Preventive medicine
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Preventive medicine · Nov 2019
Deploying science to change hearts and minds: Responding to the opioid crisis.
The U. S. opioid epidemic, now in its third decade, continues to claim tens of thousands of lives each year. Despite strong scientific evidence to support the deployment of effective interventions from prevention to treatment, implementation and access to quality care continue to lag, in part, due to continued opioid prescribing, siloing of treatment services for those with opioid use disorder (OUD), public support for non-evidence-based practices, stigma, and discrimination. ⋯ Detoxification is probably the most common form of "treatment" for OUD, but the evidence shows that detoxification actually increases the risk for overdose. Expansion of MOUD delivery in the criminal justice system, health care systems and communities is essential to stemming the tide of this epidemic. This article is a call to action for the scientific community to ensure that scientific evidence is guiding patient care, funding for treatment, and policy decisions that address the opioid epidemic.
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Preventive medicine · Nov 2019
The effect of executive function on adherence with a cardiac secondary prevention program and its interaction with an incentive-based intervention.
Participation in secondary prevention programs such as cardiac rehabilitation (CR) reduces morbidity, mortality, and hospitalizations while improving quality of life. Executive function (EF) is a complex set of cognitive abilities that control and regulate behavior. EF predicts many health-related behaviors, but how EF interacts with interventions to improve treatment adherence is not well understood. ⋯ Better cognitive flexibility, measured with the trail-making-task, also predicted CR adherence (p = 0.02). While EF has been associated with adherence to a variety of treatment regimens, this interaction between an incentive-based intervention to promote treatment adherence and EF is novel. This work illustrates the value of considering individual differences in EF when designing and implementing interventions to promote health-related behavior change.
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Preventive medicine · Nov 2019
EditorialBehavior change, health, and health disparities 2019: Opioids, tobacco, and treatment adherence.
This Special Issue of Preventive Medicine (PM) is the 6th in a series on behavior change, health, and health disparities. This is a topic of critical importance to improving U. S. population health. ⋯ The remaining six reports focus on addressing the substantive challenges that tobacco use and non-adherence with medical regimens represent in these same communities. While giving the opioid epidemic the attention that it well deserves, we cannot afford to do so at the expense of these other longstanding and also devastating public health problems. Across each of these topics we include contributions from well-regarded investigators, clinicians, and policymakers to acquaint readers with recent accomplishments while also noting knowledge gaps and unmet challenges.
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Preventive medicine · Nov 2019
Innovative approaches to reduce unintended pregnancy and improve access to contraception among women who use opioids.
Dramatic increases in the rate of opioid use disorder (OUD) during pregnancy have been paralleled by substantial increases in the number of neonates diagnosed with neonatal abstinence syndrome (NAS). Women with OUD have reliably reported high rates of unintended pregnancy and a number of studies also indicate they desire easier access to contraception. ⋯ We briefly review a number of innovative clinical approaches in these areas, including efforts to integrate family planning services into substance use disorder (SUD) treatment and other settings that serve people with OUD and interventions that aim to make family planning a higher priority among women with OUD. Results suggest many of these approaches have led to increases in contraceptive use and may aid in efforts to reduce unintended pregnancy and improve access to contraception among women with OUD now and in the future.
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Preventive medicine · Nov 2019
Treating perinatal opioid use disorder in rural settings: Challenges and opportunities.
Perinatal opioid use disorder (OUD) is a life-threatening condition that significantly impacts women in rural areas. Medication assisted treatment (MAT) is the recommended treatment but can be difficult to access. ⋯ However, initiating treatment may present challenges to providers who lack experience treating this disorder. Vermont and New Hampshire are predominantly rural states which have focused on expanding MAT access for pregnant women using two different approaches to integrating treatment with maternity care.