The individual, interactive, and syndemic effect of substance use, depression, education, and ethnicity on retention in HIV care

2020 ◽  
pp. 095646241989072
Author(s):  
Kristopher Myers ◽  
Tan Li ◽  
Marianna Baum ◽  
Gladys Ibanez ◽  
Kristopher Fennie
Keyword(s):  
Logistic Regression ◽  
Alcohol Use ◽  
Alcohol Use Disorder ◽  
Male Gender ◽  
Hiv Care ◽  
Negatively Associated ◽  
Retention In Hiv Care ◽  
The Individual ◽  
Racial Ethnic ◽  
Hispanic White

In this study, we sought to assess the individual, syndemic, and interactive associations between individual-level factors and retention in care. The sample was derived from the Miami Adult Studies on human immunodeficiency virus (HIV)/ acquired immune deficiency syndrome (AIDS) cohort from 2009 to 2014. The variables were entered into a multiple logistic regression with retention as the outcome. Backward regression, adjusting for all main effects, was conducted to determine which two-way interactions were associated with retention. Multivariable logistic regression was used to test which number of factors were associated with retention. Non-Hispanic Black race/ethnicity was associated with improved retention (odds ratio [OR] = 2.44, 95% confidence interval [CI]: 1.06–5.75, p ≤ 0.05) when compared to Non-Hispanic White persons. Black-Hispanic and Other racial/ethnic identities were associated with increased retention (OR = 4.84, 95%CI: 1.16–25.79, p ≤ 0.05 and OR = 7.24, 95%CI: 1.54–54.05, p ≤ 0.05, respectively) when compared to Non-Hispanic White persons. The interaction between depressive symptoms and Alcohol Use Disorder Identification Test (AUDIT, a test that assesses alcohol use disorder) score was significantly and negatively associated with retention in HIV care (OR = 0.14, 95%CI: 0.01–1.11, p ≤ 0.10). The interaction between age and male gender was also negatively associated with retention (OR = 0.95, 95%CI: 0.88–1.01, p ≤ 0.10), and the interaction between male gender and depression was positively associated with retention (OR = 7.17, 95%CI: 0.84–98.49, p ≤ 0.10). In conclusion, multiple races/ethnicities, specifically Non-Hispanic Black, Black-Hispanic, and Other racial/ethnic identification, were associated with increased odds of retention. Multiple interactions, specifically depressive symptoms * alcohol use disorder and male gender * age, were negatively associated with retention. The male gender * depression interaction was positively associated with retention in HIV care.

scholarly journals Prevalence and correlates of non-daily and daily cannabis use among persons 15 years and older in South Africa: Results of a national survey in 2017

2020 ◽  
Author(s):  
Shandir Ramlagan ◽  
Karl Peltzer ◽  
Supa Pengpid
Keyword(s):  
Logistic Regression ◽  
Alcohol Use ◽  
Drug Use ◽  
Alcohol Use Disorder ◽  
Multinomial Logistic Regression ◽  
Health Indicators ◽  
Cannabis Use ◽  
Cross Sectional ◽  
Negatively Associated ◽  
Male Sex

Abstract BackgroundThe study aimed to assess the prevalence and correlates of non-daily and daily cannabis use among persons 15 years and older in South Africa.MethodIn a national cross-sectional 2017 survey, 39,207 persons 15 years and older (Median = 34 years) responded to a questionnaire on substance use and health variables. Multinominal logistic regression was used to assess the determinants of nondaily and daily cannabis use and logistic regression for the determinants of daily cannabis use among active cannabis users.ResultsResults indicate that 5.0% of the participants engaged in non-daily and 2.8% in daily cannabis use in the past 3 months. In adjusted multinomial logistic regression analysis, male sex, having Grade 8–11 education, Coloureds, alcohol use disorder, living with husband or wife, not living with a partner, and other drug use were positively and students were negatively associated with daily cannabis use. Male sex, younger age, living alone or single, living with a partner, alcohol use disorder, and other drug use were positively and multimorbidity was negatively associated with nondaily cannabis use. Compared to nondaily cannabis users, male sex had higher odds and students and other drug use had lower odds of daily cannabis use.ConclusionAbout one in ten participants engaged past 3-month cannabis use, and several sociodemographic and health indicators were identified associated with non-daily and daily cannabis use.

The Impact of Comorbid Conditions on Long-Term Patient-Reported Outcomes From Burn Survivors

2020 ◽  
Vol 41 (5) ◽  
pp. 956-962
Author(s):  
Clifford C Sheckter ◽  
Kevin Li ◽  
Gretchen J Carrougher ◽  
Tam N Pham ◽  
Nicole S Gibran ◽  
...  
Keyword(s):  
Mental Illness ◽  
Alcohol Use ◽  
Mental Component Summary ◽  
Patient Reported Outcomes ◽  
Alcohol Use Disorder ◽  
Negatively Associated ◽  
Risk Of Death ◽  
Patient Reported ◽  
The Impact

Abstract Preburn comorbidities increase the risk of death in the acute phase, and negatively impact quality of life among survivors. Investigations to date have only evaluated comorbidities as indices, limiting the ability to target conditions and develop strategies for risk reduction. Therefore, we aimed to evaluate the differential effects of specific conditions on long-term, patient-reported outcomes after burn injury. A prospectively maintained trauma registry was merged with a longitudinal database of patient-reported outcomes from a regional burn center from 2007 to 2018. Demographic data, injury-specific information, and the prevalence of 20 comorbidities were systematically documented. The impact of comorbidities on responses to Short Form-12/Veterans RAND 12 (SF/VR-12) health surveys at 6, 12, and 24 months postinjury was evaluated with generalized linear models. The merged dataset included 493 adult participants. Median age was 46 years (interquartile range, IQR 32–57 years), and 72% were male. Median burn size was 14% TBSA (IQR 5–28%). Seventy percent of participants had ≥1 comorbidity (median 1 comorbidity/participant; IQR 0–2 comorbidities). SF/VR-12 mental component summary scores at 6 and 12 months postinjury were negatively associated with mental illness (P < .001, P = .013). SF/VR-12 physical component summary (PCS) scores were negatively associated with smoking (P = .019), diabetes (P = .001), and alcohol use disorder (P = .001) at 6-month follow-up. Twelve-month SF/VR-12 PCS scores were negatively associated with prior trauma admission (P = .001) and diabetes (P = .042). Twenty-four-month SF/VR-12 PCS scores were negatively associated with mental illness (P = .003). Smoking, alcohol use disorder, and diabetes were associated with lower PCS scores 6 months after injury; diabetes persisted as a negatively associated covariate at 12 months. Mental component summary scores were negatively associated with mental illness 6 and 12 months postinjury. Integrated models of postdischarge comorbidity management need to be tested in burn patients.

scholarly journals Interest in Genetic Feedback for Alcohol Use Disorder and Related Substance Use and Psychiatric Outcomes among Young Adults

2020 ◽  
Vol 10 (12) ◽  
pp. 1007
Author(s):  
Morgan Driver ◽  
Sally Kuo ◽  
Danielle Dick ◽  
Keyword(s):  
Substance Use ◽  
Alcohol Use ◽  
Genetic Risk ◽  
Alcohol Use Disorder ◽  
Genetic Risk Score ◽  
Related Substance ◽  
Direct To Consumer ◽  
Sizable Proportion ◽  
Psychiatric Outcomes ◽  
The Individual

An exponential growing number of individuals are accessing genetic risk information via direct to consumer companies. Alcohol dependence is the third most accessed genetic risk score on a publicly available direct to consumer website. Better understanding of the degree to which individuals are interested in receiving personalized genetic feedback, the factors that relate to interest, and genetic knowledge will be critical to lay the foundation for precision medicine initiatives, especially for substance use and psychiatric outcomes, where less is known. To assess interest in receiving genetic feedback for alcohol use disorder (AUD) and understanding of genetic concepts related to psychiatric conditions, we conducted a survey with participants recruited from a registry that enrolled incoming cohorts of freshmen at an urban public university; 205 participants (76.5% female; 58.9% self-reported as White; Mage = 24.48 years) completed the survey. Results indicated that participants are highly interested in receiving genetic feedback for AUD (79.0%) but there is a lack of understanding of complex genetic concepts in a sizable proportion of the sample (25.4%). Additional research is needed to assess how to address this lack of knowledge before genetic feedback for AUD can be returned in a way that benefits the individual.

Dynamic Pathways to Recovery from Alcohol Use Disorder

2021 ◽  
Keyword(s):  
Alcohol Use ◽  
Alcohol Use Disorder ◽  
Alcohol Problems ◽  
Worth Living ◽  
Multidisciplinary Research ◽  
Life Worth Living ◽  
Recovery Processes ◽  
New Ideas ◽  
Major Shift ◽  
The Individual

Alcohol use disorder is by far the most prevalent substance use disorder in the general population and is a major contributor to disease worldwide. Recovery from the disorder is a dynamic process of change, and individuals take many different routes to resolve their alcohol problems and seek to achieve a life worth living. Total abstention is not the only solution and robust recovery involves more than changing drinking practices. This volume brings together multidisciplinary research on recovery processes, contexts, and outcomes as well as new ideas about the multiple pathways involved. Experts chart the individual, social, contextual, community, economic, regulatory, policy, and structural influences that are vital to understanding alcohol use disorder and recovery. The book recommends new approaches to conceptualizing and assessing recovery alongside new avenues for research, community engagement, and policy that constitute a major shift in the practice and policy landscape.

scholarly journals Prevalence and Correlates of Hazardous, Harmful, or Dependent Alcohol Use and Drug Use Among Persons 15 Years and Older in South Africa: Results of a National Survey in 2017

2020 ◽  
Author(s):  
Supa Pengpid ◽  
Karl Peltzer ◽  
Shandir Ramlagan
Keyword(s):  
South Africa ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Psychological Distress ◽  
Alcohol Use ◽  
Drug Use ◽  
Middle Age ◽  
Older Age ◽  
Negatively Associated ◽  
Adjusted Logistic Regression

The study aimed to assess the prevalence and correlates of hazardous, harmful or dependent alcohol use (HHDA) and drug use among persons 15 years and older in South Africa. In a national cross-sectional 2017 survey, 39,210 persons 15 years and older (Median=34 years) responded to a questionnaire on substance and health variables. Logistic regression was used to assess the determinants of HHDA and any drug use. Results indicate that (10.3%) engaged HHDA, 16.5% among males and 4.6% among females, and past 3-month drug use was 8.6%, 13.3% among males and 4.1% among females. In adjusted logistic regression analysis, among men, middle age (25-34 year olds), higher education, urban residence, drug use, and psychological distress were positively and Indian or Asian and White population groups were negatively associated with HHDA. Among women, middle age (25-34 year olds), Coloureds, residing on rural farms and urban areas, drug use and psychological distress were positively and older age (55 years and older), and Indians or Asians were negatively associated with HHDA. In adjusted logistic regression analysis, among men, having Grade 8-11 education, Coloureds, being unemployed, and HHDA were positively and middle and older age (25 years and older) and being a student or learner were negatively associated with past 3-month any drug use. Among women, Coloureds, Indians or Asians, and HHDA were positively and older age (45 years and older) was negatively associated with past 3-month and drug use. About one in ten participants engaged HHDA and any drug use, and several sociodemographic and health indicators were identified associated with HHDA and any drug use.

scholarly journals Exploring the Role of Alcohol Metabolizing Genotypes in a 12-Week Clinical Trial of Naltrexone for Alcohol Use Disorder

Biomolecules ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1495
Author(s):  
João M. Castaldelli-Maia ◽  
André Malbergier ◽  
Adriana B. P. de Oliveira ◽  
Ricardo A. Amaral ◽  
André B. Negrão ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Alcohol Use ◽  
Alcohol Use Disorder ◽  
Alcohol Use Disorders ◽  
Nucleotide Polymorphisms ◽  
High Association ◽  
Unsuccessful Treatment ◽  
Naltrexone Treatment ◽  
The Individual

Background: The efficacy of naltrexone in the treatment of alcohol use disorder (AUD) has been associated with a set of variables not directly related with the expression of opioid receptors. All the variables have been found to be highly associated with AUD itself or more severe clinical levels of AUD. Objectives: Given the high association between alcohol metabolizing enzymes (AME) and the outcome of AUD, the present study aims to investigate the role of AME genotype variants in the treatment of AUD with naltrexone. Methods: We carried out a 12-week longitudinal clinical trial based on the treatment of AUD patients with naltrexone (N = 101), stratified by different alcohol metabolization genotypes. Genotyping was performed after the inclusion of the patients in the study, based on the individual presence of single nucleotide polymorphisms (SNPs) in the ADH (alcohol dehydrogenase)1B (ADH1B*2 and ADH1B*3), ADH1C (ADHC*1) and ALDH (aldehyde dehydrogenase) 2 (ALDH2*2) genes. The outcome of alcohol use has been monitored employing the timeline follow-back during the treatment. Results: The ADH1C*1 (Ile350Val, rs698) and ALDH2*2 (Glu504Lys, rs671) polymorphisms were associated with a better response to naltrexone treatment, whereas the ADH1B*3 (Arg370Cys, rs2066702) allelic variant showed a negative outcome. Conclusions: The present study explores a genomic setting for the treatment of AUD with naltrexone. According to our findings, the association between ADH1C*1 and ALDH2*2 variants and better outcomes suggests a successful treatment, whereas the ADH1B*3 mutated allele might lead to an unsuccessful treatment. Further studies should be performed to investigate the relationship between alcohol metabolizing genotypes, the family history of alcohol use disorders and the effect of naltrexone on the outcomes. Genotyping may be a valuable tool for precision-medicine and individualized approach, especially in the context of alcohol use disorders. The small number of subjects was the main limitation of the present study.

scholarly journals Physician Reimbursement and Retention in HIV Care: Racial Disparities in the US South

2021 ◽  
Author(s):  
Zhongzhe Pan ◽  
Bassam Dahman ◽  
Rose S Bono ◽  
Lindsay M Sabik ◽  
Faye Z Belgrave ◽  
...  
Keyword(s):  
Racial Disparities ◽  
Racial Differences ◽  
Hiv Care ◽  
Administrative Claims ◽  
Physician Reimbursement ◽  
Physician Visits ◽  
Retention In Hiv Care ◽  
Living With Hiv ◽  
Stratified Analysis ◽  
Hispanic White

Fewer than 60% of Americans diagnosed with HIV are retained in care, with racial disparities. Addressing structural barriers to care may improve outcomes along the HIV care continuum, such as retention, and promote health equity. We examined the relationship between physician reimbursement and retention in HIV care, including racial differences. Data included person-level demographic information and administrative claims (Medicaid Analytic eXtract, 2008-12), state Medicaid-to-Medicare fee ratios (Urban Institute, 2008, 2012), and county characteristics for 15 Southern states plus District of Columbia. The fee ratio is a standardized measure of physician reimbursement capturing state variation in Medicaid relative to Medicare physician reimbursement, which is largely consistent across states. We used generalized estimating equations to assess the association between physician reimbursement ratio and retention in HIV care (≥2 claims for physician visits, antiretroviral prescriptions, or CD4 or HIV RNA viral load tests >90 days apart in a calendar-year). We also evaluated an increase in the fee ratio to parity, where Medicaid and Medicare physician reimbursement are equal. Stratified analysis assessed racial differences. The sample included 55,237 adult Medicaid enrollees living with HIV (179,002 enrollee-years). Enrollees were retained in HIV care for approximately three-quarters (76.8%) of their enrollment-years, with retention lower among non-Hispanic Black (76.2%) versus non-Hispanic White (81.3%, p<0.001) enrollees. A 10-percentage point increase in physician reimbursement was associated with a 4% increase in the odds of retention (aOR 1.04, 95% CI 1.01, 1.08). In stratified analysis, increased physician reimbursement was significantly associated with retention among non-Hispanic Black but not non-Hispanic White enrollees. At parity, predicted retention was 81.1% (80.0%, 82.1%) and 80.4% (79%, 81.7%) of enrollment-years, overall and for non-Hispanic Black enrollees, respectively. Higher physician reimbursement improves retention in HIV care, particularly among non-Hispanic Black individuals living with HIV, and could be a structural mechanism to promote racial equity in retention.

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