scholarly journals Opioid Overdose Crises During the COVID-19 Pandemic: Implication of Health Disparities

2021 ◽  
Author(s):  
Ishika Patel ◽  
Lauren Walter ◽  
Li Li
Keyword(s):  
Health Disparities ◽  
Medical Records ◽  
Opioid Overdose ◽  
Deep South ◽  
University Of Alabama ◽  
Overdose Prevention ◽  
Ed Visits ◽  
The Mean ◽  
The University ◽  
Overdose Deaths

Abstract Background. Recent data suggests a disproportionate impact of opioid overdoses on Black Americans. The study aims to describe emergency department (ED) visits at a Southern, urban ED pertaining to opioid overdose and associated health disparities. Methods. Patients presenting to the ED at the University of Alabama at Birmingham Hospital with opioid overdoses from January 1 to October 31, 2019, and from January 1 to October 31, 2020, were identified from electronic medical records. Results. The total number of opioid overdose visits increased 9.7% (556 to 611) between January through October 2020 compared with 2019. Among patients who presented with opioid overdose, the mean ages were 50.3 years and 48.3 years, in 2019 and 2020, respectively. In both 2019 and 2020, more Blacks than whites were treated for opioid overdose in the ED (284 vs. 258 in 2019, and 306 vs. 271 in 2020) although 28 patients did not record their race in 2020. Consistently, more overdose deaths were observed in Blacks than in Whites in 2020. More individuals seeking opioid overdose treatment were single in both years. Conclusions. The study reported a greater number of visits for opioid overdoses from January to October of 2020 in an ED of a deep south region, as well as higher overdose deaths in Blacks. Our findings highlight the importance of substance use treatment, harm reduction, and overdose prevention efforts that should be immediately present to reduce opioid overdose especially for vulnerable populations in the South, i.e., Black community, and individuals experiencing singlehood.

scholarly journals Opioid overdose crises during the COVID-19 pandemic: implication of health disparities

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Ishika Patel ◽  
Lauren A. Walter ◽  
Li Li
Keyword(s):  
Health Disparities ◽  
Medical Records ◽  
Opioid Overdose ◽  
University Of Alabama ◽  
Overdose Prevention ◽  
Ed Visits ◽  
The Mean ◽  
The University ◽  
Overdose Deaths ◽  
Southeastern Region

Abstract Background Recent data suggest a disproportionate impact of opioid overdoses on Black Americans. The study aims to describe emergency department (ED) visits at a Southern, urban ED pertaining to opioid overdose and associated health disparities. Methods Patients presenting to the ED at the University of Alabama at Birmingham Hospital with opioid overdoses from January 1 to October 31, 2019, and from January 1 to October 31, 2020, were identified from electronic medical records. Results The total number of opioid overdose visits increased 9.7% (556 to 611) between January and October 2020 compared with 2019. Among patients who presented with opioid overdose, the mean ages were 50.3 years and 48.3 years, in 2019 and 2020, respectively. In both 2019 and 2020, more Blacks than whites were treated for opioid overdose in the ED (284 vs. 258 in 2019, and 306 vs. 271 in 2020) although 28 patients did not record their race in 2020. Consistently, more overdose deaths were observed in Blacks than in whites in 2020. More individuals seeking opioid overdose treatment were single in both years. Conclusions The study reported a greater number of visits for opioid overdoses from January to October of 2020 in an ED of a southeastern region, as well as higher overdose deaths in Blacks. Our findings highlight the importance of substance use treatment, harm reduction, and overdose prevention efforts that should be immediately present to reduce opioid overdose, especially for vulnerable populations in the South, i.e., Black community, and individuals experiencing singlehood.

A Thematic Analysis of Overdose Prevention and Response Efforts in States Experiencing Declines in Rates of Opioid-Involved Overdose Deaths

2021 ◽  
pp. 003335492110268
Author(s):  
Amber B. Robinson ◽  
Nida Ali ◽  
Olga Costa ◽  
Cherie Rooks-Peck ◽  
Amy Sorensen-Alawad ◽  
...  
Keyword(s):  
Thematic Analysis ◽  
Prevention Program ◽  
Data Access ◽  
Mortality Rates ◽  
Opioid Overdose ◽  
Overdose Prevention ◽  
Core Elements ◽  
Specific Activities ◽  
Context Specific ◽  
Overdose Deaths

Objective To address the opioid overdose epidemic, it is important to understand the broad scope of efforts under way in states, particularly states in which the rate of opioid-involved overdose deaths is declining. The primary objective of this study was to examine core elements of overdose prevention activities in 4 states with a high rate of opioid-involved overdose deaths that experienced a decrease in opioid-involved overdose deaths from 2016 to 2017. Methods We identified 5 states experiencing decreases in age-adjusted mortality rates for opioid-involved overdoses from 2016 to 2017 and examined their overdose prevention programs via program narratives developed with collaborators from each state’s overdose prevention program. These program narratives used 10 predetermined categories to organize activities: legislative policies; strategic planning; data access, capacity, and dissemination; capacity building; public-facing resources (eg, web-based dashboards); training resources; enhancements and improvements to prescription drug monitoring programs; linkage to care; treatment; and community-focused initiatives. Using qualitative thematic analysis techniques, core elements and context-specific activities emerged. Results In the predetermined categories of programmatic activities, we identified the following core elements of overdose prevention and response: comprehensive state policies; strategic planning; local engagement; data access, capacity, and dissemination; training of professional audiences (eg, prescribers); treatment infrastructure; and harm reduction. Conclusions The identification of core elements and context-specific activities underscores the importance of implementation and adaptation of evidence-based prevention strategies, interdisciplinary partnerships, and collaborations to address opioid overdose. Further evaluation of these state programs and other overdose prevention efforts in states where mortality rates for opioid-involved overdoses declined should focus on impact, optimal timing, and combinations of program activities during the life span of an overdose prevention program.

Preparing pharmacists to increase naloxone dispensing within community pharmacies under the Pennsylvania standing order

2020 ◽  
Author(s):  
Heather M Santa ◽  
Samira G Amirova ◽  
Daniel J Ventricelli ◽  
George E Downs ◽  
Alexandra A Nowalk ◽  
...  
Keyword(s):  
Community Pharmacists ◽  
The United States ◽  
Health Concern ◽  
Community Pharmacies ◽  
Opioid Overdose ◽  
Patient Counseling ◽  
Opioid Use ◽  
Overdose Prevention ◽  
Standing Order ◽  
Overdose Deaths

Abstract Purpose Opioid misuse and overdose deaths remain a public health concern in the United States. Pennsylvania has one of the highest rates of opioid overdose deaths in the country, with Philadelphia County’s being 3 times higher than the national average. Despite several multimodal interventions, including use of SBIRT (screening, brief intervention, and referral to treatment) methods and naloxone distribution, the rate of overdose deaths remains high. Methods To gain insights on strategies for improving access to naloxone and naloxone distribution by pharmacists in Philadelphia County, a study was conducted in 11 community pharmacies (chain and independent) in Philadelphia. Twenty-four pharmacists were recruited and completed SBIRT and naloxone trainings. Each pharmacy elected to have at least 1 pharmacy champion who received additional training on and helped develop pharmacy site–specific naloxone dispensing protocols. Results Pre-post survey results showed a reduction in stigmatizing attitudes regarding naloxone dispensing and an increase in pharmacists’ understanding of the standing order and appropriate naloxone use. There was an increase in pharmacists’ self-reported confidence in their ability to appropriately identify, discuss, and dispense naloxone to patients. All pharmacies increased their average monthly dispensing rate following protocol implementation. Conclusion Pharmacists who received both trainings were more likely to change naloxone dispensing practices, leading to an overall increase in naloxone dispensing by community pharmacists. The study addressed overall gaps in pharmacists’ knowledge, reduced stigma, and prepared pharmacists to address opioid use and overdose prevention with their patients. The described pharmacist-led patient counseling and intervention service for overdose prevention may be explored as a model for other community pharmacies to adopt to improve naloxone dispensing and similar interventions to reduce overdose deaths.

Nephrosplenic space closure significantly decreases recurrent colic in horses: a retrospective analysis

2019 ◽  
Vol 185 (21) ◽  
pp. 657-657 ◽  
Author(s):  
José Manuel Arévalo Rodríguez ◽  
Sigrid Grulke ◽  
Alexandra Salciccia ◽  
Geoffroy de la Rebière de Pouyade
Keyword(s):  
Medical Records ◽  
Telephone Interview ◽  
Horse Breed ◽  
Surgical Closure ◽  
Total Incidence ◽  
Space Closure ◽  
Chi Squared ◽  
The Mean ◽  
The University

BackgroundNephrosplenic space closure is commonly used to reduce relapse of nephrosplenic space entrapment in cases of left dorsal displacement of the left colon (LDDLC). Nevertheless, studies documenting the effectiveness of this surgery are sparse in the literature. The aim of this study was to analyse clinical data of horses presented for LDDLC and evaluate the effect of nephrosplenic space closure on the incidence of colic recurrence.MethodsMedical records of 156 horses diagnosed with LDDLC at the Equine Clinic of the University of Liège between 2004 and 2016 were retrieved for analysis. Extracted data included horse breed, sex, age and weight, initial treatment, and if a subsequent preventive surgical closure of the nephrosplenic space was carried out or not. Follow-up information was obtained by telephone interview. Statistical analyses were performed using a chi-squared test with significance set at P<0.05.ResultsFollow-up data were available for 65 per cent of horses. The mean follow-up was 35 months. There was a significant decrease in the total incidence of colic after closure surgery compared with non-operated horses. No horse was diagnosed with LDDLC after closure of the nephrosplenic space.ConclusionClosure of the nephrosplenic space significantly decreases recurrent colic in horses compared with non-operated horses.

scholarly journals Procedimentos invasivos e sepse em recém-nascidos de muito baixo peso: estudo descritivo

2016 ◽  
Vol 15 (4) ◽  
pp. 704
Author(s):  
Flavia do Valle Andrade Medeiros ◽  
Valdecyr Herdy Alves ◽  
Cristina Ortiz Sobrinho Valete ◽  
Eny Dórea Paiva ◽  
Diego Pereira Rodrigues ◽  
...  
Keyword(s):  
Birth Weight ◽  
Medical Records ◽  
Neonatal Intensive Care ◽  
Secondary Data ◽  
Delivery Room ◽  
University Hospital ◽  
Central Catheter ◽  
The Mean ◽  
The University ◽  
The City

Aim:  To  identify  the  type  of  sepsis  which  affected  newborns  withvery  low  birth  weight  and  invasive  care  procedures  to  which  they were  subjected  in  a university hospital in the city of Niterói, between the years 2008 and 2012. Method: This is a retrospective descriptive study using secondary data research in the medical records of  newborns  admitted  to  the  Neonatal  Intensive  Care  Unit  of  the  University  Hospital Antônio Pedro. Results: Of the 49 infants studied, 35 were diagnosed with early sepsis, eight with early and late sepsis and six late. The mean gestational age was 30.5 weeks and  the  weight  1.176,1  kg.  The  most  frequently  performed  care procedures  were: peripheral  venipuncture  (87.8%),  central  catheter  peripheral  venipuncture  (81.6%), assistance  to  ventilation  in  the  delivery  room  (69.4%)  and  intubation  in  the  delivery room  (28.6%).  Conclusion:  It is inferred  that the  lower  birth  weight is  associated  with the higher incidence of sepsis.

scholarly journals Limited Mobility to the Bed Reduces the Chances of Discharge and Increases the Chances of Death in the ICU

2021 ◽  
Vol 12 (1) ◽  
pp. 8-16
Author(s):  
Talita Leite dos Santos Moraes ◽  
Joana Monteiro Fraga de Farias ◽  
Brunielly Santana Rezende ◽  
Fernanda Oliveira de Carvalho ◽  
Michael Silveira Santiago ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Study ◽  
Medical Records ◽  
High Mobility ◽  
University Hospital ◽  
Limited Mobility ◽  
The Mean ◽  
The University

Background: Progressive mobility in the ICU has been recommended; however, the definitions of low, moderate, and high mobility in the ICU still diverge between studies. Therefore, our objective was to classify the mobility of the sample from verticalization and active withdrawal from the bed, and from that, to analyze the chances of discharge, death, and readmission to the ICU. Materials and methods: This is an observational and retrospective study that consults the medical records of individuals admitted to the ICU of the University Hospital of Sergipe (HU/SE) between August 2017 and August 2018. Mobility level was classified based on the Intensive Care Unit Mobility Scale (IMS). Results: A total of 121 individuals were included. The mean age was 61.45 ± 16.45, being 53.7% female. Of these, 28 (23.1%) had low mobility, 33 (27.3%) had moderate mobility, and 60 (49.6%) had high mobility. Individuals with low mobility were 45 times more likely to die (OR = 45.3; 95% CI = 3.23–636.3) and 88 times less likely to be discharged from the ICU (OR = 0.22; 95% CI = 0.002–0.30). Conclusion: Those who evolved with low mobility had a higher chance of death and a lower chance of discharge from the ICU. Moderate and high mobility were not associated with the investigated outcomes.

scholarly journals Disparities Research at the Deep South Alzheimer’s Disease Center of the University of Alabama at Birmingham

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 100-100
Author(s):  
Maria Pisu ◽  
David Geldmacher
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
South Carolina ◽  
African American ◽  
African Americans ◽  
Deep South ◽  
Medicare Beneficiaries ◽  
University Of Alabama ◽  
The Us ◽  
The University

Abstract Residents of the US Deep South (Alabama, Georgia, Louisiana, Mississippi, and South Carolina) have a 20–30% higher risk of developing Alzheimer’s disease or related dementia (ADRD). Moreover, &gt;20% of African Americans, who are at higher ADRD risk than whites, live in this region. Therefore, one important goals of the Deep South Alzheimer’s Disease Center (DS-ADC) of the University of Alabama at Birmingham is to spearhead research to address these disparities. This panel presents current DS-ADC research, with two presentations focusing on the local patient population and the last two on the Deep South population compared to the rest of the nation. Addressing the challenge of recruiting representative samples in clinical research, the first paper is part of a research program to understand difference that may exist between African American and white research participants. The second paper examines patients with multiple conditions, in particular dementia and cancer, showing a marked disadvantage in cognition outcomes for African Americans. The next two papers take a broader perspective to better understand the population of older adults with ADRD in the Deep South and in the rest of the US. The third paper examines socioeconomic and medical contexts of African American and white older Medicare beneficiaries with ADRD, and the fourth paper examines differences in utilization of specialists, ADRD drugs, and hospitalizations in the two regions taking these contexts into account. The discussant will close the session by placing these studies in the larger context of the disparities research at the DS-ADC.

scholarly journals INTEREST GROUP SESSION—PATIENT/PERSON ENGAGEMENT IN RESEARCH INTEREST GROUP (PPER-IG): STRENGTH IN AGE: ENGAGING OLDER ADULTS AS HEALTH RESEARCHERS THROUGH COMMUNITY-BASED PARTNERSHIPS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S404-S404
Author(s):  
Silvia Sörensen ◽  
Rebecca S Allen ◽  
Reza Yousefi Nooraie
Keyword(s):  
Older Adults ◽  
Interest Group ◽  
Health Research ◽  
Deep South ◽  
University Of Alabama ◽  
Community Members ◽  
Patient Centered ◽  
Community Stakeholders ◽  
Research Findings ◽  
The University

Abstract The lack of clear translation of health research to improving older under-served patients’ lives presents a serious problem. Studies of aging rarely include the older adults themselves in the process of conceptualizing questions, implementing the research, and applying and evaluating the results. Lack of input particularly from marginalized and minority older adults may compromise the relevance and accuracy of health research findings. In this symposium, we present the design and evaluation of two projects funded by the Patient-Centered Outcomes Research Institute (PCORI), in which older adults are trained to understand research language, culture, and methods, and are subsequently incorporated into research projects in a variety of roles. Silvia Sörensen will describe the “Engaging Older Adult Learners as Health Researchers” (ENGOAL) in Rochester, NY. This program provides six months of weekly classes and 4-6 months of research apprenticeships for older adults. Dorine Otieno and Kate Kondolf will describe evaluation results from both quantitative and qualitative analyses. Rebecca Allen will describe the design and implementation of “Sharing Opinions and Advice about Research (SOAR) in the Deep South,” a partnership of The University of Alabama with community stakeholders from Sumter and Holt County to recruit and train community members to assist in the formulation of research questions based on the needs of their communities. Allen and Dragan will present the evaluation results from this project with regard to implementation and graduate education. Reza Yousefi-Nooraie will synthesize the insights from these projects and add the perspective of a social network analyst.

Choosing Wisely: Opportunities for improving value of cancer care in the Deep South.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 13-13
Author(s):  
Maria Pisu ◽  
Gabrielle Betty Rocque ◽  
Kelly Kenzik ◽  
Bradford E. Jackson ◽  
Yufeng Li ◽  
...  
Keyword(s):  
Cancer Care ◽  
Choosing Wisely ◽  
Administrative Claims ◽  
Evidence Based ◽  
Deep South ◽  
Medicare Beneficiaries ◽  
University Of Alabama ◽  
Cancer Centers ◽  
American Society ◽  
The University

13 Background: Under the Choosing Wisely (CW) Campaign, the American Society of Clinical Oncology (ASCO) and the American Society of Therapeutic Radiology and Oncology (ASTRO) recommend against non-evidence-based costly medications, tests, and procedures. CW recommendation adherence in the Deep South is largely unknown, and opportunities to reduce overuse and costs may exist. Methods: Analysis of administrative claims and tumor registry data from 12 cancer centers of the University of Alabama Health System Cancer Community Network, for Medicare beneficiaries ≥65 years old with cancer. Main outcome: percent of beneficiaries adhering to 9 CW recommendations. Results: 2012-2015 (Q1) adherence varied across CW recommendations and cancer centers, and increased over time for CW 2 and 7, decreased for 3, 5, and 6, and did not change for others. Conclusions: Opportunities to improve quality and value of cancer care exist in the Deep South. Research should understand how to minimize use of non-evidence based medications, tests, and procedures. [Table: see text]

scholarly journals Rural and Urban Differences in Overdose Response and Prevention Among Persons Who Inject Drugs

2021 ◽  
Author(s):  
Suzan M Walters ◽  
Marisa Felsher ◽  
David Frank ◽  
Tarlise Townsend ◽  
Brandon Muncan ◽  
...  
Keyword(s):  
New York ◽  
Drug Market ◽  
Test Strip ◽  
Opioid Overdose ◽  
Structured Interviews ◽  
Persons Who Inject Drugs ◽  
Overdose Prevention ◽  
Rural And Urban ◽  
Theoretical Sampling ◽  
Overdose Deaths

Abstract BackgroundOverdose is a leading cause of morbidity and mortality among people who inject drugs (PWID). Illicitly manufactured fentanyl is now a major driver of opioid overdose deaths. This analysis explores rural-urban differences in overdose experiences among PWID. We focus on perceptions of fentanyl and overdose prevention and reversal strategies.MethodsSemi-structured interviews were conducted with 59 participants who injected drugs, 19 from rural southern Illinois and 40 from New York City (NYC). Seven key informants were also interviewed (three from Illinois and four from NYC) to provide additional perspectives. Data were analyzed using constant comparison and theoretical sampling methods.ResultsParticipants in urban NYC described most commonly injecting heroin and fentanyl, which differed from the rural Illinois drug market that was dominated by methamphetamines. Despite these geographic differences, participants from both locations were concerned about the growing presence of fentanyl in their drug supply and many disclosed overdose experiences. Strategies to lower overdose risk included purchasing drugs from trusted network members and partial drug injection, however, fentanyl test strip use was low in both locations. A key difference emerged related to the use of naloxone; NYC participants commonly described using naloxone as a primary overdose response, but participants in rural Illinois did not. Low naloxone use in Illinois was attributed to perceived risks of its use, such as fear of arrest and opioid withdrawal symptoms the naloxone receiver may experience. ConclusionsDespite similarities in fentanyl awareness and concern, important rural-urban differences emerged related to access to overdose prevention and reversal resources. Findings can inform regional-specific interventions to reduce overdose risk among PWID.

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