Prescription Drug Abuse

Background. In the United States, the leading cause of injury death is from prescription drug overdose. The most commonly abused prescription medications are (a) pain relievers (opioids), (b) CNS depressants (tranquilizers, sedatives, hypnotics), and (c) stimulants. Opioids are a class of drugs that includes both heroin and prescription pain relievers. CNS depressants are for managing anxiety and stimulates are used in ADHD. A consequence of abuse is drug overdose death, with opioids being the leading cause. Opioids are safe for short term use but have a strong potential to be abused resulting in addiction. In order to understand this crisis, it is critical to examine: (a) demographics, (b) reasons for abuse, and (c) the provider of drugs for targeted prevention. Methodology. Information was gathered utilizing the search engines (a) Journal of the American Medical Association, (b) EBSCO host, (c) Google Scholar, and (d) the LIU library database. Search terms included: (a) prescription drug abuse, (b) prescription drug overdose, (c) United States, and (d) demographics. All publications were from 2010 to 2018 and in English. Results. Mental health disorders put an individual at greater risk for abuse, especially when an opioid is prescribed in conjunction with: (a) an antidepressant, (b) antipsychotic, or (c) benzodiazepine. In examining specific demographics, (a) non-Hispanic males are more likely to abuse prescription stimulants and tranquilizers, (b) Hispanic males are more likely to abuse prescription painkillers, and (c) non-Hispanic females are more at risk to abuse prescription sedatives. Young adults from the age 18 to 25 years old were found to be the largest population that abuses (a) opioid pain relievers, (b) ADHD stimulants and (c) anti-anxiety drugs. From 2004-2011 emergency department visits related to prescription drug abuse rose 114%. Prescription drug abuse (28%) outpaces illicit drug (25%) use in emergency department visits. Among the prescription medicines, pain relievers have shown to be the most problematic with 75.2% of all pharmaceutical overdose deaths being from opioids. Prescription pain relievers are frequently abused to (a) alleviate pain inappropriately (62.3%), (b) feel good or get high (12.9%), (c) relax or relieve tension (10.8%), (d) as a coping mechanism (3.9%), and (f) aid in sleep (3.3%). Prescription pain relievers are typically received from (a) a friend/relative (53%), (b) a healthcare provider (37.5%), or (c) bought from a stranger (6%). Conclusions. Over 80% of Americans will see a healthcare provider within the year which provides them with the opportunity to screen for prescription drug abuse at the bedside. Patients must be counseled on the use and storage of their prescriptions to prevent redistribution to unintended audiences. Health practitioners should utilize the electronic prescription drug monitoring program before prescribing scheduled drugs and evaluate the patient’s medication history to prevent dangerous drug interactions. If prescription pain relievers are indicated, then it should be prescribed for short term use at a low dose without refills. Prescribers should offer close follow up and consider alternative methods for chronic pain relief such as acupuncture and physical therapy

Attitudes of transgender men and non-binary people to cervical screening: a cross-sectional mixed-methods study in the UK.

BACKGROUND: Transgender men and non-binary people assigned female at birth (TMNB) who have not had surgery to remove the cervix are recommended to undertake cervical screening with the same frequency as cisgender women, but evidence suggests that TMNB have lower odds of lifetime and up-to-date cervical screening uptake. AIM: To understand the attitudes towards and preferences for cervical screening among UK-based TMNB. DESIGN AND SETTING: Cross-sectional survey of TMNB at an NHS gender identity clinic (GIC) and an NHS sexual health service specialising in care of transgender people. METHOD: Recruitment was via email invitations to patients of the GIC and sexual health service. Inclusion criteria were: female sex assigned at birth; transgender man, masculine, or non-binary gender identity; aged ≥18 years; and UK resident. Quantitative results were analysed using descriptive statistics, and free-text comments were analysed thematically. RESULTS: In total there were 137 participants; 80% identified as transmasculine,18% as non-binary, and the remaining participants reported other noncisgender identities. Sixty-four participants (47%) were eligible for cervical screening and 37 (58%) of those had been screened. Only 34 (53%) of those eligible felt they had sufficient information about cervical screening. Just over half (n = 71/134, 53%) stated they would like the option to self-swab for high-risk human papillomavirus. Only half (n = 68/134, 51%) of participants were in favour of an automatic invitation for cervical screening. Thematic analysis identified a number of additional barriers to and facilitators of screening. CONCLUSION: TMNB have identified numerous potential areas for change that may improve cervical screening uptake and patient experience

Editing independent effects of ADARs on the miRNA/siRNA pathways

Adenosine deaminases acting on RNA (ADARs) are best known for altering the coding sequences of mRNA through RNA editing, as in the GluR-B Q/R site. ADARs have also been shown to affect RNA interference (RNAi) and microRNA processing by deamination of specific adenosines to inosine. Here, we show that ADAR proteins can affect RNA processing independently of their enzymatic activity. We show that ADAR2 can modulate the processing of mir-376a2 independently of catalytic RNA editing activity. In addition, in a Drosophila assay for RNAi deaminase-inactive ADAR1 inhibits RNAi through the siRNA pathway. These results imply that ADAR1 and ADAR2 have biological functions as RNA-binding proteins that extend beyond editing per se and that even genomically encoded ADARs that are catalytically inactive may have such functions

A multi-center prospective study of plant-based nutritional support in adult community-based patients at risk of disease-related malnutrition

IntroductionThere is an emerging need for plant-based, vegan options for patients requiring nutritional support.MethodsTwenty-four adults at risk of malnutrition (age: 59 years (SD 18); Sex: 18 female, 6 male; BMI: 19.0 kg/m2 (SD 3.3); multiple diagnoses) requiring plant-based nutritional support participated in a multi-center, prospective study of a (vegan suitable) multi-nutrient, ready-to-drink, oral nutritional supplement (ONS) [1.5 kcal/mL; 300 kcal, 12 g protein/200 mL bottle, mean prescription 275 mL/day (SD 115)] alongside dietary advice for 28 days. Compliance, anthropometry, malnutrition risk, dietary intake, appetite, acceptability, gastrointestinal (GI) tolerance, nutritional goal(s), and safety were assessed.ResultsPatients required a plant-based ONS due to personal preference/variety (33%), religious/cultural reasons (28%), veganism/reduce animal-derived consumption (17%), environmental/sustainability reasons (17%), and health reasons (5%). Compliance was 94% (SD 16). High risk of malnutrition (‘MUST’ score ≥ 2) reduced from 20 to 16 patients (p = 0.046). Body weight (+0.6 kg (SD 1.2), p = 0.02), BMI (+0.2 kg/m2 (SD 0.5), p = 0.03), total mean energy (+387 kcal/day (SD 416), p < 0.0001) and protein intake (+14 g/day (SD 39), p = 0.03), and the number of micronutrients meeting the UK reference nutrient intake (RNI) (7 vs. 14, p = 0.008) significantly increased. Appetite (Simplified Nutritional Appetite Questionnaire (SNAQ) score; p = 0.13) was maintained. Most GI symptoms were stable throughout the study (p > 0.06) with no serious adverse events related.DiscussionThis study highlights that plant-based nutrition support using a vegan-suitable plant-based ONS is highly complied with, improving the nutritional outcomes of patients at risk of malnutrition

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Employee and customer interaction within coffee shops.

We are currently using qualitative methods to research factors that contribute to interactions between employees and customers

Healthcare Disparities In Preoperative Risk Management For Total Joint Arthroplasty

Introduction: Preoperative risk management has been introduced as an avenue to improve postoperative outcomes for patients considering total joint arthroplasty (TJA). However, preoperative risk management programs may be contributing to healthcare disparities by preventing certain patient populations from accessing TJA care.Methods: We performed a systematic literature review to better understand potential impacts of preoperative risk management programs on healthcare disparities related to postoperative outcomes following TJA. In addition, we performed an additional study to determine the use of preoperative cutoffs for hemoglobin A1c and body mass index (BMI) at the top orthopaedic institutions as well as the availability of resources for weight loss, smoking cessation, and dental care. Results: Our literature review found a total of 12 studies that described the implementation of comprehensive risk management programs. The majority of these programs utilized artificial cutoffs for hemoglobin A1c and BMI and did not perform stratified analyses to assess the impact of preoperative risk management programs on specific patient populations. We found similar trends in our complementary study as the majority of top orthopaedic institutions utilized cutoffs for hemoglobin A1c and BMI while providing limited resources for smoking cessation and dental care. Conclusions: Preoperative risk management programs have the potential to improve patient outcomes, however care must be taken to ensure that these programs are not further contributing to healthcare disparities in orthopaedics

Girls Into Tech Online Program: Keeping Young Women Interested In STEM

Once girls reach middle school, their interest in science, technology, engineering, and math (STEM) decreases significantly. There is a critical need for educational STEM programs in New Mexico to help young girls retain interest. We helped the Girls into Tech program in their goal of sustaining STEM interest in middle school girls of NM. We conducted comparative analysis, observation, a survey, and interviews. Through these research methods we developed a model for an online STEM learning program to be integrated with the GIT curriculum. This outline consists of a year long calendar for exploring STEM careers. Each month, girls will learn about STEM careers through gamified learning modules, stories from female professionals, and an at home, hands-on activity