Telehealth Services for Substance Use Disorders: A 3-month Longitudinal Assessment of Intensive Outpatient Programming and Data Collection Practices During the COVID-19 Pandemic (Preprint)

BACKGROUND The onset of the COVID-19 pandemic necessitated the rapid transition of many types of substance use disorder (SUD) treatment to telehealth formats, despite limited information about what makes treatment effective in this novel format. OBJECTIVE To examine the feasibility and effectiveness of virtual intensive outpatient program (IOP) treatment for SUD in the context of a global pandemic, while considering the unique challenges posed to data collection during an unprecedented public health crisis. METHODS The study is based on a longitudinal study with a baseline sample of 3,642 patients who enrolled in intensive outpatient addiction treatment (in-person, hybrid, or virtual) from January 2020 to March 2021 at a large substance use treatment center in the United States. The analytical sample consisted of patients who completed the 3-month post-discharge outcome survey as part of routine outcome monitoring (n = 1,060) (response rate = 29%). RESULTS No significant differences were detected by delivery format in continuous abstinence (χ2 = 0.42, P = .81), overall quality of life (F(2,826) = 2.06, P = .13), financial well-being (F(2,767) = 2.30, P = .10), psychological well-being (F(2,918) = 0.72, P = .49), and confidence in one’s ability to stay sober (F(2,941) = 0.21, P = .81). Individuals in hybrid programming were more likely to report a higher level of general health than those in virtual IOP (F(2,917) = 4.19, P = .01). CONCLUSIONS Virtual outpatient care for the treatment of SUDs is a feasible alternative to in-person only programming leading to similar self-reported outcomes at 3-months post-discharge. Given the many obstacles presented throughout data collection during a pandemic, further research is needed to better understand under what conditions telehealth is an acceptable alternative to in-person care.

Study of nutritional parameters and physical activity in psoriasis patients attended at a reference center in Northeastern Brazil / Estudo de parâmetros nutricionais e atividade física em pacientes com psoríase atendidos em um centro de referência no Nordeste do Brasil

Psoriasis is defined as an immune-mediated disease, which has a chronic and relapsing nature, multifactorial etiology, strong participation of genetic, immunological and environmental factors. Studies show the association of psoriasis with risk factors for cardiovascular diseases. An adequate diet combined with the practice of physical activity is capable of positively influencing the prognosis of the disease. The present study aimed to assess the nutritional status and physical activity practice of patients diagnosed with psoriasis seen at the Reference, Support and Treatment Center for Psoriasis Patients of the University Hospital Lauro Wanderley (HULW), in João Pessoa, Paraiba state from October to December 2018. Patients were evaluated by means of a semi-structured questionnaire to collect information such as identification data, skin color, family history of the disease, previous pathological history, life habits and feeding. High BMI prevailed in 80% of the patients, being 35% overweight and 45% obese. The result showed that 45% of the patients had a diagnosis of type 2 DM and 60% of SAH. When asked about the diagnosis of dyslipidemia, 25% of the patients reported having high cholesterol and/or triglyceride and 10% of the patients did not know how to report. With regard to the practice of physical activity, 65% of patients reported performing physical activities, of which 84.6% performed it at a frequency of 1 to 3 times a week and 15.4%, from 4 to 7 times. This preliminary study allowed us to identify the nutritional profile and the practice of physical activity of individuals with psoriasis treated at a Reference Center. The results showed the coexistence of psoriasis and comorbidities related to the metabolic syndrome in the majority of patients evaluated, with a predominance of obesity, systemic arterial hypertension and type 2 diabetes mellitus.

MANAGING MASS CASUALTIES IN LIMITED RESOURCE SETTING: A COMPARISON BETWEEN A PERIPHERAL HOSPITAL AND FORWARD TREATMENT CENTER

Objective: To share our experience of handling mass casualties at remote locations with an aim to help formulate a policy regarding future training of doctors. Study Design: Case series. Place and Duration of Study: Combined Military Hospital Thal Pakistan, from Jan 2016 to Sep 2018, including three months in Forward Treatment Center in operational areas. Methodology: The injuries due to war trauma were included in our study. Resource management and changes made to accommodate the influx of mass trauma that required damage control surgery were described. Results: A total of 16 casualties from two mass casualty incidents at two medical centers were included in our study. There was no difference in triage class (p=0.96). Splinter injury limbs were most common injury. One patient required damage control surgery done at Combined Miliary Hospital with most requiring hemostasis prior to transport (8 at Combined Military Hospital versus 3 at Forward Treatment center), p=0.346. Conclusion: Most of mass casualties at our hospital were minor injuries requiring immediate first aid. In addition, the damage control resuscitation and surgery done at these remote locations may have helped prevent mortality and morbidity in the more severely injured.

Predictors of Delay in Seeking Post-Exposure Prophylaxis in Older Adults with Animal Bite Injuries: A Population-Based Study

Introduction: Animal bites are of the major health threats. Delayed post-exposure prophylaxis (PEP), especially in frail older people, may lead to mortal risks in this age group. The aim of this study was to investigate the pattern of delayed PEP in animal-bites injuries and to identify its contributing factors in older people of Tabriz city, Iran. Methods: In this cross-sectional study, the census method was used to obtain data from health records of older adults who were referred to Tabriz's Rabies Treatment Center between March 2013 and March 2018. The delay was defined as starting PEP longer than 24 hours after a suspected rabies virus exposure. The relations between delayed PEP and each of the predictors were investigated using the chi-square test in univariate analysis. The decision tree model was applied to predict the delay time of PEP. Results: A total of 322 older people with a mean age of 67.62 ± 7.18 were studied. In all, 31.7 % of the older persons victims who were bitten by an animal had a delayed PEP. Urban victims (34.1%) compared to rural (16.3 %), stray animal victims (42.0 %) compared to an owned animal-bite victim 24.6 %, all other animal bite-related victims (39.9 %) compared to dog-bite injuries (23.8%) experienced a higher frequency of delayed PEP. The decision tree revealed that animal ownership status, animal status, and animal species were the most important factors for predicting delayed PEP (p < 0.001). Conclusion: The possibility of delayed PEP in older adults bites victims, increased if the animal was ownerless and escaped. A reasonable approach to tackle this issue might be to conduct larger population studies in the future.

Use of the Violence Risk Scale – Sexual Offense version (VRS-SO) within sexually violent persons evaluations

In many parts of the United States, individuals can be civilly committed as Sexually Violent Persons (SVP) to a secure treatment center based on their history of sexual offenses, current mental disorder, and current risk for sexual recidivism. While the specific criteria vary between jurisdictions, SVP civil commitment is indefinite, and periodic examinations occur to determine if ongoing commitment is necessary. Release recommendations may be made in part based on patients’ treatment progress. Therefore, incorporating treatment change into periodic risk assessments is an important role of the SVP evaluator. The current paper sought to explore the benefits of using an actuarial tool within SVP populations to measure decreased sexual recidivism risk as a result of treatment change. Specific discussion of the use of the Violence Risk Scale – Sexual Offense version (Olver et al., 2007, https://doi.org/10.1037/1040-3590.19.3.318) is provided.

Treating Severe Traumatic Brain Injury: Combining Neurofeedback and Hyperbaric Oxygen Therapy in a Single Case Study

In 2014, a 26-year-old male was involved in a motor vehicle accident resulting in a severe traumatic brain injury (TBI). The patient sustained a closed-head left temporal injury with coup contrecoup impact to the frontal region. The patient underwent a left side craniotomy and was comatose for 26 days. After gaining consciousness, he was discharged to a brain injury treatment center that worked with physical, speech, and occupational issues. He was discharged after eight months with significant speech, ambulation, spasticity, and cognitive issues as well as the onset of posttraumatic epilepsy. His parents sought hyperbaric oxygen treatment (HBOT) from a doctor in Louisiana. After 165 dives, the HBOT doctor recommended an addition of neurofeedback (NFB) therapy. In March 2019 the patient started NFB therapy intermixed with HBOT. The combination of NFB and HBOT improved plasticity and functionality in the areas of injury and the correlated symptoms including short-term memory, personality, language, and executive function, as well as significantly reducing the incidence of seizures. Severe brain injuries often leave lasting deficits with little hope for major recovery and there is a need for further research into long-term, effective neurological treatments for severe brain injuries. These results suggest that HBOT combined with NFB may be a viable option in treating severe brain injuries and should be investigated.

Interventional Effect of Nanosilver Paint on Fungal Load of Indoor Air in a Hospital Ward

Hospital ward environments contain various types of microorganisms, in which fungal agents are one of the main contaminants that may cause hospital-acquired infections. Regarding this, the aim of the present study was to evaluate the effect of nanosilver paint on reducing fungal contaminants of indoor air in an educational, research, and treatment center. Two rooms in the hematology ward were selected. One room was painted using usual paint (control room) and the other room was painted with paint containing nanosilver particles (experimental room). One hundred and twelve samples were collected using active (Anderson BioSampler) and passive (settle plate or open plate) air sampling techniques. The samples were incubated for 3–7 days at 35°C, and the positive fungal cultures were examined according to morphological and microscopic characteristics. Following active sampling, the mean and standard deviation of the number of colony-forming units (CFU/m3) of fungi colonies in the experimental and control rooms were 29.21 ± 17.99 and 22.50 ± 10.02 before intervention and 13.79 ± 6.20 and 31.07 ± 21.1 after intervention, respectively. Following passive sampling, the number of CFU/plate in the experimental and control rooms was 6 and 0 before and 1and 1 after intervention, respectively. The use of the nanosilver paint was effective in reducing air fungal contamination. Moreover, the active sampling method was more sensitive to measuring the concentration changes for fungal bioaerosols.

Oral Manifestations of Immune Thrombocytopenic Purpura

Introduction: Hemorrhagic lesions of the oral mucosa are the most common clinical manifestations of Immune thrombocytopenic purpura (ITP). Case Report: A 41-year-old female patient consulted the oral surgery department of the dental consultation and treatment center in Rabat for spontaneous gingivorrhagia. Clinical examination and further examination showed severe thrombocytopenia associated with an anemic syndrome. The diagnosis of ITP was made. Treatment was based on oral corticosteroids and immunoglobulin in the hospital. Conclusion: These manifestations sometimes lead the patient to consult his dental surgeon in the first intention, hence the need to make the diagnosis based on a thorough global examination and to refer the patient to an adapted structure.

Treatment of Dental Anxiety and Phobia—Diagnostic Criteria and Conceptual Model of Behavioural Treatment

Dental anxiety and dental phobia are still prevalent among adult individuals and should be considered a dental public health issue. Dental anxiety/phobia is often described as a vicious cycle where avoidance of dental care, poor oral health, and psychosocial effects are common features, often escalating over time. Treatment should include therapy for dental anxiety/phobia and oral diseases. This paper discusses aetiology, prevalence, and diagnosis of dental anxiety/phobia and, in detail, presents a conceptual treatment model at the Dental Fears Research and Treatment Center in Gothenburg, Sweden. In addition, based on systematic reviews, evidence-based treatment for dental anxiety is revealed including the interdisciplinary approach between psychology and dentistry.