Jacobs Institute of Women's Health
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Client and program-level factors associated with planned use of medications for opioid use disorder in specialty substance use treatment programs: Evidence from linked administrative data and survey data
No full textBACKGROUND: Most patients in specialty drug treatment programs that are not federally licensed Opioid Treatment Programs (OTPs) programs do not receive medications for opioid use disorder (MOUD). METHODS: We linked results from a survey of non-OTP treatment program directors in New Jersey (n = 81) to statewide administrative records of admissions for opioid use to those programs between July 2021-June 2022. Using multi-level regression, we examined the association of three types of factors with planned MOUD use: program survey responses, client-level factors, and program-level client characteristic mix. RESULTS: Of 9583 opioid treatment admissions in non-OTP settings, 41 % included treatment plans involving MOUD. Programs where directors reported staff concerns about buprenorphine\u27s efficacy or diversion had a lower proportion of clients with planned MOUD, as did programs reporting too little physical space to prescribe. Being self-referred to treatment, unemployed and not looking for work, aged 30-49, heroin use (vs. prescription opioid use), and stimulant use in addition to opioids, were positively associated with planned MOUD; while non-Medicaid insurance, and Black and Hispanic race/ethnicity, were negatively associated with planned MOUD. Clients were more likely to have planned MOUD if their programs had a higher proportion of clients aged 30 or older, heroin as primary drug of abuse, stimulant use, and not working but actively looking for work. CONCLUSION: Findings suggest addressing program staff attitudes toward buprenorphine could help increase planned MOUD. There is also a need to improve access for clients with non-Medicaid insurance, address within-program race and ethnic disparities, and address employment-related barriers to medication
Cardiac Biomarkers Aid in Differentiation of Kawasaki Disease from Multisystem Inflammatory Syndrome in Children Associated with COVID-19
No full textKawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 show clinical overlap and both lack definitive diagnostic testing, making differentiation challenging. We sought to determine how cardiac biomarkers might differentiate KD from MIS-C. The International Kawasaki Disease Registry enrolled contemporaneous KD and MIS-C pediatric patients from 42 sites from January 2020 through June 2022. The study population included 118 KD patients who met American Heart Association KD criteria and compared them to 946 MIS-C patients who met 2020 Centers for Disease Control and Prevention case definition. All included patients had at least one measurement of amino-terminal prohormone brain natriuretic peptide (NTproBNP) or cardiac troponin I (TnI), and echocardiography. Regression analyses were used to determine associations between cardiac biomarker levels, diagnosis, and cardiac involvement. Higher NTproBNP (≥ 1500 ng/L) and TnI (≥ 20 ng/L) at presentation were associated with MIS-C versus KD with specificity of 77 and 89%, respectively. Higher biomarker levels were associated with shock and intensive care unit admission; higher NTproBNP was associated with longer hospital length of stay. Lower left ventricular ejection fraction, more pronounced for MIS-C, was also associated with higher biomarker levels. Coronary artery involvement was not associated with either biomarker. Higher NTproBNP and TnI levels are suggestive of MIS-C versus KD and may be clinically useful in their differentiation. Consideration might be given to their inclusion in the routine evaluation of both conditions
Expanding choices of antiretroviral treatment regimens for pregnant and breastfeeding persons with HIV
No full textSore throat or severe threat? The teleconsultation that uncovered neutropenic sepsis
No full textThis case report describes a telemedicine visit by a patient with fever, sore throat, and odynophagia. The patient had recently started taking propylthiouracil (PTU) for Graves disease. She was referred to the ED, where a complete blood cell count revealed agranulocytosis with a neutrophil count of 200 cells/mm3. PTU was promptly discontinued, and she received treatment with IV piperacillin-tazobactam, resulting in an improvement in her condition. With the rise of telemedicine, clinicians must prioritize thorough history-taking to detect uncommon complications of medications and to ensure patient safety
The heterogeneous association between education and the adoption of safe food handling practices in Ethiopia
No full textBACKGROUND: Foodborne disease is a great concern to low- and middle-income countries. To prevent illness and death, intervention strategies need to be implemented across the food safety system and should include promoting the adoption of safe food handling practices. The positive association between education and health has been well-established, and one possible mechanism is that education may improve health by encouraging individuals to adopt more appropriate protective practices. Decisions regarding adoption of these practices may also be influenced by the food safety risks individuals face, the trade-offs they make to maximize utility, or behavior biases which may be correlated with education. This study aims to estimate the heterogeneous association between education and the adoption of safe food handling practices among people facing different levels of food safety risk. METHODS: Models were constructed based on the Grossman health model and risk as well as behavior bias theories. Multivariate logistic regression models were estimated to explore the heterogeneous associations using data from a community survey conducted in Ethiopia. Agricultural household status and livestock presence were used as proxies to represent varying risk levels. Average marginal effects were estimated to provide a more accessible interpretation of the results. RESULTS: Results showed that the association between education and certain safe food handling practices was positive among individuals in households assumed to face higher food safety risks, while the association was less pronounced (or even negative) for those facing lower levels of risk. We observed that secondary education attainment was associated with a 20 percentage points increase (p \u3c 0.01) in the probability of washing hands compared to the reference group (illiterate) in agricultural households. However, for non-agricultural households, secondary education was associated with a 10 percentage points decrease (p \u3c 0.05) in probability. Similar patterns were found for washing surface. CONCLUSIONS: Education is associated with increased adoption of safe food handling practices among individuals facing higher food safety risks. This has important implications for developing targeted policies focused on individuals most susceptible to foodborne diseases. Future policies aimed at increasing the adoption of safe food handling practices should also integrate individuals\u27 decision-making processes and behavior biases in the context of varying risk levels
Perceptions and predictors of COVID-19 vaccine hesitancy among healthcare providers across five countries in sub-Saharan Africa
No full textThe African continent has some of the world\u27s lowest COVID-19 vaccination rates. While the limited availability of vaccines is a contributing factor, COVID-19 vaccine hesitancy among healthcare providers (HCP) is another factor that could adversely affect efforts to control infections on the continent. We sought to understand the extent of COVID-19 vaccine hesitancy among HCP, and its contributing factors in Africa. We evaluated COVID-19 vaccine hesitancy among 1,499 HCP enrolled in a cross-sectional study conducted as a telephone survey in Burkina Faso, Ethiopia, Nigeria, Tanzania, and Ghana between July to December of 2021. We defined COVID-19 vaccine hesitancy among HCP as self-reported responses of definitely not, maybe, unsure, or undecided on whether to get the COVID-19 vaccine, compared to definitely getting the vaccine. We used log-binomial or modified Poisson regression models to evaluate factors influencing vaccine hesitancy among HCP. Approximately 65.6% of the HCP interviewed were nurses and the mean age (±SD) of participants was 35.8 (±9.7) years. At least 67% of the HCP reported being vaccinated. COVID-19 vaccine hesitancy affected 45.7% of the HCP in Burkina Faso, 25.7% in Tanzania, 9.8% in Ethiopia, 9% in Ghana and 8.1% in Nigeria. Among unvaccinated HCP reasons for low vaccine uptake included concern about vaccine effectiveness, side effects, and fear of receiving experimental and unsafe vaccines. HCP reporting that COVID-19 vaccines are very effective (RR: 0.21, 95% CI: 0.08, 0.55), and older HCP (45 or older vs.20-29 years, RR: 0.65, 95% CI: 0.44, 0.95) were less likely to be vaccine-hesitant. Nurses were more likely to be vaccine-hesitant (RR 1.38, 95% CI: 1.01, 1.89) than doctors. Information asymmetry among HCP, beliefs about vaccine effectiveness, and the endorsement of vaccines by public health institutions may be important. Efforts to address hesitancy should consider information and knowledge gaps among different cadres of HCP alongside efforts to increase vaccine supply
Cannabinoid Hyperemesis Syndrome Is Associated With High Disease Burden: An Internet-Based Survey
No full textCannabinoid hyperemesis syndrome is an underrecognized condition associated with recurrent vomiting and abdominal pain in individuals with prolonged cannabis use. This study used an internet-based survey targeting individuals with self-reported cannabinoid hyperemesis syndrome to assess the burden of disease and to examine associations between heavy cannabis use, early initiation of cannabis use, and cannabinoid hyperemesis syndrome episode frequency. A total of 1,052 participants were included, with the majority reporting frequent cannabis use and significant health care utilization, including emergency department visits and hospitalizations. This study highlights the substantial disease burden associated with cannabinoid hyperemesis syndrome in an online support group cohort and underscores the possible risks of heavy daily cannabis use and of use starting in adolescence. Future studies on heavy cannabis users are necessary to further elucidate cannabinoid hyperemesis syndrome and its link to daily cannabis use and the dangers of heavy use in adolescence
Growth and Growth-Promoting Treatments in Turner Syndrome
No full textShort stature is a common presenting feature and an important concern for families of children with Turner syndrome. In this review, we summarize the data that shaped the updated international consensus guidelines for Turner syndrome published in 2024. The natural history of growth in Turner syndrome, the safety and efficacy of recombinant human growth hormone therapy, and the alternate growth promoting agents under consideration are presented. Timely, adequate growth hormone therapy can counter growth failure in childhood, promote catch-up growth and help many individuals with Turner syndrome attain a near-normal adult height. However, individual responses to growth hormone treatment are highly variable and are influenced by factors such as parental heights, age, baseline height, timing of estrogen initiation and pubertal status. Shared decision making on initiation of treatment, a candid conversation regarding the modest gradual height gain resulting from growth hormone therapy, and individualization of therapeutic goals can facilitate realistic expectations of growth promoting therapy in Turner syndrome
Social risk factors screening preferences among breast and prostate cancer survivors: A qualitative study
No full textOBJECTIVES: This project aimed to understand the experiences and preferences for social risk factor screening among racially, ethnically, and linguistically diverse cancer survivors in the Washington, DC, region. METHODS: Semi-structured interviews were conducted with English, Spanish, and Amharic-speaking breast and prostate cancer survivors. Data were inductively coded to identify themes, and differences by race and preferred language were evaluated. FINDINGS: Twenty-two interviews in English (n = 14), Spanish (n = 7), and Amharic (n = 1) among participants who identified as Black (n = 8), White (n = 5), Asian (n = 1), Other (n = 6), and multiracial (n = 2) were completed. Participants reported unresolved needs during treatment including transportation, healthful food, mental health care, financial help, and employment assistance. COVID-19 exacerbated many needs. Most participants did not recall discussing needs with oncology teams, but all participants were open to having these conversations. CONCLUSION(S): This research reveals that cancer survivors might benefit from culturally appropriate strategies that address social needs
Outcomes of reoperation following failed laser ablation surgery for epilepsy in pediatric patients
No full textOBJECTIVE: There are significant challenges in the surgical management of pharmacoresistant epilepsy. Laser interstitial thermal therapy (LITT) has emerged as a less invasive alternative to resection. However, seizure persistence or recurrence following LITT is not uncommon, and there is currently a lack of guidance and consensus on the best way to manage seizure recurrence after LITT for different epilepsy etiologies in children, or for the use of LITT when open resection has left residual epileptogenic tissue. The objective of this study was to assess the outcomes of secondary epilepsy surgery after failed initial LITT. METHODS: The authors performed a retrospective chart review of patients who underwent secondary epilepsy surgery after failed LITT at Children\u27s National Hospital. RESULTS: A total of 36 patients were treated with LITT, and 4 were excluded due to the palliative purpose of LITT. Thirteen of 32 patients (40.6.%) achieved Engel I, 1 patient (3.1%) achieved Engel II, and 18 patients (56.2%) had poor outcomes (Engel III-IV). Of these 32 patients, 9 (28.1%) underwent reoperation after their first laser ablation surgery due to a recurrence of epilepsy. Seven patients had a second laser ablation, and 2 patients underwent open resection. Of these 9 patients, 3 (33.3%) had Engel I outcomes, and 6 (66.7%) had poor seizure outcomes (Engel III-IV). When considering only patients who had repeat LITT for reoperation, 2 of 7 (28.6%) of these patients achieved seizure freedom (Engel I). Of the 32 patients, short-term complications were transient oculomotor (n = 1, 3.1%) or trochlear (n = 1, 3.1%) nerve deficit, which entirely resolved within 6 months, and superior quadrantanopia (n = 1, 3.1%) after initial LITT. CONCLUSIONS: Although LITT has shown promising results in treating pharmacoresistant epilepsy, the recurrence of seizures necessitates further evaluation and consideration of reoperation, which may result in seizure freedom. Repeat LITT is a low-risk option for secondary surgery after seizure recurrence