Preventive medicine
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Preventive medicine · Nov 2021
Challenges and opportunities during the COVID-19 pandemic: Treating patients for substance use disorders during the perinatal period.
The coronavirus disease 2019 (COVID-19) pandemic exacerbated the opioid use disorder epidemic and accelerated alcohol and other substance use disorders. Sudden health care service delivery changes during the COVID-19 pandemic created both challenges and opportunities for all patients with substance use disorders including the use of virtual or telemedicine visits, medication access issues and ensuring access to naloxone when supplies cannot be handed out. Unique challenges for pregnant and post-partum patients with substance use disorders includes some evidence of reduced access to medication to treat opioid use disorders and changes in delivery protocols that isolate birthing people from supports. ⋯ For pregnant and post-partum patients with substance use disorders, hybrid models of telemedicine and in-person visits reduced no-show visit rates and increased flexibility in medication dosing regimens. Thus, there is a unique opportunity to study the success of different virtual care models given the variety of implemented strategies. The COVID-19 pandemic provides an unprecedented opportunity to dramatically transform standard care approaches to help optimize care for all patients, including pregnant and post-partum people.
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Preventive medicine · Nov 2021
Identifying key barriers to effective breast cancer control in rural settings.
Breast cancer is the most common cancer and the second most common cause of cancer mortality among women in the United States. Efforts to promote breast cancer control in rural settings face specific challenges. Access to breast cancer screening, diagnosis, and treatment services is impaired by shortages of primary care and specialist providers, and geographic distance from medical facilities. ⋯ Travel distance to treatment centers is the most substantial barrier to improved breast cancer outcomes in rural areas. While numerous interventions have been demonstrated in controlled studies to be effective in promoting treatment access and adherence, widespread dissemination in public health and clinical practice remains lacking. Efforts to improve breast cancer control in rural areas should focus on implementation strategies for improving access to breast cancer treatments.
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Preventive medicine · Nov 2021
Systematic review of risk and protective factors for suicidal and self-harm behaviors among children and adolescents involved with cyberbullying.
Cyberbullying is associated with increased risk of suicidal and self-harm behaviors in children and adolescents. However, no review to date has explored factors that exacerbate and mitigate this relationship. This systematic review concerns research on factors that influence the impact of cyberbullying on suicidal and self-harm behaviors. ⋯ School connectedness, restrictive style of parenting, parental support, life satisfaction, having a healthy diet, personal skills and having family dinners were associated with less risk of suicidal and self-harm behaviors following cyberbullying. These protective factors suggest prevention strategies to reduce the impacts of cyberbullying by teaching better personal skills, promoting school social connections and proposing family interventions. More research is needed including exploration of the differential impacts of different forms of cyberbullying, and evaluations of the impacts of programs to increase personal skills, improve family relationships and foster school connectedness to reducing suicidal and self-harm behaviors in this vulnerable population.
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Preventive medicine · Nov 2021
The three-step theory of suicide: Description, evidence, and some useful points of clarification.
There has been considerable uptake of the Three-Step Theory (3ST) of suicide since its publication in 2015. The 3ST is a concise, evidence-based, and actionable theory that explains suicide in terms of four factors: pain, hopelessness, connection, and capability for suicide. The 3ST has not only been cited in hundreds of scientific papers, but incorporated into continuing education programs, gatekeeper training, and self-help resources. ⋯ Thus, the present article describes the 3ST, provides an updated evidence review for each of its premises, and offers several points of clarification so that the claims of the 3ST may be better understood, evaluated, and applied. To date, research (including research on correlates, risk factors, motivations, warning signs, and means-safety interventions) supports the 3ST. At the same time, there are aspects of the theory that are challenging to operationalize and that require further testing.
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Preventive medicine · Nov 2021
An integrative systematic review of online resources and interventions for people bereaved by suicide.
Suicide bereavement is frequent in the general population and it can have deleterious consequences on the mental health and social functioning of the bereaved individuals. However, those bereaved can face substantial barriers to receive support, and online resources may improve the accessibility of support. This systematic review aimed at examining the use and benefits of online resources dedicated to people bereaved by suicide and appraising the quality of the research in this field. ⋯ People bereaved by suicide use online resources to seek and share support, share and find information, memorialize their loved one and for meaning-making. Negative effects of online resources are rare. The evidence on the use and benefits of online resources for people bereaved by suicide remains scarce but show encouraging results regarding their positive impact on the mental and psychosocial health of the users.