Treatment Program Research Articles

Using the IFASIS (Inventory of Factors Affecting Successful Implementation and Sustainment) to Advance Context-Specific and Generalizable Knowledge of Implementation Determinants: Case Study of a Digital Contingency Management Platform.

Background Contingency management (CM) is the most effective treatment for stimulant use disorder but is underutilized by opioid treatment programs (OTPs), despite the high prevalence of stimulant use in this setting. As part of a state-wide initiative, we piloted a novel assessment, the Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS), to examine determinants of implementation of a digital CM platform across a set of OTPs. We describe how the IFASIS was used to elucidate both generalizable and context-specific implementation determinants, and to guide the provision of implementation facilitation. Methods Six OTPs received a multi-level implementation strategy (including facilitation) to promote programmatic uptake of a digital CM platform. Pre-implementation, OTPs completed the IFASIS, a 27-item questionnaire that assesses both the valence (positive/negative) and importance of determinants across 4 domains: outside the organization, within the organization, about the intervention, and about intervention recipients. OTP staff completed the IFASIS as a team, identifying consensus ratings during recorded discussions. Transcripts of IFASIS recordings were analyzed using rapid qualitative analysis. Quantitative IFASIS results were aggregated into medians and ranges within and across organizations. Implementation facilitation meeting notes were analyzed to examine how the IFASIS was used to guide facilitation. Results Quantitative ratings and qualitative feedback revealed common barriers to implementation of the digital CM platform, including a lack of sustainable funding sources, absence of external and organizational policies, insufficient higher-level leadership support, and mixed attitudes among staff members toward CM. Common implementation facilitators included enthusiasm and commitment among organization leadership and the perception that the digital CM platform would reduce the workload and burden on OTP counselors. The IFASIS was used to guide facilitation in several ways, including stimulating discussion about barriers and facilitators, brainstorming strategies to address barriers rated as "very important", and identifying facilitators that could be harnessed as part of implementation efforts. Conclusions The IFASIS identified important determinants of CM implementation in OTPs and was instrumental in shaping facilitation. The IFASIS may be a valuable assessment for the implementation science community to identify and address generalizable and context-specific implementation determinants.

High-intensity pulse magnetic therapy and drinking mineral water in rehabilitation treatment of patients with chronic pancreatitis at inpatient stage

BACKGROUND: Sanogenetic effects of physical factors, providing restoration of disturbed functions of the organism, are the basis for their inclusion in the standardised programme of restorative treatment of patients with chronic pancreatitis. AIM: To study the effectiveness of high-intensity pulse magnetic therapy and low-mineralized drinking mineral waters in the restorative treatment of patients with chronic pancreatitis at the inpatient stage. MATERIALS AND METHODS: There has been carried out an open-label, randomized, controlled, prospective study of 125 patients with chronic pancreatitis. The patients were divided into 3 groups using the simple randomization method. In the control group (n=40) the patients underwent restorative treatment in accordance with federal clinical guidelines; in the group of comparison (n=42) he patients were additionally prescribed low-mineralized drinking mineral water; in the main group (n=43) the patients had high-intensity pulse magnetic therapy in addition to the treatment of the group of comparison. The effectiveness of rehabilitation measures was monitored using a visual analogue scale, a carbolene test, a hospital scale of anxiety and depression. RESULTS: The statistical analysis showed that the inclusion of drinking mineral water and high-intensity pulse magnetic therapy contributed to a significant reduction of pain (p 0.01) and dyspeptic syndromes (p 0.01), an improvement in motor evacuation function of intestine (p 0.01), a decrease in enzymatic activity and the severity of anxiety-depressive manifestations (p 0.01). The effectiveness of the developed programmes of restorative treatment of the patients suffering from chronic pancreatitis was 87.8–92.5%, the standardized programme ― 78.5%. CONCLUSION: The inclusion of drinking mineral waters and high-intensity pulse magnetic therapy in the standardized program of restorative treatment of the patients suffering from chronic pancreatitis at the inpatient stage provides a significant restoration of pancreatic external secretory function.

Payment and billing strategies to support methadone take-home medication: Perspectives of financial leaders of opioid treatment program organizations in New York State

IntroductionRecent federal regulatory changes governing the delivery of methadone treatment for opioid use disorder at Opioid Treatment Programs (OTPs) support continued practice changes towards greater and flexible methadone take-home medication. Existing payment models for OTPs were closely tied with onsite medication administration and thus misaligned with the need to conduct more and flexible take-homes. This study aims to understand OTP organizations' experience with the newly created OTP bundled payment model in New York State as an alternative to the pre-existing per-service payment model during 2020–2023 to inform financing strategies to support and sustain practice changes. MethodsThe study conducted semi-structured interviews with financial leaders and staff from OTP organizations in New York State. Snowball sampling supplemented purposeful sampling of OTP organizations based on their billing practices by. Qualitative data from 12 interviews (with 11 OTP organizations and 1 trade organization) were analyzed with an integrated (inductive and deductive) approach to derive themes. ResultsStudy informants recognized that the bundled payment model served to protect revenue in a time when OTPs had to pivot quickly to increase take-home medication to patients. Informants described a wide spectrum of practices to operationalize billing in the alternative payment systems, revealing confusion with the billing rules and significant logistical and technical challenges. Informants expressed concerns regarding the substantial difference between the full bundled rate, paid in weeks with one or more qualifying services, and the medication-only rate, reporting that extended (2 weeks or more) take-homes might not be sustainable under the two-tiered model with the low medication-only rate and advocating for a single bundled rate. Informants believed that increased take-home medication and federal regulatory changes had profound implications for the delivery of counseling services, the counselor workforce, and financial viability for OTPs. ConclusionsOur study of OTP organization experience in New York State provided data on OTP organization perspectives regarding the potential revenue-protecting effects of bundled payments and generated insights to inform future research and policy experimentation to support flexible take-home medication. Future implementation studies are needed to better understand the roles of financing strategies at large in supporting clinical practice changes in substance use disorder treatment.

Patterns of HIV-1 Drug Resistance Observed Through Geospatial Analysis of Routine Diagnostic Testing in KwaZulu-Natal, South Africa.

HIV-1 drug resistance (HIVDR) impedes treatment and control of HIV-1, especially in high-prevalence settings such as KwaZulu-Natal (KZN) province, South Africa. This study merged routine HIV-1 genotypic resistance test (GRT) data with Geographic Information Systems coordinates to assess patterns and geographic distribution of HIVDR in KZN, among ART-experienced adults with virological failure. We curated 3133 GRT records generated between 1 January 2018 and 30 June 2022, which includes the early phase of dolutegravir (DTG) rollout, of which 2735 (87.30%) had HIVDR. Of the 2735, major protease, nucleoside, and non-nucleoside reverse transcriptase inhibitor mutations were detected in 41.24%, 84.97% and 88.08% of GRTs, respectively. Additional genotyping of HIV-1 integrase for 41/3133 (1.31%) GRTs showed that 17/41 (41.46%) had integrase strand transfer inhibitor resistance. Notably, of 26 patients on DTG with integrase genotyping, 9 (34.62%) had DTG-associated resistance mutations. Dual- or triple-class resistance was observed in four of every five GRTs. The odds of HIVDR increased significantly with age, with ≥60 years having 5 times higher odds of HIVDR compared to 18-29 years (p = 0.001). We identified geospatial differences in the burden of HIVDR, providing proof of concept that this could be used for data-driven public health decision making. Ongoing real-time HIVDR surveillance is essential for evaluating the outcomes of the updated South African HIV treatment programme.

Changes are good for OTPs and patients

Not for the first time, the changes opioid treatment programs (OTPs) must make to comply with new regulations have been praised by OTPs themselves. Mark Parrino, president of the American Association for the Treatment of Opioid Dependence told ADAW last week that most of the states' OTPs are already in compliance. Patti Juliana, Ph.D., who heads the federal Division of Pharmacologic Therapies at the Substance Abuse and Mental Health Services Administration, told him that 44 states are in alignment and compliance with the new rules. She meets with the State Opioid Treatment Authorities regularly. We caught up with Parrino at the COMPA Symposium in Schenectady, New York this month.

COMPA Symposium brings together New York OTPs to focus on new rules

The finalized rules for opioid treatment programs (OTPs) issued in February were required as of this month. The COMPA Symposium was the perfect time for OTPs to gather to answer the question, at least in New York, about how to decide what the take‐home dose should be when there are no longer the 8‐point criteria (see ADAW https://onlinelibrary.wiley.com/doi/10.1002/adaw.20209). Patients must no longer be stable to get 28 days of take‐homes, but it's up to the OTP to decide how many doses a patient can get.

New York limits administrative discharge from OTPs

No longer can opioid treatment programs (OTPs) summarily discharge patients for non‐payment, use of drugs or other reasons having to do with anything other than safety, at least not in New York. Most OTPs never did this, especially in New York, but the publication last month of new guidance from the state's Office of Addiction Services and Supports (OASAS) clearly delineates the circumstances under which a patient can be discharged against their will.

Quality of Life of Breast Cancer Women under Treatment at a Tertiary Care Center of Western Maharashtra

Background: ‘Breast cancer’ the most common cancer amongst females in India. Having good Quality of life (QoL) among the patients undergoing treatment is one of the vital and significant factors for ensuring holistic approach to treatment and well-being of cancer patients. The present study was conducted to assess the QoL and its determinants among breast cancer patients undergoing treatment at a tertiary care institute in western Maharashtra. Material and Methodology: 300 histopathologically confirmed breast cancer patients undergoing treatment at a tertiary care centre were divided into three groups to include 100 patients in each group. Group 1 (patients with duration of treatment 1 to 2 years) Group 2 (patients with duration of treatment 2 to 5 years) and Group 3 (more than 5 years). Validated tool Function Assessment of Cancer Therapy Breast specific (FACT-B) questionnaire was used to collect information on QoL and analysed using appropriate statistical tests. Results: Mean age of patients was 53.2 + 10.08 years, 136 (45.33%) were from age group 51 to 65 years. Majority of the patients 106 (35.33%) were educated till secondary schooling and 172 (57.33 %) were belonging to the middle-upper class. Lump in breast was most common presenting symptom in 235 (78.33%) cases followed by nipple retraction. 275 (91.67 %) cases had infiltrating ductal Carcinoma and 144 (48%) patents were in Stage II cancer. Over all mean FACT-B score for QoL was 104.02 + 18.65 out of 141. Mean FACT-B score for Group 1, Group 2 and Group 3 was 88.18 +17.20, 105.89 + 11.78 and 118.28 + 12.45 respectively with (p< 0.05), suggests significant improvement in QoL with increase in time elapsed since treatment. Conclusion: Socio-demographic factors, type of surgery and duration of treatment had significant effect on QoL among breast cancer patients. Apropos physicians, paramedic staff and domestic care givers need to be sensitised on importance of QoL for collective and deliberate efforts to achieve holistic care. QoL can be made integral part of breast cancer treatment and management policy or programme.

Yoga, Physical Therapy and Home Exercise Effects on Chronic Low Back Pain: Pain Perception, Function, Stress, and Quality of Life in a Randomized Trial.

Low back pain is a common health problem. In this study, we investigated the effects of yoga, physical therapy (PT), and home exercise (HE) on pain perception, function, stress, and quality of life in chronic low back pain (cLBP). We randomly assigned 54 participants to three distinct treatment groups: (a) a physical therapy group (PT) who received spinal stabilization exercises (SSE) combined with local heat and transcutaneous electrical stimulation; (b) a home exercise group (HE) who received SSE as part of the home program; and (c) a yoga group who received yoga exercises. The primary outcome measures were a Visual Analog Scale (VAS) for measuring pain, and the Oswestry Disability Index (ODI) to measure function. Secondary outcome measures were the Tampa Kinesiophobia Scale (TKS), Central Sensitization Inventory (CSI), pain sensitivity (L3 and deltoid R/L PPTs), Spielberger State-Trait Anxiety Inventory (STAI), plasma cortisol and DHEA-S levels, Transversus Abdominis (TrA) muscle activation, and the Nottingham Health Profile (NHP). Assessments were conducted before and after a six-week intervention period. All three groups demonstrated improvements in pain on the VAS, function on the ODI, pain sensitivity on the L3 and deltoid R/L PPTs, CSI, anxiety on the STAI, TrA muscle activation, and quality of life on the NHP (p < .05). The PT group exhibited a more pronounced improvement on the ODI score (p < .05) than the other groups. Cortisol levels only decreased in the PT group (p < .05). The exercises did not impact DHEA-S and NHP-S parameters. Thus, all interventions resulted in decreased stress, pain intensity, pain sensitivity, central sensitization, and improved function and quality of life; there was no singularly superior approach between interventions. These findings will aid in tailoring treatment programs for managing cLBP according to individual needs.

"The efficiency of treatment practices in adolescents diagnosed with substance use disorder".

Substance abuse has been an increasingly common entity among youth, that has turned into one of the major concerns for almost all countries in the world. This study aimed to evaluate the efficiency of inpatient and outpatient treatment practises for adolescent diagnosed with susbtance use disorder (SUD). Participants included 30 adolescents with SUD in the outpatient unit, 30 in the inpatient unit, and a control group of 30 adolescents without psychiatric diagnoses. Measurements were taken at the beginning and end of an 8-week treatment program using CGAS and HoNOSCA scales. The 8-week treatment program significantly improved overall functioning and reduced psychiatric symptoms, with greater improvements observed in the inpatient group. Inpatient treatment resulted in better overall functioning and symptom improvement in adolescents with SUD. Long-term follow-up studies are needed.

Services for perinatal patients with opioid use disorder: a comprehensive Baltimore City-wide 2023 assessment

BackgroundOverdose is a leading cause of maternal mortality; in response, maternal mortality review committees have recommended expanding substance use disorder (SUD) screening, improving collaboration between obstetric and SUD treatment providers, and reducing fragmentation in systems of care. We undertook an analysis of the perinatal SUD treatment landscape in Baltimore, Maryland in order to identify barriers to treatment engagement during pregnancy and the postpartum period and guide system improvement efforts.MethodsWe conducted a survey of seven birthing hospitals, 31 prenatal care practices, and 108 SUD treatment providers in Baltimore from April-June 2023. Organizations were asked to quantify care for perinatal patients with opioid use disorder (OUD) as well as about screening, service availability, referral practices, and support needed to improve care.Results61% of the 145 contacted organizations responded. Birthing hospitals reported caring for pregnant persons with OUD with greater frequency than prenatal care practices or SUD treatment programs. Most birthing hospitals and prenatal care practices reported screening for OUD at intake, but the minority reported using validated tools. Service availability varied by type of organization and type of service. In general, prenatal care practices offered the fewest number of SUD-related services. Most SUD treatment programs that offered buprenorphine or methadone to the general population also offered these medications to pregnant patients. Withdrawal management for comorbid alcohol/benzodiazepine use disorders during pregnancy was more limited. The majority of birthing hospitals and prenatal care practices reported offering neither direct naloxone distribution nor prescriptions. Few SUD treatment programs offered tailored services for perinatal patients or for parents of young children, and many programs do not permit children onsite. Respondents reported high levels of interest in education and consultative support on SUD treatment in pregnancy within obstetric settings and on pregnancy-related medical concerns within SUD programs.ConclusionsThis project provides a comprehensive picture of services available for treatment of perinatal OUD in a major US city. Results have served as a guide for ongoing citywide system improvement efforts by our project team and offer a model for other jurisdictions hoping to strengthen services for perinatal OUD and reduce maternal mortality.

Differential Treatment Responses of Maltreated and Neglected Children and Adolescents Following an Evidence-based Multisystemic Intervention.

Limited studies have investigated differential treatment responses to family-based treatment programs and subgroup trajectories in youth in a high-risk context. This study pioneered an examination of Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) and built on prior research that identified subgroups with different psychopathologies. Participants included 208 parent-child dyads enrolled in the MST-CAN evaluation in Switzerland. Parents reported their children's (Mage = 10.27years, SDage = 3.5, 44.2% girls, 55.8% boys, 98.6% White) emotional and behavioral problems. Longitudinal data were examined to analyze the differential changes within the pre- and post-treatment (T1 and T2) subgroups. The T1 cluster and T2 cluster were cross-tabulated to examine changes in the symptom class over time. Overall, the treatment proved to be highly beneficial. Subgroup analyses revealed that four out of the five subgroups (80%) showed positive changes in at least two outcome measures. The treatment was most successful for children with externalizing symptoms. Children with multiple symptoms also showed improvements across different symptoms. Regarding specific symptoms, children with anxious-avoidant symptoms benefited from the treatment. Additionally, the treatment was beneficial for children with normative emotions and behavior. Meanwhile, the treatment did not have any significant effects for children with internalizing symptoms. Notably, child neglect was reduced in three (60%) subgroups. The symptom class remained stable across time for children with externalizing and multiple symptoms. Ultimately, MST-CAN reduced emotional and behavioral problems and child neglect in most families. Understanding children's differential treatment responses to complex treatment programs is essential to adequately address different needs.

Substance use patterns and negative urine opioid screen among patients on methadone treatment at a referral hospital in Nairobi, Kenya

Background Substance use is a global health concern, with opioids contributing significantly to the disease burden. In Kenya, Medically Assisted Therapy (MAT) programs using methadone have been implemented to address opioid use disorder. Despite the effectiveness of methadone, the concurrent use of other substances remains a critical challenge. This study aimed to assess substance use patterns at enrolment and evaluate the prevalence of negative urine opioid screens among patients attending a MAT clinic at a tertiary hospital in Kenya. Methods This retrospective cohort study analyzed data from the medical records of 713 patients enrolled in the MAT clinic between December 2014 and February 2018. Data on sociodemographic characteristics, concurrent substance use at enrolment, and urine opioid screen results at 6, 12, 18, and 24 months were collected. Multivariate analyses were performed to identify factors associated with concurrent substance use, and the likelihood of achieving negative urine opioid screens. Results At enrolment into the MAT program, nearly all participants (712 out of 713) reported concurrent use of additional substances, with tobacco (91%) and cannabis (82.9%) being the most common. Concurrent substance use was significantly influenced by participants age, gender, education level, and route of administration of the substance. The program achieved an 81.3% retention rate at 24 months. However, the prevalence of negative urine opioid screens was lower compared to other populations, with a gradual increase from 61.3% at 6 months to 81.4% at 24 months. Notably, male patients (HR = 1.411, 95% C.I. 1.063–1.873, p = 0.01700) and those receiving higher methadone doses (HR 7.052, 95% CI 3.408–14.593, p&lt;0.0001) were more likely to achieve negative urine opioid screens. Conclusions This study reveals a high prevalence of concurrent substance use among patients enrolling in the MAT program in Kenya, which may affect their likelihood of achieving negative urine opioid screens. These findings underscore the need for methadone treatment programs to adopt comprehensive approaches that address all substance use disorders to improve treatment outcomes.

Effectiveness of Adjunctive Drug Therapy to Endoscopic Stenting in Liver Cirrhosis Complicated by Refractory Variceal Bleeding

AIM OF THE STUDY. Comparative clinical analysis of the efficacy of terlipressin and octreotide as additional drug therapy to mechanical hemostasis with nitinol stent in patients with liver cirrhosis complicated by bleeding from esophageal varices refractory to endoscopic treatment.MATERIAL AND METHODS. Thirty-one patients with liver cirrhosis complicated by esophageal variceal bleeding refractory to endoscopic treatment , in whose complex treatment program, as a first-line life­saving measure, hemostasis with a self-expanding hemostasis was performed nitinol stent were randomly assigned to two groups. In group A, 20 patients were treated with terlipressin as an adjuvant to mechanical hemostasis, and in group B, 11 patients were treated with octreotide. Unpaired Student’s t-test was used for statistical analysis of the results. Graphs for assessing the survival function of patients for 8 weeks after the end of treatment were constructed using the Kaplan-Meier method.RESULTS. In the acute observation period terlipressin and octreotide were equally effective in treating refractory variceal bleeding. In the subacute observation period, the administration of octreotide was generally accompanied by a greater number of side effects (54.5%) than terlipressin (30.0%) (p=0.453). In the remote observation period, 8-week survival in the group of patients receiving terlipressin was higher than in the group of patients receiving octreotide.CONCLUSION. Terlipressin is as effective as octreotide as an adjunct to endoscopic stenting in drug therapy for liver cirrhosis complicated by esophageal variceal bleeding refractory to endoscopic treatment. At the same time, terlipressin has a greater effect than octreotide on reducing 8-week mortality, which approaches statistical significance. In this regard, terlipressin may be the vasoactive drug of choice in acute refractory variceal bleeding.

Routine outcome monitoring and feedback in alcohol and other drug treatment: A qualitative study of client perspectives on implementation.

Routine outcome monitoring (ROM) and feedback is an evidence-supported strategy for evaluating alcohol and other drug (AOD) treatment outcomes. However, the implementation of ROM and feedback into AOD services remains a significant challenge. Research aimed at understanding client perspectives on ROM and feedback is needed to facilitate successful implementation. This study examined experiences with and perceptions of ROM and feedback in a sample of clients receiving AOD treatment. Interviews and online surveys were conducted with N = 26 people (13 male; Mage = 36.12 years, SD = 10.29) enrolled in an AOD treatment program in Australia. Data analysis of the transcripts was guided by thematic analysis, while descriptive statistics were used to analyse quantitative survey data. Four major themes were identified in the qualitative data: (i) ROM and feedback is valuable to AOD treatment; (ii) clear and concise outcome measures with an integrated feedback loop are vital to reliable ROM; (iii) desire for visual and verbal feedback that highlights progress; and (iv) ROM and feedback can be emotionally challenging. Participants valued ROM when it was clearly integrated within AOD treatment and they received feedback on their responses. Potential facilitators to implementing and improving the provision of ROM and feedback in AOD treatment include: (i) a clear, treatment-based rationale to foster client buy-in for ROM and maximise AOD treatment benefit; (ii) brief outcome measure surveys; and (iii) graphical visualisations of ROM feedback.

"I feel so small and big at the same time"-exploring body experience and binge eating disorder following inpatient treatment: a qualitative study.

Limited research into binge eating disorder (BED), a low treatment rate, and a lack of treatment rights, reflects a marginalized disorder in society and a treatment context. The aim of this study was to gain a deeper understanding of the psychopathology of BED, by exploring the patients' meanings related to the disorder and the role of the body in the treatment of BED. Qualitative methodology using a reflexive thematic analysis. The data material is based on semi-structured in-depth interviews with six cis-gendered women who had previously completed an inpatient treatment program for BED at a department for EDs and met the criteria for 307.51 Binge Eating Disorder in DSM-5. The qualitative analysis rendered two meta-themes comprising six themes and 12 subthemes. The initial meta-theme was "Relational challenges and feelings could not be talked about at home." The secondary meta-theme was "Body contempt disturbs the experience of self and others" and the third was "Their body has not been a theme in previous treatment." This categorization depicts a narrative of the disorder in terms of development, current condition, and experiences with prior treatment. The findings indicate that shame and disgust are central to playing pivotal roles in the embodiment of BED, highlighting the significance of addressing one's relationship with their body for achieving recovery and preventing an experienced repetition of the perceived rejection as a child.

The Effect of 6 weeks Physical Activity on Cognitive Control and Trait Impulsivity in Multi-problem Young Adults: First Findings of an RCT-study.

This study aimed to report the effect of a 6-week light-active versus moderate-active physical activity intervention embedded in a multimodal day treatment program on selected measures of cognitive control (i.e., response inhibition, error processing, and cognitive interference) and trait impulsivity. A randomized controlled design was implemented, including male multi-problem young adults (aged 18-27) assigned to either light-active (N = 12) or moderate-active physical activity lessons (N = 11). A repeated measures design was used to examine treatment effects between the two groups over time on response inhibition, error processing, and cognitive interference (measured respectively with a Go/NoGo task, a Flanker task, and the Stroop) and trait impulsivity (measured with the Dutch Baratt Impulsiveness Scale). Cognitive control, but not trait impulsivity, improved over time. Specifically, enhancements in inhibition and reduced cognitive interference were observed after 6 weeks. Error processing did not improve, but we did observe improved performance on an error-processing task. No interaction with physical activity intensity was found, suggesting similar treatment effects regardless of intensity. Results should be interpreted with caution due to several limitations, including the small sample size. Overall, due to current limitations (i.e., physical activity embedded in a larger treatment program, small sample size at follow-up, and low intervention adherence), it is not possible to draw any definite conclusions. However, the current findings contribute to a growing body of evidence suggesting potential benefits of physical activity (embedded in a multi-modal day treatment program) in the enhancement of cognitive control deficits in at-risk populations, independent of exercise intensity.

Comprehensive Tuberculosis Screening and Treatment at a Prison in Central Papua Province, Indonesia.

Incarcerated people have been reported to have higher rates of tuberculosis (TB) than the general population. However, TB is rarely reported among incarcerated people in correctional facilities in Mimika District, in Central Papua Province of Indonesia. This study aims to describe the outcomes of comprehensive screening and treatment of TB disease and latent TB infection (LTBI) within a prison in Mimika. In response to a newly reported case of TB within a prison, a facility-wide comprehensive screening and treatment program was carried out for both TB disease and LTBI between September 2021 and June 2022. We evaluated the outcomes of the screening intervention, including the number of people found to have TB and LTBI and the number and proportion of people who started and completed TB-preventive treatment at the facility. A total of 403 incarcerated people and facility staff participated in the comprehensive screening program. Ten participants were found to have TB disease, all of whom commenced treatment. LTBI was detected in 256 (64%) participants, 251 (98%) of whom completed TB-preventive treatment. Comprehensive screening revealed a high prevalence of TB disease and LTBI in this prison. Completion of treatment for TB disease and latent TB infection was high. These outcomes suggest a role for routine search-treat-prevent strategies for TB in this setting.

"He Just Wants Someone to Hear Him and Listen to Him": Barriers and Facilitators to Autistic Youth with Anxiety Receiving Quality Mental Healthcare.

About half of autistic youth present with clinically interfering anxiety. Psychotherapies with exposure-focused elements are effective in academic clinical settings and controlled trials. However, there is relatively less research examining the implementation of modified interventions for autistic youth with anxiety in community mental health settings. The current study explores community members' perceptions of barriers and facilitators that impact autistic youth with anxiety's receipt of quality mental health services in their community. Semi-structured interviews were conducted with 15 autistic youth, 15 caregivers of autistic youth, 11 community mental health clinicians, and 8 community mental health clinic leaders. Interviews were analyzed thematically. Participants shared their experiences with facilitators and barriers to autistic youth with anxiety receiving quality mental healthcare. Themes that emerged include (1) characteristics of the autistic youth, (2) engagement of autistic youth and caregivers, (3) building rapport between providers, autistic youth, and caregivers, (4) access to mental health services, (5) intervention fit, and (6) provider characteristics. Based on participants' perspectives and suggestions, future directions for anxiety treatment programs tailored for autistic youth include building more time into the intervention sessions to build rapport, incorporating autistic youth's preferences into provider matches, and providing families with more psychoeducation.

Application of CRISPR/Cas9 gene-editing technology in Alzheimers disease

Alzheimer's disease (AD) is a prevalent neurodegenerative disorder. It triggers metabolic disorders within the body due to genetic mutations, thus leading to irreversible damage to one's memory and brain. The primary pathogenic features of AD are intracellular neurofibrillary tangles caused by hyperphosphorylated Tau and extracellular amyloid plaques created by the buildup of -amyloid -protein (A). However, up to now, there has been no effective treatment program for Alzheimer's disease. And after a long time of development, many gene editing technologies have been perfected and utilized in practice. Among them, CRISPR-Cas9 technology is the most efficient and practical. As a result, an increasing number of scientists have examined and debated the potential use of CRISPR-Cas9 technology in the management of Alzheimer's disease. This review addresses the use of the CRISPR/Cas9 system to treat Alzheimer's disease and presents the disease's pathophysiology, including the establishment of AD models, genetic screening for the cause of AD, and targeted therapy for AD.