duration of the program had 2–3 times the odds of out-of-home placement at 90 days post-discharge and 1–3 times the odds at 180 days post-discharge as compared to program completers. CANS scores showed improvement in 40.1% of youth who completed the program as compared to only 11.7%–18.2% for those who did not. The results of this study suggest that ESFT-FBMHS is effective for youth with SED as a group and can improve youth functioning and reduce out-of-home placement.

PROBLEMS OF MANAGING THE IMMUNE RESPONSE UNDER CONDITIONS OF COMPETITIVE ADSORPTION, DIFFUSION PERTURBATIONS AND TEMPERATURE RESPONSE OF THE ORGANISM

Analysis of the problems associated with the rapid spread of infectious diseases indicates the need for new approaches to the diagnosis and develop- ment of effective personalized treatment programs. One of the important aspects of solving this problem is the creation of a mathematical modeling toolkit for predicting the dynamics of infectious diseases, taking into account spatial effects, concentrated effects, various mechanisms of body protec- tion in the conditions of the application of various types of therapeutic methods of treatment. An important component of complex methods of treat- ment of a wide range of infectious diseases is the use of adsorption drugs, which, along with detoxification of the body, are able to provide an addi- tional mechanism of neutralization of viral elements. In the process of using such means, not only pathogenic elements and toxins will be adsorbed, but also various types of immune agents, which will affect the dynamics of the immune response. In the paper the infectious disease model is generalized to take into account the features of competitive adsorption of antigens and immune agents in the conditions of diffusion perturbations, concentrated influences and temperature reaction of the body. By synthesizing the ideas of step-by-step procedures, asymptotic and numerical methods, an effective computational technology of step-by-step approximation of the solution of the original model singularly perturbed problem was built. The results of the computer experiments presented in the paper illustrate the features of reducing the predicted concentration of viral elements during their competi- tive adsorption together with immune agents, in particular, the effect of reducing the efficiency of the use of non-specific adsorbents. It is emphasized that taking into account the features of the action of competitive adsorption is important for making decisions regarding the formation of rational treatment programs with the complex use of adsorbing substances and immunological drugs.

Tracing HIV Infection among high-risk Tuberculosis Patients in Hodiedah Referral Center, Yemen

Background: HIV and tuberculosis [TB] are major public health concerns in Yemen. However, in this population, there is limited information on the prevalence of HIV infection among TB patients. This study aims to trace and describe cases of HIV infection among high-risk tuberculosis patients attending the Hodiedah referral center in Yemen. Methods: A cross-sectional study design was employed, and a convenience sampling method was used to select 40 high-risk tuberculosis patients out of 164 confirmed cases. Data was collected through a questionnaire regarding sociodemographic features and clinical signs. Results: Of 40 high-risk TB patients, only 4 tested positive for HIV, indicating a 10% prevalence. More than half [55.0%] were aged between 18 and 40 years, with the majority [57.5%] being male. Over half [57.5%] resided in urban areas, and approximately two-thirds [62.5%] had no formal education. Most participants [87.5%] belonged to a low socioeconomic status, with a monthly income of less than 50,000 Yemeni Riyals. The age group of 18–40 years had the highest frequency of HIV-positive cases [50.0%]. All HIV-positive cases occurred in males. Younger age and travel history showed higher odds of HIV positivity. Diarrhea, bone pain, and abdominal pain were associated with HIV-TB co-infection. Conclusion: A relatively high HIV prevalence points to an urgent need to scale up integrated screening, testing, and treatment programs within existing TB clinics to address this unmet HIV/TB burden. Males, younger ages, and travel outside the country emerged as potential high-risk groups that could be prioritized for screening; incorporating symptom-based algorithms into clinical protocols may help front-line workers recognize and refer to suspected co-infection cases for testing. Larger studies are warranted to validate the findings and better inform control programs.

Quality of Life With and Without Using Smart Phone Among Visually Impaired People

Background and Objectives: The quality of life (QoL) of blind people is affected by various variables, including age, sex, level of education, severity of low vision, use of applications and software, etc. This research aims to compare the QoL of people with low vision who use and do not use low-vision applications on smartphones. Methods: The statistical population included all patients with low vision who were referred to low vision research centers and other institutions active in the field of blindness and low vision in Tehran City, Iran. The sample size of this study was 43 people using the conviniece sampling method and Cochran’s formula, which was considered to be 90 people due to the existence of two groups for comparison. The research data collection tool was Hakimzadeh Yazdi’s QoL questionnaire (2022). Two-way one-variable analysis of variance and SPSS software, version 21 were used to analyze the data. Results: The results showed that people with low vision who use low-vision applications have a higher QoL compared to people with low-vision who do not use low-vision applications (P<0.05). Also, the effect of demographic variables on the QoL of low-vision patients using and not using applications was presented (P<0.05). Age and gender had no significant effect on QoL. Conclusion: Considering the impact of applications in facilitating the daily affairs of low vision patients, it is recommended to use it in treatment and educational programs in hospitals and even in the family.

Sociodemographic associated factors with non-disclosure of HIV sero-status to sexual partners in Maputo, Mozambique

The HIV prevalence in Maputo city is 16.2%. There is a lack of data describing associated factors with disclosure or non-disclosure of HIV-positive sero-status to sexual partners. This analysis describes associated factors of non-disclosure of HIV sero-status to sexual partners among people living with HIV (PLHIV) participating in a serostatus disclosure support program at three health facilities in Maputo, Mozambique. We used a cross-sectional design of PLHIV aged over 18 years. Datas were collected between December 2019 and September 2020. Univariate and multivariable logistic regression models were used to evaluate factors associated of non-disclosure of HIV sero-status. A total of 377 patients were enrolled in the HIV sero-status disclosure Program. Of these, nearly two-thirds (61.5%) were women, 52.9% had completed secondary school, 47.7% were 25–34 years old, 50.9% had informal employment with low income, and 73.2% were married. Univariate logistic regression model showed greater odds of non-disclosure among patients who had an employment contract with a maximum wage (Crude Odds Ratio [cOR] 2.02, 95% confidence interval [CI] 1.15–3.55, p = 0.015); were single (cOR 3.85, 95% CI 2.22–6.69, p < 0.001); were living with parents (cOR 2.30, 95% CI 1.07–4.93, p = 0.033); received financial support for their monthly household expenses from parents or a close relative (cOR 7.15, 95% CI 2.19–23.36, p = 0.001); or brought a parent/close relative and/or a friend as a confidant during HIV care(cOR 3.17, 95% CI 1.74–5.76, p < 0.001; and cOR 5.97, 95% CI 1.57–22.66, p = 0.009, respectively). Multivariable logistic regression model showed: from parents/close relative and from partner (Adjusted Odds Ratio [aOR] 8.19, 95% CI 1.44–46.46, p = 0.018; and aOR 4.34, 95% CI 1.05–17.17, p = 0.043), respectively); in those who brought a parent/close relative and/or a friend as a confidant during HIV care (aOR 8.86, 95% CI 2.16–36.31, p = 0.002; and 195 aOR 21.68, 95% CI 3.02–155.87, p = 0.002, respectively). Non-disclosure of serostatus is a critical issue for HIV care and treatment programs, given that non-disclosure of HIV serostatus increases risk of HIV transmission. Understanding the factors associated with non-disclosure is crucial for designing strategies to address these factors and end the HIV epidemic by 2030. Our findings suggest that HIV serostatus disclosure programs might target the sociodemographic factors strongly associated with non-disclosure.

Association between non-injection drug use and hepatitis C infection among HIV-negative men who have sex with men

BackgroundPrior research predominantly examined the association between HIV-positive men who have sex with men (MSM) or those using injection drugs and hepatitis C virus (HCV) infection. However, limited attention has been given to understanding the association among HIV-negative MSM who do not inject drugs. This gap leaves apportion of the population unexamined, potentially overlooking important factor that may contribute to the transmission and prevalence of HCV. This study aims to investigate the relationship between non-injection drug use and HCV infection in this population.MethodsIn this cross-sectional study, we analyzed data on 118 MSM who reported use of non-injection drugs. The participants were recruited from two inner-city communities in Houston, TX, between 2004 and 2007 and were negative for both HIV and hepatitis B virus infection. Latent class analysis (LCA) was used to identify drug use latent classes. Multinomial logistic regression analysis was used to evaluate the association between drug use latent class and HCV infection.ResultsFour distinct latent classes of drug use were identified: class 1, persons ≥ 42 years of age who used only crack cocaine; class 2, persons approximately 42 years of age who used > 2 drugs; class 3, persons < 42 years of age who used > 5 drugs; and class 4, persons ≥ 42 years of age who used > 6 drugs. Class 4 was significantly associated with HCV infection. The odds of HCV infection in members of class 4 was 17 times higher than in class 2 members (adjusted odds ratio [aOR] = 16.9, 95% confidence interval [CI]: 1.4–205.4) and almost 22 times higher than in class 3 members (aOR = 21.8, 95% CI: 1.5–322.8).ConclusionsAmong MSM with non-injection drug use, the subgroup of individuals who were ≥ 42 years of age and used multiple drugs (including heroin, speedball, methamphetamine, crack cocaine, and marijuana) had a high probability of HCV infection. Public health and education programs, as well as drug treatment and rehabilitation programs, should be developed for this high-risk subgroup of individuals to prevent HCV acquisition and transmission.

Multifunctional gallium doped bioactive glasses: a targeted delivery for antineoplastic agents and tissue repair against osteosarcoma

Osteosarcoma (OS) is the mostly commonly occurring primary bone cancer. Despite comprehensive treatment programs including neoadjuvant chemotherapy and tumour resection, survival rates have not improved significantly since the 1970s. Survival rates are dramatically reduced for patients who suffer a local recurrence. Furthermore, primary bone cancer patients are at increased risk of bone fractures. Consequently, there is an urgent need for alternative treatment options. In this paper we report the development of novel gallium doped bioactive glass that selectively kill bone cancer cells whilst simultaneously stimulating new bone growth. Here we show, using a combination of 3-(4.5-dimethylthiazol-2-yl)-2.5-diphenyltetrazolium bromide, LIVE/DEAD assays and image analysis, that bioactive glasses containing gallium oxide are highly toxic and reduce both the proliferation and migration of bone cancer cells (Saos-2) in a dose dependant manner. Glasses containing 5 mol% gallium oxide reduced the viability of OS cells by 99% without being cytotoxic to the non-cancerous normal human osteoblasts (NHOst) control cells. Furthermore, Fourier transform infrared and energy-dispersive x-ray spectroscopy results confirmed the formation of an amorphous calcium phosphate/hydroxyapatite like layer on the surface of the bioactive glass particulates, after 7 d incubating in simulated body fluid, indicating the early stages of bone formation. These materials show significant potential for use in bone cancer applications as part of a multimodal treatment.

Alternative reinforcers enhance the effects of opioid antagonists, but not agonists, on oxycodone choice self-administration in nonhuman primates.

Clinical reports suggest that the most effective strategies for managing opioid use disorder comprise a comprehensive treatment program of both pharmacological and non-pharmacological approaches. However, the conditions under which these combinations are most effective are not well characterized. This study examined whether the presence of an alternative reinforcer could alter the efficacy of FDA-approved opioid antagonist or agonist medications, as well as the non-opioid flumazenil, in decreasing oxycodone choice self-administration in nonhuman primates. Adult squirrel monkeys (n=7; 4 females) responded under concurrent second-order FR3(FR5:S);TO45s schedules of reinforcement for intravenous oxycodone (0.1mg/kg) or saline on one lever and 30% sweetened condensed milk or water on the other. Doses of naltrexone (0.00032-1.0mg/kg), nalbuphine (0.32-10mg/kg), buprenorphine (0.0032-0.032mg/kg), methadone (0.32-1.0mg/kg), or flumazenil (1-3.2mg/kg) were administered intramuscularly prior to oxycodone self-administration sessions that occurred with either milk or water as the alternative. Naltrexone, a m-opioid receptor antagonist, was >30-fold more potent when milk was available compared to water and abolished oxycodone intake (injections/session) while concomitantly increasing milk deliveries at the highest dose tested. Pretreatment with the low efficacy m-agonist nalbuphine was most effective in the presence of milk compared to water, decreasing oxycodone preference to <50% of control values. The higher efficacy m-agonists, methadone and buprenorphine, and the benzodiazepine antagonist flumazenil, did not appreciably alter the reinforcing potency of oxycodone under either condition. These results suggest that antagonist medications used in combination with alternative reinforcers may be an effective strategy to curtail opioid abuse-related behaviors. Significance Statement Clinical treatment programs for opioid use disorder utilize a combination of pharmacological and non-pharmacological approaches. However, the conditions under which these combinations are most effective have not been fully characterized. This study examined whether the effectiveness of m-opioid medications to decrease oxycodone self-administration is altered in the presence of an alternative reinforcer. The results suggest that alternative reinforcers enhance the effects of antagonist or low efficacy partial agonists suggesting they may be a more effective strategy to curtail opioid use.

Strategies to Avoid Physical Restraint in the Summer Treatment Program

ABSTRACT As our Summer Treatment Program (STP) grew, the rates of timeouts involving physical restraint increased. These increases necessitated significant restructuring of our approach to screening/intake, crisis response and intervention, reinforcement, staff training, and program group and leadership structure. We describe the evolution of these approaches since 2015, when the STP was first offered, through present day (2023). During STP, timeouts were documented when they occured. These data were entered for each year and analyzed. Additionally, disruptive behavior, anxiety and depression symptoms, and impairment rating scales gathered as part of the eligibility screening process were examined across years. We present data showing the decrease in physical management (restraint) during timeout associated with these changes in the STP. Since these changes were implemented, we have had zero incidents of timeout with physical management over the past 3 years. We also show that these strategies did not just eliminate the most severe children. We believe clinical decision-making for eligibility using our screening criteria and other modifications were associated with the decrease in need for physical restraint and provide guidance for future use by other Summer Treatment Programs.

Eating concerns in youth with functional abdominal pain disorders.

Adolescents with functional abdominal pain (FAP) often experience pain and other gastrointestinal symptoms in the context of eating, which may place them at risk for eating disorders. This study compared disordered eating and its sequalae in adolescents with FAP to those with chronic headache. Participants in this retrospective chart review study were 270 adolescents and young adults (mean age 15.9; standard deviation [SD] = 1.63; 60% female) attending an intensive, interdisciplinary pain treatment program (IIPT), including 135 youth with FAP and an age- and gender-matched control group with a primary pain diagnosis of chronic headache. Information was extracted related to eating- and weight-related symptoms. Independent t-tests and χ2 analyses found that compared with adolescents with chronic headache, patients with FAP showed significantly more eating pathology as reflected by scores on the Eating Attitudes Test-26 (EAT-26) (p < 0.001), endorsement of pain-related restrictive eating (p < 0.01), eating disorder history (p < 0.001), and avoidant restrictive food intake disorder (ARFID) diagnoses (p < 0.001). Compared to those with chronic headache, significantly more patients with FAP had lost 10 pounds or more (p < 0.01) and a higher proportion were underweight (p < 0.001). Among all participants, a history of exclusion diets used to manage symptoms significantly increased the risk for ARFID (p < 0.001). The results of this study highlight the increased risk of eating-related concerns among youth with FAP, as well as the judicious use of exclusion diets to manage symptoms in these patients.

Correlates of fentanyl preference among people who use drugs in Rhode Island

BackgroundFentanyl is increasingly pervasive in the unregulated drug supply and is a driver of drug overdose deaths in the United States. The aims of this study were to characterize and identify correlates of fentanyl preference among people who use drugs (PWUD) in Rhode Island (RI).MethodsUsing bivariate analysis, we examined associations between fentanyl preference and sociodemographic and psychosocial characteristics at baseline among participants enrolled in the RI Prescription Drug and Illicit Drug Study from August 2020-February 2023. Fentanyl preference was operationalized based on responses to a five-point Likert scale: “I prefer using fentanyl or drugs that have fentanyl in them.” Participants who responded that they “strongly disagree,” “disagree,” or were “neutral” with respect to this statement were classified as not preferring fentanyl, whereas participants who responded that they “agree” or “strongly agree” were classified as preferring fentanyl.ResultsAmong 506 PWUD eligible for inclusion in this analysis, 15% expressed a preference for fentanyl or drugs containing fentanyl as their drug of choice. In bivariate analyses, preference for fentanyl was positively associated with younger age, white race, lifetime history of overdose, history of injection drug use, past month enrollment in a substance use treatment program, past month treatment with medications for opioid use disorder, and preferences for heroin and crystal methamphetamine (all p < 0.05). Descriptive data yielded further insight into reasons for fentanyl preference, the predominant having to do with perceived effects of the drug and desire to avoid withdrawal symptoms.ConclusionsOnly a relatively small subset of study participants preferred drugs containing fentanyl. Given the increased prevalence of fentanyl contamination across substances within the unregulated drug market, the result for PWUD is increasingly less agency with respect to choice of drug; for example, people may be forced to use fentanyl due to restricted supply and the need to mitigate withdrawal symptoms, or may be using fentanyl without intending to do so. Novel and more effective interventions for PWUD, including increased access to age-appropriate harm reduction programs such as fentanyl test strips and overdose prevention centers, are needed to mitigate fentanyl-related harms.

Diversion or death? The moral framework shaping bifurcated punishments for drug offences in Indonesia

Background As the UN urges states to move from harsh punishments for drug offences towards treatment programmes, Indonesia has adopted a bifurcated penal policy. Most of those convicted are sentenced to imprisonment or death, but some ‘minor’ offenders are diverted to drug treatment centres. We explore the moralities that shape drug policy, justice professionals’ interpretation and application of laws and policies, and judgements about who is deserving of diversion. Methods We draw on experiences and perceptions of 136 Indonesian criminal justice professionals, through in-depth qualitative interviewing and focus groups, to reveal the moral landscapes shaping policy and practice. Results Justice narratives blur penal concerns with moral judgments about drug offending, with normative responses shaping punishments in law and practice. While there is some compassion for ‘minor’ drug offenders, driving rationales for diversion, drug traffickers are regarded as morally deserving of prison and capital punishment, with traditionalist perceptions of harm amplified by a purgative rationale. Conclusion This article highlights the analytical potential of moralities such as ‘compassion’ and ‘traditionalism’ in criminal justice research and policy in Southeast Asia. Understanding the formation and navigation of these normative values may assist in challenging harsh penal policy in Indonesia and the wider region.

Prognosis evaluation and efficacy analysis of different treatment options for patients with visceral pleural invasion in stage IIA–IIB lung cancer

ObjectiveControversy surrounds the treatment of visceral pleural invasion in lung cancer, and no studies have compared the efficacy of its four main treatment options (i.e., surgery, chemotherapy, targeted therapy, and immunotherapy). This study aims to compare and analyze surgery, chemotherapy, targeted therapy, and immunotherapy outcomes and explore the optimal treatment of visceral pleural invasion in lung cancer.MethodsWe searched electronic databases (i.e., Pubmed, Embase, Cochrane Library, CNKI, and Chinese Biomedical Literature Database Search) for relevant studies of treatment options for patients with visceral pleural invasion in stage IIA–IIB lung cancer. Searches times were limited to studies published between January 1, 2000 and February 20, 2021. Meta analysis was performed using RevMan 5.3 software We also downloaded original RNA transcription data about lung cancer invasion in the GEO and TCGA tumor databases, and used R 4.0.3 software to perform differential expression and co-expression gene network analyses.ResultsWe included a total of 25 high-quality (i.e., Jadad score 4–7) studies. Meta-analysis found that surgical treatment was associated with a 3-year survival rate OR = 3.80 (95% CI 3.53, 4.09; P < 0.0001), 5-year survival rate OR = 4.10 (95% CI 3.72, 4.53; P < 0.0001), and median survival time OR = 2.71 (95% CI 2.53, 2.89; P < 0.0001). Chemotherapy was associated with a 3-year survival rate OR = 2.08 (95% CI 1.93, 2.25; P < 0.0001), 5-year survival rate OR = 1.68 (95% CI 1.49, 1.89; P < 0.0001), and median survival time OR = 1.84 (95% CI 1.66, 2.04; P < 0.0001). Targeted therapy was associated with a 3-year survival rate OR = 2.91 (95% CI 2.65, 3.19; P < 0.0001), 5-year survival rate OR = 1.83 (95% CI 1.39, 2.33; P < 0.0001), and median survival time OR = 1.76 (95% CI 1.59, 1.94; P < 0.0001). Finally, immunotherapy was associated with a 3-year survival rate OR = 1.89 (95% CI 1.73, 2.07; P < 0.0001), 5-year survival rate OR = 1.66 (95% CI 1.46, 1.88; P < 0.0001), and median survival time OR = 2.53 (95% CI 2.27, 2.82; P < 0.0001). After screening differential genes and co-expressed genes in tumor gene databases, we found that AC245595.1, ITGB1-DT and AL606489.1 may be involved in the process of lung cancer invasion, and macrophages M1 and M2, CD4+-Th1, CD8+-Th1 may participate in immune infiltration.ConclusionsIn patients with visceral pleural invasion of stage IIA-IIB lung cancer, chemotherapy has shown a significant effect on improving prognosis and enhancing efficacy. However, surgical treatment did not significantly improve the overall prognosis. Therefore, the individual situation of the patient and the comprehensive benefits of the treatment program should be fully considered when developing the treatment program.