Preventive medicine
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Preventive medicine · Nov 2021
Challenges of addressing opioid use disorder in rural settings: A state perspective.
Rural states and communities continue to face significant challenges as they work to address the ongoing opioid epidemic and to implement specific strategies for prevention and treatment of opioid use disorder (OUD) and other substance use disorders (SUDs). While a growing number of innovative strategies have been identified that can offer promise for rural communities, state and clinical leaders from rural communities will need to identify evidence-based approaches that can work best in their communities, and ways to tailor options to meet their unique needs. This article identifies a set of five considerations for rural states and communities as they continue their work to identify solutions to this deadly epidemic.
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This article updates a 2006 review of empirical data concerning whether clinicians can predict whether patients will die by suicide, or whether fatality can be prevented. Based on further empirical data, a negative conclusion remains justified. There is good evidence that treatment programs, using psychotherapy and medication, can reduce suicide attempts. ⋯ Research on suicide prevention has not shown that fatalities among patients can be predicted, or that clinical interventions can reduce the risk. The strongest evidence for prevention derives from reducing access to means. Population-based strategies are more effective than high-risk strategies focusing on patients with suicidal ideas or attempts.
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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
ReviewContributing factors to suicide: Political, social, cultural and economic.
This review summarizes recent research in four environmental areas affecting risk of deaths by suicide. Politically, the weight of the evidence suggests that laws increasing social welfare expenditures and other policies assisting persons with low incomes (e.g., minimum wage) tend to lower suicide rates. Other legal changes such as those restricting firearms and alcohol availability can also prevent suicides. ⋯ At the individual level of analysis, two of the strongest predictors of suicide are economic ones: unemployment and low socio-economic status. Attention is drawn to enhancing the minimum wage as a policy known to lower state suicide rates. Limitations of research include model mis-specification, conflicting results especially when ecological data are employed, and a need for more research exploring moderators of established patterns such as that between religiousness and suicide.