We conducted a pilot randomized controlled trial (RCT) to explore whether a hospital inpatient addiction consult team (Substance Use Treatment and Recovery Team START) based on collaborative care was ...feasible, acceptable to patients, and whether it could improve uptake of medication in the hospital and linkage to care after discharge, as well as reduce substance use and hospital readmission. The START consisted of an addiction medicine specialist and care manager who implemented a motivational and discharge planning intervention.
We randomized inpatients age ≥ 18 with a probable alcohol or opioid use disorder to receive START or usual care. We assessed feasibility and acceptability of START and the RCT, and we conducted an intent-to-treat analysis on data from the electronic medical record and patient interviews at baseline and 1-month postdischarge. The study compared RCT outcomes (medication for alcohol or opioid use disorder, linkage to follow-up care after discharge, substance use, hospital readmission) between arms by fitting logistic and linear regression models.
Of 38 START patients, 97 % met with the addiction medicine specialist and care manager; 89 % received ≥8 of 10 intervention components. All patients receiving START found it to be somewhat or very acceptable. START patients had higher odds of initiating medication during the inpatient stay (OR 6.26, 95 % CI = 2.38–16.48, p < .001) and being linked to follow-up care (OR 5.76, 95 % CI = 1.86–17.86, p < .01) compared to usual care patients (N = 50). The study found no significant differences between groups in drinking or opioid use; patients in both groups reported using fewer substances at the 1-month follow-up.
Pilot data suggest START and RCT implementation are feasible and acceptable and that START may facilitate medication initiation and linkage to follow-up for inpatients with an alcohol or opioid use disorder. A larger trial should assess effectiveness, covariates, and moderators of intervention effects.
•A hospital consult team consisting of an addiction medicine specialist and care manager is feasible and acceptable.•Patients receiving the intervention may be more likely to initiate medication and be linked to follow-up care.•Patients in both study conditions reduced their use in the one month after discharge.
Heart failure (HF) affects more than 6 million adults in the US and more than 64 million adults worldwide, with 50% prevalence of depression. Patients and clinicians lack information on which ...interventions are more effective for depression in HF.
To compare the effectiveness of behavioral activation psychotherapy (BA) vs antidepressant medication management (MEDS) on patient-centered outcomes inpatients with HF and depression.
This pragmatic randomized comparative effectiveness trial was conducted from 2018 to 2022, including 1-year follow-up, at a not-for-profit academic health system serving more than 2 million people from diverse demographic, socioeconomic, cultural, and geographic backgrounds. Participant included inpatients and outpatients diagnosed with HF and depression, and data were analyzed as intention-to-treat. Data were analyzed from 2022 to 2023.
BA is an evidence-based manualized treatment for depression, promoting engagement in personalized pleasurable activities selected by patients. MEDS involves the use of an evidence-based collaborative care model with care managers providing coordination with patients, psychiatrists, and primary care physicians to only administer medications.
The primary outcome was depressive symptom severity at 6 months, measured using the Patient Health Questionnaire 9-Item (PHQ-9). Secondary outcomes included physical and mental health-related quality of life (HRQOL), measured using the Short-Form 12-Item version 2 (SF-12); heart failure-specific HRQOL, measured using the Kansas City Cardiomyopathy Questionnaire; caregiver burden, measured with the Caregiver Burden Questionnaire for Heart Failure; emergency department visits; readmissions; days hospitalized; and mortality at 3, 6, and 12 months.
A total of 416 patients (mean SD age, 60.71 15.61 years; 243 58.41% male) were enrolled, with 208 patients randomized to BA and 208 patients randomized to MEDS. At baseline, mean (SD) PHQ-9 scores were 14.54 (3.45) in the BA group and 14.31 (3.60) in the MEDS group; both BA and MEDS recipients experienced nearly 50% reduction in depressive symptoms at 3, 6, and 12 months (eg, mean SD score at 12 months: BA, 7.62 (5.73); P < .001; MEDS, 7.98 (6.06); P < .001; between-group P = .55). There was no statistically significant difference between BA and MEDS in the primary outcome of PHQ-9 at 6 months (mean SD score, 7.53 5.74 vs 8.09 6.06; P = .88). BA recipients, compared with MEDS recipients, experienced small improvement in physical HRQOL at 6 months (mean SD SF-12 physical score: 38.82 11.09 vs 37.12 10.99; P = .04), had fewer ED visits (3 months: 38% 95% CI, 14%-55% reduction; P = .005; 6 months: 30% 95% CI, 14%-40% reduction; P = .008; 12 months: 27% 95% CI, 15%-38% reduction; P = .001), and spent fewer days hospitalized (3 months: 17% 95% CI, 8%-25% reduction; P = .002; 6 months: 19% 95% CI, 13%-25% reduction; P = .005; 12 months: 36% 95% CI, 32%-40% reduction; P = .001).
In this comparative effectiveness trial of BA and MEDS in patients with HF experiencing depression, both treatments significantly reduced depressive symptoms by nearly 50% with no statistically significant differences between treatments. BA recipients experienced better physical HRQOL, fewer ED visits, and fewer days hospitalized. The study findings suggested that patients with HF could be given the choice between BA or MEDS to ameliorate depression.
ClinicalTrials.gov Identifier: NCT03688100.
Illnesses transmitted by food and water cause a major disease burden in the United States despite advancements in food safety, water treatment, and sanitation. We report estimates from a structured ...expert judgment study using 48 experts who applied Cooke's classical model of the proportion of disease attributable to 5 major transmission pathways (foodborne, waterborne, person-to-person, animal contact, and environmental) and 6 subpathways (food handler-related, under foodborne; recreational, drinking, and nonrecreational/nondrinking, under waterborne; and presumed person-to-person-associated and presumed animal contact-associated, under environmental). Estimates for 33 pathogens were elicited, including bacteria such as Salmonella enterica, Campylobacter spp., Legionella spp., and Pseudomonas spp.; protozoa such as Acanthamoeba spp., Cyclospora cayetanensis, and Naegleria fowleri; and viruses such as norovirus, rotavirus, and hepatitis A virus. The results highlight the importance of multiple pathways in the transmission of the included pathogens and can be used to guide prioritization of public health interventions.
Given school psychology's longstanding workforce shortages, mentorship may be an invaluable mechanism for supporting current and future school psychologists. To advance the literature in this area, ...we conducted a systematic review of mentoring research in school psychology. Through a comprehensive search of peer-reviewed scholarship, we identified 16 empirical studies published between 1988 and 2020 that directly examined mentoring. We then performed a qualitative thematic synthesis of their findings. Results indicated several benefits of mentoring, including support for mentees' career planning and psychosocial well-being. All studies were cross-sectional, and the majority did not consider the intersection of race and ethnicity with mentoring experiences; however, several described barriers to mentoring for individuals with racial, ethnic, sex, and gender minoritized identities. Findings indicate a need for more methodologically diverse research that centers the voices of mentors and protégés from traditionally marginalized backgrounds. Implications for reconceptualizing mentoring research and practice are discussed.
Impact Statement
Between 1988 and 2020, only 16 published studies examined mentoring experiences and outcomes among school psychology practitioners, faculty, and trainees. A review of these studies revealed a variety of career and psychosocial benefits of mentoring; however, it also indicated racial, ethnic, sex, and gender inequities in mentoring experiences. Findings indicate a need for additional well-designed research that centers the voices of people with traditionally marginalized identities.
The 2013-2016 Ebola virus disease (EVD) epidemic resulted in more infections and deaths than all prior outbreaks in the 40-year history of this virus combined. This study examines how experiences of ...EVD infection, and preventive measures such as social distancing, were linked to experiences of stigma and social exclusion among those reintegrating into their communities. Key informant interviews (n = 42) and focus group discussions (n = 27) were conducted in districts with a high prevalence of EVD and representing geographical and ethnic diversity (n = 228 participants). The final sample was composed of adults (52%) and children (48%) who were EVD-infected (46%) and -affected (42%) individuals, and community leaders (12%). Data were coded using a Grounded Theory approach informed by Thematic Content Analysis, and analyzed using NVivo. Interrater reliability was high, with Cohen's kappa = 0.80 or higher. Interpretation
Schizophrenia is a severe mental disorder affecting ∼1% of the world population, with heritability of up to 80%. To identify new common genetic risk factors, we performed a genome-wide association ...study (GWAS) in the Han Chinese population. The discovery sample set consisted of 3,750 individuals with schizophrenia and 6,468 healthy controls (1,578 cases and 1,592 controls from northern Han Chinese, 1,238 cases and 2,856 controls from central Han Chinese, and 934 cases and 2,020 controls from the southern Han Chinese). We further analyzed the strongest association signals in an additional independent cohort of 4,383 cases and 4,539 controls from the Han Chinese population. Meta-analysis identified common SNPs that associated with schizophrenia with genome-wide significance on 8p12 (rs16887244, P = 1.27 × 10(-10)) and 1q24.2 (rs10489202, P = 9.50 × 10(-9)). Our findings provide new insights into the pathogenesis of schizophrenia.
Creating Compassion is an empathy-focused creative arts curriculum designed to provide short-term, low-cost, high-quality social-emotional learning (SEL) to communities and settings with limited ...resources. The present study sought to determine whether Creating Compassion was effective for increasing displays of prosocial behaviors and broad SEL skills for early elementary school students (n = 9) through a multiple baseline single-case design, as empathy has previously been posited as a core factor in global social-emotional skill development. Results from this study confirmed the hypothesis that Creating Compassion would increase observed prosocial behaviors with moderate effectiveness for children in first, second, and third grades, including those with identified social-emotional skill deficits. Participant scores on a pre/post assessment of global SEL competence also increased after intervention. Ultimately, findings from this study suggest the Creating Compassion intervention might be used by school psychologists and other group interventionists to expose their school communities to arts programming and engage them in a fun and creative approach to accessible early SEL intervention.
Impact Statement
This paper presents results from a combined arts and empathy training intervention, Creating Compassion. As an empathy-focused intervention, implementation of Creating Compassion led to increases in displays of prosocial behavior with moderate effectiveness. Increases in participants' levels of overall SEL skill competence were also observed. Results from this study support the provision of a high-quality, low-cost, arts-based SEL program to benefit Low-Income and Economically Marginalized (LIEM) communities within educational settings.
To describe national antibiotic prescribing for acute gastroenteritis (AGE).
Ambulatory care.
We included visits with diagnoses for bacterial and viral gastrointestinal infections from the National ...Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (NAMCS/NHAMCS; 2006-2015) and the IBM Watson 2014 MarketScan Commercial Claims and Encounters Database. For NAMCS/NHAMCS, we calculated annual percentage estimates and 99% confidence intervals (CIs) of visits with antibiotics prescribed; sample sizes were too small to calculate estimates by pathogen. For MarketScan, we used Poisson regression to calculate the percentage of visits with antibiotics prescribed and 95% CIs, including by pathogen.
We included 10,210 NAMCS/NHAMCS AGE visits; an estimated 13.3% (99% CI, 11.2%-15.4%) resulted in antibiotic prescriptions, most frequently fluoroquinolones (28.7%; 99% CI, 21.1%-36.3%), nitroimidazoles (20.2%; 99% CI, 14.0%-26.4%), and penicillins (18.9%; 99% CI, 11.6%-26.2%). In NAMCS/NHAMCS, antibiotic prescribing was least frequent in emergency departments (10.8%; 99% CI, 9.5%-12.1%). Among 1,868,465 MarketScan AGE visits, antibiotics were prescribed for 13.8% (95% CI, 13.7%-13.8%), most commonly for
(46.7%; 95% CI, 21.4%-71.9%),
(44.8%; 95% CI, 41.5%-48.1%),
(39.7%; 95% CI, 35.9%-43.6%), typhoid or paratyphoid fever (32.7%; (95% CI, 27.2%-38.3%), and nontyphoidal
(31.7%; 95% CI, 29.5%-33.9%). Antibiotics were prescribed for 12.3% (95% CI, 11.7%-13.0%) of visits for viral gastroenteritis.
Overall, ∼13% of AGE visits resulted in antibiotic prescriptions. Antibiotics were unnecessarily prescribed for viral gastroenteritis and some bacterial infections for which antibiotics are not recommended. Antibiotic stewardship assessments and interventions for AGE are needed in ambulatory settings.
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