Clinician identification of youth abusing over-the-counter products for weight control in a large U.S. integrated health system

Background: Abuse of over-the-counter (OTC) products, such as diet pills and laxatives, for weight control by adolescents is well-documented and can precipitate serious medical conditions. Yet only a small percentage of youth with disordered weight control behaviors receive treatment. The objective of this study was to examine how often clinicians communicate with youth with symptoms consistent with abuse of OTC products for weight control about possible use of these products. We used electronic medical records and administrative claims for services for 53,229 12 to 17 year old patients receiving care from an integrated health system in the U.S. Northwest from August 2007 to December 2010. We examined electronic text of clinical notes to identify encounters in which the clinician noted one of 10 metabolic conditions potentially associated with abuse of OTC products (diet pills, laxatives, diuretics, ipecac, orlistat, and alli®) for weight control and then assessed whether clinicians noted communication with adolescent patients about possible use of OTC products for weight control. Results: We identified 130 (0.2% of sample) patients with clinical notes indicating one or more of the metabolic conditions. In clinical notes for only four (3.1%) of these patients did clinicians document suspicion or communication about possible abuse of the OTC products. All four had a previous eating disorder diagnosis. In the 12 months subsequent to the clinical encounter in which a metabolic disturbance was identified, medical notes for only three (2.3%) of the 130 patients indicated clinician suspicion or communication about possible abuse of these products or an eating disorder. Conclusions: Clinicians are missing a critical window of opportunity to query adolescents when presenting with suspicious metabolic disturbances about possible abuse of OTC products for weight control. Clinicians may need more training to detect OTC product abuse, and electronic medical records should prompt more thorough enquiry

Microbial surfactants: fundamentals and applicability in the formulation of nano-sized drug delivery vectors

Microbial surfactants, so-called biosurfactants, comprise a wide variety of structurally distinct amphipathic molecules produced by several microorganisms. Besides exhibiting surface activity at the interfaces, these molecules present powerful characteristics including high biodegradability, low toxicity and special biological activities (e.g. antimicrobial, antiviral, anticancer, among others), that make them an alternative to their chemical counterparts. Several medical-related applications have been suggested for these molecules, including some reports on their potential use in the formulation of nano-sized drug delivery vectors. However, despite their promises, due to the generalized lack of knowledge on microbial surfactants phase behavior and stability under diverse physicochemical conditions, these applications remain largely unexplored, thus representing an exciting field of research. These nano-sized vectors are a powerful approach towards the current medical challenges regarding the development of efficient and targeted treatments for several diseases. In this review, a special emphasis will be given to nanoparticles and microemulsions. Nanoparticles are very auspicious as their size, shape and stability can be manipulated by changing the environmental conditions. On the other hand, the easiness of formulation, as well as the broad possibilities of administration justifies the recent popularity of the microemulsions. Notwithstanding, both vector types still require further developments to overcome some critical limitations related with toxicity and costs, among others. Such developments may include the search for other system components, as the microbial surfactants, that can display improved features.The author acknowledges the financial support from the Strategic Project PEst-OE/EQB/LA0023/2013 and project ref. RECI/BBB-EBI/0179/2012 (project number FCOMP-01-0124-FEDER-027462) funded by Fundacao para a Ciencia e a Tecnologia

Population-Based Outreach Versus Usual Care to Prevent Suicide Attempt: Study Protocol for a Randomized Clinical Trial

Background: Suicide is the 10th leading cause of death. PHQ-9 item #9 (which asks about suicidal thoughts) identifies those at risk of suicide attempt/death. Patients with scores of 2 or 3 on item 9 show a sustained increase in risk, with a cumulative hazard near 4% over 12 months. Methods: Outpatients who score a 2 or 3 on item #9 of the PHQ-9 are identified using electronic health record (EHR) data at three Mental Health Research Network sites: Group Health Cooperative, HealthPartners and Kaiser Permanente Colorado. Using a modified Zelen design, patients are automatically assigned 1:1:1 to continue in usual care (ie, no contact) or to be offered one of two population-based prevention programs meant to supplement usual care: 1) Care Management (systematic outreach to assess risk, EHR-based tools for risk-based pathways, and care management to facilitate and monitor recommended follow-up care); or 2) Skills Training (interactive online training in dialectical behavioral therapy skills supported by reminder and reinforcement messages). Randomization automatically occurs within each site’s sampling computer program, stratified by item #9 score. A computer-generated concealed allocation table provides randomly generated assignments in block sizes of either 6 or 9. The multisite interventions are embedded in the EHR. Online patient-provider secure messaging via the EHR patient portal is used for patient invitation and outreach as well as administration of suicide risk questionnaires. Secure provider-to-provider messaging is used to communicate with primary care and mental health providers. Population management and reporting tools are used to apply follow-up algorithms and deliver recommendations to care managers regarding outreach and follow-up. Nonfatal and fatal suicide attempts are identified using state vital statistics data and diagnoses of self-inflicted injury from EHR and claim records. Primary evaluation will compare risk of first suicide attempt over the 18 months following randomization. Groups will be compared according to initial treatment assignment, regardless of level of participation in either intervention. Results: To date, 4,869 outpatients out of a planned 18,000 have been randomized across the three sites. Conclusion: Our experience thus far illustrates the promise and challenges of implementing multisite clinical trial recruitment and intervention delivery in EHR systems

BALTA Newsletter - Winter 2010

This is the newsletter of the of the BC-Alberta Social Economy Research Alliance (BALTA). It contains news about BALTA and social economy developments in Alberta and British Columbia, Canada.BC-Alberta Social Economy Research Alliance (BALTA) ; Funding provided by Social Sciences and Humanities Research Council of Canada (SSHRC