Specialty substance use disorder services following brief alcohol intervention: a meta‐analysis of randomized controlled trials

Background and aimsBrief alcohol interventions in medical settings are efficacious in improving self‐reported alcohol consumption among those with low‐severity alcohol problems. Screening, Brief Intervention and Referral to Treatment initiatives presume that brief interventions are efficacious in linking patients to higher levels of care, but pertinent evidence has not been evaluated. We estimated main and subgroup effects of brief alcohol interventions, regardless of their inclusion of a referral‐specific component, in increasing the utilization of alcohol‐related care.MethodsA systematic review of English language papers published in electronic databases to 2013. We included randomized controlled trials (RCTs) of brief alcohol interventions in general health‐care settings with adult and adolescent samples. We excluded studies that lacked alcohol services utilization data. Extractions of study characteristics and outcomes were standardized and conducted independently. The primary outcome was post‐treatment alcohol services utilization assessed by self‐report or administrative data, which we compared across intervention and control groups.ResultsThirteen RCTs met inclusion criteria and nine were meta‐analyzed (n = 993 and n = 937 intervention and control group participants, respectively). In our main analyses the pooled risk ratio (RR) was = 1.08, 95% confidence interval (CI) = 0.92–1.28. Five studies compared referral‐specific interventions with a control condition without such interventions (pooled RR = 1.08, 95% CI = 0.81–1.43). Other subgroup analyses of studies with common characteristics (e.g. age, setting, severity, risk of bias) yielded non‐statistically significant results.ConclusionsThere is a lack of evidence that brief alcohol interventions have any efficacy for increasing the receipt of alcohol‐related services.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/112279/1/add12950.pd

Revisiting our review of Screening, Brief Intervention and Referral to Treatment (SBIRT): meta‐analytical results still point to no efficacy in increasing the use of substance use disorder services

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152618/1/add13146.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152618/2/add13146_am.pd

Implementing an mHealth System for Substance Use Disorders in Primary Care: A Mixed Methods Study of Clinicians’ Initial Expectations and First Year Experiences

Millions of Americans need but don’t receive treatment for substance use, and evidence suggests that addiction-focused interventions on smart phones could support their recovery. There is little research on implementation of addiction-related interventions in primary care, particularly in Federally Qualified Health Centers (FQHCs) that provide primary care to underserved populations. We used mixed methods to examine three FQHCs’ implementation of Seva, a smart-phone app that offers patients online support/discussion, health-tracking, and tools for coping with cravings, and offers clinicians information about patients’ health tracking and relapses. We examined (a) clinicians\u27 initial perspectives about implementing Seva, and (b) the first year of implementation at Site 1

Information and Communication Technologies in Social Work

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78034/1/46.pd

Oxidized phospholipids are proinflammatory and proatherogenic in hypercholesterolaemic mice.

Oxidized phospholipids (OxPL) are ubiquitous, are formed in many inflammatory tissues, including atherosclerotic lesions, and frequently mediate proinflammatory changes 1 . Because OxPL are mostly the products of non-enzymatic lipid peroxidation, mechanisms to specifically neutralize them are unavailable and their roles in vivo are largely unknown. We previously cloned the IgM natural antibody E06, which binds to the phosphocholine headgroup of OxPL, and blocks the uptake of oxidized low-density lipoprotein (OxLDL) by macrophages and inhibits the proinflammatory properties of OxPL2-4. Here, to determine the role of OxPL in vivo in the context of atherogenesis, we generated transgenic mice in the Ldlr-/- background that expressed a single-chain variable fragment of E06 (E06-scFv) using the Apoe promoter. E06-scFv was secreted into the plasma from the liver and macrophages, and achieved sufficient plasma levels to inhibit in vivo macrophage uptake of OxLDL and to prevent OxPL-induced inflammatory signalling. Compared to Ldlr-/- mice, Ldlr -/- E06-scFv mice had 57-28% less atherosclerosis after 4, 7 and even 12 months of 1% high-cholesterol diet. Echocardiographic and histologic evaluation of the aortic valves demonstrated that E06-scFv ameliorated the development of aortic valve gradients and decreased aortic valve calcification. Both cholesterol accumulation and in vivo uptake of OxLDL were decreased in peritoneal macrophages, and both peritoneal and aortic macrophages had a decreased inflammatory phenotype. Serum amyloid A was decreased by 32%, indicating decreased systemic inflammation, and hepatic steatosis and inflammation were also decreased. Finally, the E06-scFv prolonged life as measured over 15 months. Because the E06-scFv lacks the functional effects of an intact antibody other than the ability to bind OxPL and inhibit OxLDL uptake in macrophages, these data support a major proatherogenic role of OxLDL and demonstrate that OxPL are proinflammatory and proatherogenic, which E06 counteracts in vivo. These studies suggest that therapies inactivating OxPL may be beneficial for reducing generalized inflammation, including the progression of atherosclerosis, aortic stenosis and hepatic steatosis

Use of Salvia divinorum in a Nationally Representative Sample

http://deepblue.lib.umich.edu/bitstream/2027.42/85730/1/Salvia.pd

Prevalence and correlates of specialty substance use disorder treatment for Department of Veterans Affairs Healthcare System patients with high alcohol consumption

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78096/1/67.pd

The effects of dust on the optical and infrared evolution of SN 2004et

We present an analysis of multi-epoch observations of the Type II-P supernova SN 2004et. New and archival optical spectra of SN 2004et are used to study the evolution of the Halpha and [O I] 6300A line profiles between days 259 and 646. Mid-infrared imaging was carried out between 2004 to 2010. We include Spitzer `warm' mission photometry at 3.6 and 4.5um obtained on days 1779, 1931 and 2151, along with ground-based and HST optical and near-infrared observations obtained between days 79 and 1803. Multi-wavelength light curves are presented, as well as optical-infrared spectral energy distributions (SEDs) for multiple epochs. Starting from about day 300, the optical light curves provide evidence for an increasing amount of circumstellar extinction attributable to newly formed dust, with the additional extinction reaching 0.8-1.5 magnitudes in the V-band by day 690. The overall SEDs were fitted with multiple blackbody components, in order to investigate the luminosity evolution of the supernova, and then with Monte Carlo radiative transfer models using smooth or clumpy dust distributions, in order to estimate how much new dust condensed in the ejecta. The luminosity evolution was consistent with the decay of 56Co in the ejecta up until about day 690, after which an additional emission source is required, in agreement with the findings of Kotak et al. (2009). Clumped dust density distributions consisting of 20% amorphous carbons and 80% silicates by mass were able to match the observed optical and infrared SEDs, with dust masses that increased from 8x10^{-5} Msun on day 300 to 1.5x10^{-3} Msun on day 690, still significantly lower than the values needed for core collapse supernovae to make a significant contribution to the dust enrichment of galaxies.Comment: 24 pages, 12 figures, 9 tables, published in MNRA

A Compilation of Strategies for Implementing Clinical Innovations in Health and Mental Health

Efforts to identify, develop, refine, and test strategies to disseminate and implement evidence-based treatments have been prioritized in order to improve the quality of health and mental healthcare delivery. However, this task is complicated by an implementation science literature characterized by inconsistent language use and inadequate descriptions of implementation strategies. This article brings more depth and clarity to implementation research and practice by presenting a consolidated compilation of discrete implementation strategies, based upon a review of 205 sources published between 1995 and 2011. The resulting compilation includes 68 implementation strategies and definitions, which are grouped according to six key implementation processes: planning, educating, financing, restructuring, managing quality, and attending to the policy context. This consolidated compilation can serve as a reference to stakeholders who wish to implement clinical innovations in health and mental healthcare and can facilitate the development of multifaceted, multilevel implementation plans that are tailored to local contexts

Receipt of medications for opioid use disorder among youth engaged in primary care: data from 6 health systems

PURPOSE: Little is known about prevalence and treatment of OUD among youth engaged in primary care (PC). Medications are the recommended treatment of opioid use disorder (OUD) for adolescents and young adults (youth). This study describes the prevalence of OUD, the prevalence of medication treatment for OUD, and patient characteristics associated with OUD treatment among youth engaged in PC. METHODS: This cross-sectional study includes youth aged 16-25 years engaged in PC. Eligible patients had ≥ 1 PC visit during fiscal years (FY) 2014-2016 in one of 6 health systems across 6 states. Data from electronic health records and insurance claims were used to identify OUD diagnoses, office-based OUD medication treatment, and patient demographic and clinical characteristics in the FY of the first PC visit during the study period. Descriptive analyses were conducted in all youth, and stratified by age (16-17, 18-21, 22-25 years). RESULTS: Among 303,262 eligible youth, 2131 (0.7%) had a documented OUD diagnosis. The prevalence of OUD increased by ascending age groups. About half of youth with OUD had documented depression or anxiety and one third had co-occurring substance use disorders. Receipt of medication for OUD was lowest among youth 16-17 years old (14%) and highest among those aged 22-25 (39%). CONCLUSIONS: In this study of youth engaged in 6 health systems across 6 states, there was low receipt of medication treatment, and high prevalence of other substance use disorders and mental health disorders. These findings indicate an urgent need to increase medication treatment for OUD and to integrate treatment for other substance use and mental health disorders