Preventive medicine
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Rural communities suffer from significant disparities in cardiovascular health. The reasons for worse cardiovascular health and outcomes is due to a number of factors including economic, educational, and healthcare access. This commentary draws attention to these challenges and highlights how telemedicine may reduce a portion of this gap. In particular, an opportunity to modify cardiac rehabilitation programs to include a remotely-administered model using telemedicine is a novel method that holds promise.
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Preventive medicine · Nov 2021
Randomized Controlled TrialPosttraumatic stress disorder in individuals seeking treatment for opioid use disorder in vermont.
Posttraumatic stress disorder (PTSD) and opioid use disorder (OUD) may be associated with poor outcomes in rural areas where access to mental health services and opioid agonist treatment (OAT) is limited. This study examined the characteristics associated with a history of PTSD among a sample of individuals seeking buprenorphine treatment for OUD in Vermont, the second-most rural state in the US. Participants were 89 adults with OUD who participated in one of two ongoing randomized clinical trials examining the efficacy of an interim buprenorphine dosing protocol for reducing illicit opioid use during waitlist delays to OAT. ⋯ PTSD- individuals (ps < 0.05). These findings indicate that a history of PTSD is prevalent and associated with worse outcomes among individuals seeking treatment for OUD in Vermont. Dissemination of screening measures and targeted interventions may help address the psychiatric and medical needs of rural individuals with OUD and a history of PTSD.
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Preventive medicine · Nov 2021
Randomized Controlled TrialCumulative vulnerabilities as a potential moderator of response to reduced nicotine content cigarettes.
Risk for smoking increases in a summative manner corresponding to the number of co-occurring vulnerabilities present (cumulative vulnerability). We examined whether cumulative vulnerabilities moderate response to reduced nicotine content cigarettes in a secondary analysis of results from 775 participants in three 12-week randomized clinical trials examining research cigarettes varying in nicotine content (0.4, 2.4, 15.8 mg nicotine/g tobacco). Participants were categorized as having 0-1, 2-3, or ≥ 4 cumulative vulnerabilities. ⋯ The only exception across the other outcomes was on Questionnaire-on-Smoking-Urges Factor-2 ratings for usual-brand cigarettes where cumulative vulnerability, dose, and time interacted (P = 0.007), with craving at the 0.4 and 2.4 mg/g doses decreasing over time, but inconsistently across vulnerability categories. Overall, we saw little evidence that cumulative vulnerabilities moderate response to reduced nicotine content cigarettes suggesting that a policy reducing nicotine content in cigarettes to minimally addictive levels could benefit even highly vulnerable smokers including those residing in rural or other regions with overrepresentation of co-occurring vulnerabilities. Clinicaltrials.gov identifiers: NCT02232737, NCT02250664, NCT02250534.
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Preventive medicine · Nov 2021
ReviewSuicide, firearms, and legislation: A review of the Canadian evidence.
Suicide accounts for approximately 4000 deaths a year in Canada, of which about 16% of those are suicide using a firearm. Canada has undertaken legislative efforts to regulate and control firearms, Bill C-51 in 1977 and Bills C-17 and C-68 in 1991 and 1995. Regulatory approaches that decrease the availability of firearms are hypothesized to reduce suicide by firearm however the substitution effect suggests it is possible that people may substitute other methods of suicide in place. ⋯ Six studies examining the effects of Bill C-17 and C-68 revealed a decrease in the rates of suicide by firearms, with a corresponding increase in non-firearms suicide rates and no decrease in overall suicide rates. One study even suggested no associated decrease in firearm suicide rates with an increasing rate of suicide by hanging possibly due to changes in preferences. These results suggest legislation has mixed effects on firearm suicide rates and may not alone reduce overall suicide in Canada.
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Preventive medicine · Nov 2021
Frequent follow-up of suicidal youth assessed in the emergency room: Long-term trajectory and predictors of suicidality.
Suicide was the second‑leading cause of US deaths in 2018 among 15-24-year-olds. Suicide attempts, a risk factor for completions, and suicide ideation have doubled among pediatric emergency room (ER) patients during the past decade. Borderline Personality Disorder (BPD), a comorbid condition, has a 10% suicide rate. We examined the 4-year outcome of a cohort of suicidal adolescents, many also suffering from BPD and having undergone some form of treatment, to identify baseline factors which could inform intervention that would minimize suicidality 4 years post-discharge.