34,000 healthcare professionals surveyed indicate they have higher bias against transgender people

Peer-Reviewed Publication

CELL PRESS

 

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A SCREENSHOT OF THE TRANSGENDER IAT PROCEDURE

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CREDIT: HELIYON/DERBYSHIRE ET AL.

By analyzing data from the Harvard Implicit Association Test—a widely accepted measure of a person’s attitudes toward people based on characteristics like race, gender, and sexuality—researchers find that healthcare professionals, and in particular nurses, are more biased against transgender people than are people who are not healthcare professionals. A questionnaire administered before and after the test shows that healthcare professionals are less likely to know transgender people personally and that nurses are more likely to conflate sex and gender identity. These results are reported November 3 in the journal Heliyon.

The Implicit Association Test works by asking participants to categorize groups of people with “good” words like “nice” or “laughter” and “bad” words like “nasty” or “rotten.” Its results are collected by a team of scientists as a part of Project Implicit since 1998 and are made available for use by the public and other researchers.

To specifically assess the attitudes of healthcare professionals towards transgender people, the researchers focused on a subset of the respondents from 2020 to 2022, including 11,996 nursing healthcare professionals and 22,443 non-nursing healthcare professionals. These responses were compared to 177,810 responses of non-healthcare professionals.

A person’s bias is reported as their “D-score,” which can range from -2 to 2, with higher scores indicating more anti-transgender views. The standard classification for this test lists values over 0.15 as “slightly biased,” and over 0.35 and 0.65 as “moderately” and “strongly” biased, respectively.

Non-healthcare professionals on average reported a D-score of 0.116, which is considered to mean that they have little to no bias. However, healthcare professionals (non-nursing), reported an elevated score of 0.149, which is on the edge of what is considered to be “slightly biased.” The average D-score for nursing healthcare professionals was 0.176, which falls clearly within the range of “slightly biased.”

The participants’ D-score assesses their implicit bias—their true beliefs which they may be too reluctant to share—but their explicit bias, or their self-reported views, were assessed by a questionnaire.

Nursing healthcare professionals were significantly more likely to agree with statements like “I believe a person can never change their gender” or “I think there is something wrong with a person who says they are neither a man nor a woman” compared to other healthcare professionals and non-healthcare professionals.

“Our finding that nurses have higher levels of implicit bias towards transgender people may be related to a tendency to conflate sex and gender identity, as shown by higher levels of agreement with transphobic statements that conflate these two distinct concepts,” write authors Daniel W. Derbyshire (@DWDerbyshire) of the University of Exeter and Tamsin Keay of Coventry University.

The questionnaire also asked about the participants’ relationships with transgender people in their daily lives. While healthcare professionals—including nurses and non-nurses—were more likely to have met a transgender person than non-healthcare professionals, they reported that they were less likely to have a transgender friend or family member.

“This suggests that healthcare professionals’ (both nurses and non-nurses) experience of interacting with transgender people may be largely confined to a work context,” write the authors.

The authors note that the participants in this test are limited to those who visited the Project Implicit website and chose to complete the test. “As such, the sample may be subject to sample selection bias in terms of the demographics and Implicit Association Test (IAT) results of participants,” write the authors. “However, it may be anticipated that people with particularly negative attitudes towards transgender people would avoid taking the Transgender IAT and the results presented here may therefore under-represent the extent of implicit bias towards transgender people.”

 

Images of transgender people used in the Implicit Association test

 

Images of cisgender people used in the Implicit Association test

CREDIT

Heliyon/Derbyshire et al.

Heliyon, Derbyshire et al. “Nurses’ Implicit and Explicit Attitudes towards Transgender People and the need for Trans-Affirming Care” https://cell.com/heliyon/fulltext/S2405-8440(23)07970-7

Heliyon (@HeliyonJournal), part of the Cell Press family, is an open access journal publishing scientifically accurate and valuable research across life, physical, social, and medical sciences journal. Visit https://www.cell.com/heliyon. To receive Cell Press media alerts, contact press@cell.com.

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JOURNAL

Heliyon

DOI

10.1016/j.heliyon.2023.e20762 

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Nurses’ Implicit and Explicit Attitudes towards Transgender People and the need for Trans-Affirming Care

ARTICLE PUBLICATION DATE

3-Nov-2023

 

Health care expenditures for black and white adults living under similar conditions

JAMA Health Forum

Peer-Reviewed Publication

JAMA NETWORK

About The Study: In this study of a nationally representative sample of 7,062 non-Hispanic Black or white adults, health care spending for Black adults in the U.S. was equal to or less than that of white adults, but only in areas of racial and economic equity and equitable insurance access. The results underscore the continuing need to recognize place as a contributor to race-based differences in health care spending. 

Authors: Lorraine T. Dean, Sc.D., of the Johns Hopkins Bloomberg School of Public Health in Baltimore, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamahealthforum.2023.3798)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Embed this link to provide your readers free access to the full-text article 

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About JAMA Health Forum: JAMA Health Forum is an international, peer-reviewed, online, open access journal that addresses health policy and strategies affecting medicine, health and health care. The journal publishes original research, evidence-based reports and opinion about national and global health policy; innovative approaches to health care delivery; and health care economics, access, quality, safety, equity and reform. Its distribution will be solely digital and all content will be freely available for anyone to read.

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JOURNAL

JAMA Health Forum

Black and white adults have similar health care expenditure levels in racially and economically integrated communities

In integrated communities, Black adults spent $79 less than whites on health expenditures per year; in non-integrated communities, Black adults spent $2,145 less on health care per year than whites

Peer-Reviewed Publication

JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH

Differences in health care expenditures between Black and white adults vary substantially with the local level of racial and economic integration, and tend to be low or nonexistent in highly integrated communities, according to a study led by researchers at the Johns Hopkins Bloomberg School of Public Health.

For their study, the researchers compared health care expenditures for a nationally representative sample of Black and white adults in census tracts across the United States. They found that, at the same level of health, health expenditures by Black adults were much lower than white adults’ in census tracts with the lowest levels of racial integration but were virtually the same in tracts where the level of integration was highest. The researchers also found that more-integrated areas also had signs of more equitable health access for Black and white adults.

Individuals’ health expenditures are indicators of people’s health needs and the types of health care they may or may not be able to access. The findings add to evidence that health disparities between Black and white adults are largely attributable to social factors that can be changed.

The study was published online November 3 in JAMA Health Forum.

“Fixing health care disparities may require both health care and non-health care solutions—making sure people have health insurance and that the resources they have based on where they live give them the best opportunities to be healthy,” says study lead author Lorraine Dean, ScD, an associate professor in the Bloomberg School’s Department of Epidemiology. “We already knew from previous research that health disparities mostly disappeared when Black and white adults lived in more equitable areas—now we know that extends to health care expenditures, too.”

Because of external factors—including different levels of exposure to poverty, economic opportunity, health care access, and neighborhood environments—life expectancy, disease risk, health outcomes, and other health care-related measures have long been known to differ between white and Black Americans. Black adults on average have shorter lives and higher rates of common ailments including diabetes, hypertension, and kidney disease.

A 2011 study, also by Bloomberg School researchers including a co-author of the new study, Darrell Gaskin, PhD, the William C. and Nancy F. Richardson Professor in the Bloomberg School’s Department of Health Policy and Management, described a racially and socioeconomically integrated area of Baltimore in which disparities in the rates of hypertension, diabetes, and other health measures were much lower than national averages, and for some measures disappeared entirely. The study used the term “place, not race” to capture the findings.

In the new study, Dean and colleagues addressed the closely related issue of whether health care expenditures vary with the level of racial and socioeconomic integration.

For their analysis, the researchers used data from a 2016 U.S. government survey called the Medical Expenditure Panel Survey (MEPS), which included data on race, socioeconomic status, health status, health care access, health care use, and health care expenditures (including insurer payments) for a nationally representative sample of Americans. The investigators also used data on each MEPS participant’s community levels of racial and socioeconomic integration, based on the U.S. Census Bureau’s American Community Survey (ACS) for 2013–17.

The analysis covered a total of 7,062 adult MEPS participants age 21 or older—one-third of them Black, two-thirds white—living in 2,238 census tracts where the population was at least five percent Black.

For each of these census tracts, the researchers used census data to calculate a measure of socioeconomic and Black/white integration called the Index of Concentration at the Extremes (ICE). They defined this as the number of non-Hispanic white adults in high-income (≥$100,000) households minus the number of non-Hispanic Black persons in low-income (<$20,000) households, divided by the total population with known income in that census tract.

The analysis, which adjusted for potential confounding factors such as age, sex, and education level, found that in communities where the ICE was highest—many high-income white adults, few low-income Black adults—racial disparities in health care expenditures were pronounced. In these relatively non-integrated communities, Black adults spent $2,145 less on health care per year compared to white adults. These differences could reflect undertreatment for Black adults or overuse of health care by white adults. By contrast, in communities where the ICE was in a medium range, indicating the highest level of racial and socioeconomic integration, these expenditure disparities mostly disappeared—the computed difference in overall annual expenditure being a mere $79.

In the least integrated communities, where Black adults had lower overall health care expenditures, they still had levels of physical health similar to white adults’. Their lower overall expenditures were driven mainly by lower doctor’s-office, prescription drug, and dental expenditures. But in highly integrated areas, differences in individual expenditure categories were minimized. The most integrated areas also had relatively equitable health care access, according to MEPS data.

On the whole, the researchers say, the findings suggest that reducing health care expenditure disparities between Blacks and whites is possible, though it might be much easier to achieve in areas where socioeconomic and health care access disparities are minimized.

“Health care expenditures for Black and White US Adults Living Under Similar Conditions” was co-authored by Lorraine Dean, Yuehan Zhang, Rachael McCleary, Rahel Dawit, Roland Thorpe, and Darrell Gaskin.

Funding for the study was provided by the National Institute on Minority Health and Health Disparities (U54MD000214) and the National Heart, Blood, and Lung Institute (R01HL164116).

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JOURNAL

JAMA Health Forum

Disclaimer: AAAS and EurekAler

 

Large herbivores such as elephants, bison and moose contribute to tree diversity

Peer-Reviewed Publication

LUND UNIVERSITY

Using global satellite data, a research team has mapped the tree cover of the world’s protected areas. The study shows that regions with abundant large herbivores in many settings have a more variable tree cover, which is expected to benefit biodiversity overall.

Maintaining species-rich and resilient ecosystems is key to preserving biodiversity and mitigating climate change. Here, megafauna – the part of the animal population in an area that is made up of the largest animals – plays an important role. In a new study published in the scientific journal One Earth, an international research team, of which Lund University is a part, has investigated the intricate interplay between the number of voracious herbivores and the diversity of trees in the world’s protected areas.

“Our findings reveal a fascinating and complex story of how large herbivorous animals shape the world’s natural landscapes. The tree cover in these areas is sparser, but the diversity of the tree cover is much higher than in areas without large herbivores,” says Lanhui Wang, a researcher in physical geography and ecosystem science at Lund University.

“In our global analysis, we find a substantial association between the biomass of large herbivores and varied tree cover in protected areas, notably for browsers and mixed-feeders such as elephants, bison and moose and in non-extreme climates”, explains the study’s senior author, Jens-Christian Svenning, professor at Aarhus University.

Hereby, the study supports that large wild herbivores promote a diverse vegetation structure, creating a rich habitat for many other species. This is due to the animals’ consumption of vegetation as well as physical disturbances. 

According to Lanhui Wang, these new research findings highlight the need to integrate large herbivores into restoration and conservation strategies. Not only for the sake of the animals themselves but also for the vital role they play in shaping landscapes and influencing biodiversity. The researchers argue that this aspect is not sufficiently considered within the framework of sustainable land management and ecosystem restoration.

“At a time when global initiatives are intensely focused on combating climate change and biodiversity loss, our findings highlight the need for a broader and more nuanced discussion about ecosystem management and conservation measures. It is of utmost importance to integrate understanding of the ecological impact of megafauna into this,” says Lanhui Wang.

The UN has declared the 2020s as the decade of ecosystem restoration. In total, 115 countries have agreed to restore up to 100,000 square kilometres of nature in total. To achieve this, more wild-living large herbivores are needed worldwide, says Lanhui Wang.

“I believe that we will need to protect and conserve large herbivores to achieve the UN goals. Megafauna are crucial for tree cover, which in turn promotes carbon sequestration and a diversity of habitats,” says Lanhui Wang.

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JOURNAL

One Earth

DOI

10.1016/j.oneear.2023.10.007 

ARTICLE TITLE

Tree cover and its heterogeneity in natural ecosystems is linked to large herbivore biomass globally

ARTICLE PUBLICATION DATE

1-Nov-2023

 

The kids aren't alright: Saplings reveal how changing climate may undermine forests

UArizona researchers studied how young trees respond to a hotter, drier climate. Their findings can help shape forest management policy and our understanding of how landscapes will change

Peer-Reviewed Publication

UNIVERSITY OF ARIZONA

 

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AFTER 20 WEEKS OF DROUGHT AND A ONE-WEEK HEAT WAVE, THE DOUGLAS FIR SAPLINGS WERE DRY AND BRITTLE.

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CREDIT: ALEXANDRA LALOR

As climate scientist Don Falk was hiking through a forest, the old, green pines stretched overhead. But he had the feeling that something was missing. Then his eyes found it: a seedling, brittle and brown, overlooked because of its lifelessness. Once Falk's eyes found one, the others quickly fell into his awareness. An entire generation of young trees had died.

Falk – a professor in the UArizona School of Natural Resources and the Environment, with joint appointments in the Laboratory of Tree-Ring Research and the Arizona Institute for Resilience – refers to this large-scale die-off of the younger generation of trees as a recruitment failure. This is particularly devastating for a population of trees because the youngest are essential for forest recovery following massive die-off events, such as severe wildfires and insect outbreaks, both of which will become more frequent as the climate continues to change, he said.

To better understand how extreme climate conditions might trigger recruitment failure, Falk and his co-authors examined how five species of 4-year-old trees responded to extended drought and heat.

They found that different species had different levels of drought tolerance and that all species were more tolerant of the heat wave than expected. Their findings were published in the journal Frontiers in Forests and Global Change.

In general, older trees are more tolerant of tougher conditions, Falk said. But when there are massive die-off events – which can be caused by drought and heat, sometimes with associated insects, pathogens or wildfire – tree populations become dependent on their ability to regenerate.

"When scientists make models about future tree growth based on the conditions an adult tree can tolerate, it might not accurately reflect the future of the forests," Falk said. "That's why we focused on this seedling bottleneck."

The team gathered trees from across five species found at various elevations in the Jemez Mountains of New Mexico. From lowest elevation to highest, this included ponderosa pine, piñon pine, Englemann spruce, Douglas fir and limber pine. They then exposed the young trees to drought and heat conditions in a growth chamber, which allowed them to precisely control temperature, humidity, light and water.

In the first round of the experiment, the team maintained the normal average temperature for each species and simply stopped watering the plants to test their response to drought conditions.

"About 8 weeks out, pretty much every tree was still dealing with it," Falk said. "But then, as the drought got on to 12 and 14 weeks, the ponderosa pine seedlings started to die, and then the piñon seedlings started to die off, then the Engelmann spruce, and the Douglas fir. The ones that lasted longest, which really surprised us (lasting 36 weeks without water) was limber pine."

"You would think that the species that live at lower, warmer elevations would be more drought adapted than trees living at the higher elevation," Falk said. "But the higher elevation trees – the Douglas fir and limber pine – grow in the coolest temperatures and lived the longest. It appears that the trees are only as drought tolerant as they need to be. As climate change progresses, it will put more stress on the trees, and then there'll probably be selection for those more drought- tolerant traits."

Next, the team simulated an average heat wave by cranking up the temperature by 10 degrees for all species for one week.

As a result, each species died out in the exact same order, and died only slightly sooner.

"These results surprised me in a couple of ways," said co-author and UArizona professor emeritus David Breshears. "First, heat waves do indeed matter, but I expected them to have a larger effect than they did. So, they're important, but the underlying drought and average warming seem to be the key drivers. Second, we found limber pine was the heartiest species and this has important implications for how our landscapes are likely to change."

In their next experiment, the team plans to intensify the heat wave, Falk said.

"We need this type of information to help forest managers know what to expect next and guide what to plant following wildfire or other large die-off events of adult trees," Breshears said.

UArizona graduate student Alexandra Lalor, who graduated with her master's degree in Natural Resources Studies, with emphasis in Fire Ecology in December 2022, led the paper. Co-authors include professor Greg Barron-Gafford in the School of Geography, Development and Environment, assistant research professor Jason Field in the School of Natural Resources and the Environment, former UArizona colleague Darin Law and others from the United Sates Geological Survey and USDA Forest Service. The research was supported by the USGS Southwest Climate Adaptation Science Center.

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JOURNAL

Frontiers in Forests and Global Change

DOI

10.3389/ffgc.2023.1198156 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Mortality thresholds of juvenile trees to drought and heatwaves: implications for forest regeneration across a landscape gradient

 

America’s low-carbon transition could improve employment opportunities for all

Peer-Reviewed Publication

IMPERIAL COLLEGE LONDON

The USA is likely to see consistent job growth from the transition to net zero, but the gains will be unevenly distributed, shows a new analysis.

The analysis, conducted by Imperial College London researchers and published today in Nature Climate Change, shows that some states will need new policies to ensure a ‘just’ transition.

The USA, alongside many countries, is planning for a low-carbon future, where energy production releases little to no carbon dioxide and what is released is removed from the atmosphere, creating net-zero carbon emissions. This has been backed by new policies, including the 2022 Inflation Reduction Act, which includes large investment into domestic clean energy production.

This move to renewable energy sources is essential to curb global heating, but its impact on employment is uncertain. Now, researchers from Imperial College London have carried out an analysis to understand what kinds of jobs are likely to be created at a state level, and the societal implications of different scenarios for low carbon transitions in the US electricity system.

They found that decarbonization brings consistent job growth. However, major fossil fuel-producing states need to prepare for fewer mining jobs by looking to create other opportunities.

The analysis shows lowest-skilled workers will experience more uncertain employment outcomes, so states need to plan carefully to make sure the energy transition is ‘just’ – fair to all. Sizable new opportunities will be available to workers with some training though, in the utilities and construction sectors.

The team also found that the renewable energy sector generally employs more women, which could boost gender equality in fossil fuel-dependent states, but not enough to disrupt the national gender status quo.

First author Judy Jingwei Xie, from the Centre for Environmental Policy and the Grantham Institute at Imperial, said: “Overall, our analysis is good news: recent policies such as the Inflation Reduction Act will lead to consistent job growth. There are some states currently very reliant on fossil fuel production that could lose out, but there are tools available for them to get ahead of the problem and take advantage of the situation to turn themselves into leaders of the clean energy revolution.

“By boosting retraining opportunities for the existing workforce and training young people in low-carbon technologies, traditional coal-producing states like Wyoming could put themselves at the forefront. The new American Climate Corps can provide these opportunities if it manages to deliver the targeted compensatory support to communities in need.”

To conduct the analysis, the team used the Regional Energy Development System (ReEDS) energy system model developed and maintained by the US National Renewable Energy Laboratory. This includes 70 detailed future energy system scenarios, which they fed into a model of how these would impact employment across states based on their energy profile and demographics.

The wide range of scenarios included the US Long-Term Strategy, which aims for 100% reduction of electricity system carbon emissions by 2035 and showed consistently positive job growth. The team have made their code openly available, allowing integration of new policies, and the ability for models to be created for other countries and regions, as long as the right input data is available.

Co-author Dr Iain Staffell, from the Centre for Environmental Policy at Imperial, said: “A lot of new stuff needs to be built to transform the energy system globally, and the Inflation Reduction Act in the US has created some key conditions for big companies to make this shift.

“The USA and China are ahead in this regard, and if we in the UK want a part of this boon, we need similar policies to incentivise the rapid shift to clean energy, which would boost employment and progress towards global goals of reducing carbon emissions.”

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JOURNAL

Nature Climate Change

DOI

10.1038/s41558-023-01802-5 

ARTICLE TITLE

Distributional labour challenges and opportunities for decarbonizing the US power system

ARTICLE PUBLICATION DATE

2-Nov-2023

 

An exotic tick that can kill cattle is spreading across Ohio

Pasture infestation estimated to exceed 1 million Asian longhorned ticks

Peer-Reviewed Publication

OHIO STATE UNIVERSITY

COLUMBUS, Ohio – A species of exotic tick arrived in Ohio in 2021 in such huge numbers that their feeding frenzy on a southeastern farm left three cattle dead of what researchers believe was severe blood loss.

The scientists from The Ohio State University have reported in the Journal of Medical Entomology on the state’s first known established population of Asian longhorned ticks, and are now conducting research focused on monitoring and managing these pests.

So far, these ticks are not deemed to be a threat to human health. They tend to favor large livestock and wildlife, such as cattle and deer. Just a handful of the hundred ticks from the farm screened for infectious agents tested positive for pathogens, including one, Anaplasma phagocytophilium, that can cause disease in animals and humans. Elsewhere this tick carries another pathogen, Theileria orientalis, that affects cattle, and cases of bovine theileriosis have been reported in Ohio.

Researchers say the tiny brown ticks – the size of a sesame seed in some life stages and pea-sized when engorged – are persistent, however: Surveillance showed they returned the following summer to the farm despite the application of pesticides in 2021.

“They are going to spread to pretty much every part of Ohio and they are going to be a long-term management problem. There is no getting rid of them,” said Risa Pesapane, senior author of the paper and an assistant professor of veterinary preventive medicine at Ohio State.

“The good news about the ticks, though, is that most tick control agents that we currently have seem to kill them. Still, managing them is not easy because of how numerous they are and how easily they can come back.”

Asian longhorned ticks originate from East Asia and were first detected in the United States in New Jersey in 2017. When Pesapane joined Ohio State in 2019 as a tick-borne disease ecologist, the ticks were reported in West Virginia – meaning it was only a matter of time before they crossed the river into Ohio, she said.

She found the first of these ticks in Ohio, on a stray dog in Gallia County in 2020, and another was collected from a cow in Jackson County in June 2021. And then a farmer from Monroe County called Ohio State later that summer to report three of his 18 cattle, heavily infested with ticks, had died.

“One of those was a healthy male bull, about 5 years old. Enormous. To have been taken down by exsanguination by ticks, you can imagine that was tens of thousands of ticks on one animal,” said Pesapane, who also has a faculty appointment in Ohio State’s School of Environment and Natural Resources.

Pesapane and colleagues collected almost 10,000 ticks within about 90 minutes on the farm, leading her to speculate that there were more than 1 million of them in the roughly 25-acre pasture.

Asian longhorned ticks’ secret colonization weapon is the ability to reproduce asexually, with each female laying up to 2,000 eggs at a time – and all 2,000 of those female offspring able to do the same.

“There are no other ticks in North America that do that. So they can just march on, with exponential growth, without any limitation of having to find a mate,” Pesapane said. “Where the habitat is ideal, and anecdotally it seems that unmowed pastures are an ideal location, there’s little stopping them from generating these huge numbers.”

Because of their ability to hide in vegetation, Asian longhorned ticks also can escape pesticides that kill only when coming into direct contact with a pest.

“It would be wisest to target them early in the season when adults become active, before they lay eggs, because then you would limit how many will hatch and reproduce in subsequent years. But for a variety of reasons, I tell people you cannot spray your way out of an Asian longhorned tick infestation – it will require an integrated approach,” Pesapane said.

She and colleagues are working as rapidly as they can at filling in knowledge gaps about these invaders and developing training materials and policy recommendations for affected industries. As one example, Pesapane said, tick inspections of livestock could provide a window for application of an antiparasitic agent to eliminate the risk of transporting the exotic arachnids across multiple state lines.

Ohioans are encouraged to help with research efforts: People who think they’ve spotted an Asian longhorned tick can email ticks@osu.edu for instructions on how to collect the specimen and send it to Ohio State scientists as part of ongoing surveillance. To date, the lab has received Asian longhorned ticks from residents of 11 Ohio counties.

More information about spotting Asian longhorned ticks and preventing tick exposure is available on Ohio State’s Bite Site.

This work was supported by the U.S. Department of Agriculture. Co-authors on the study were Andreas Eleftheriou, Julia Beckett and Ningzhu Bai, all of Ohio State.

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Contact: Risa Pesapane, Pesapane.1@osu.edu

Written by Emily Caldwell, Caldwell.151@osu.edu; 614-292-8152

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JOURNAL

Journal of Medical Entomology

DOI

10.1093/jme/tjad104 

ARTICLE TITLE

An established population of Asian longhorned ticks (Acari: Ixodidae) in Ohio, USA

Opioid disorder treatment: first three weeks forecast success

Peer-Reviewed Publication

COLUMBIA UNIVERSITY IRVING MEDICAL CENTER

NEW YORK, NY--A newly developed prediction model may be able to calculate the risk of opioid relapse among individuals in the early stages of medication treatment—as early as three weeks into therapy. 

“Medication treatment for opioid use disorder, contrary to popular belief, is very effective and likely to succeed if patients achieve early treatment success,” says Sean X. Luo, MD, PhD, assistant professor of psychiatry at Columbia University Vagelos College of Physicians and Surgeons, who developed the model with Daniel Feaster, PhD, of the University of Miami.

The model, based on data from 2,199 adults enrolled in clinical trials of opioid use medications, estimates in the first few weeks of treatment the likelihood that a patient will return to using opioids before the end of a 12-week treatment program.

More specifically, for patients prescribed buprenorphine, increasing dose of an oral formulation or switching to an extended-release injection formulation could be considered quickly. Physicians should also evaluate patients with high risk of relapse for other factors that may need attention, such as co-occurring psychiatric disorders.

To disseminate the tools developed from this project, the team built a web portal (www.oudriskscore.org) that allows clinicians to estimate the risk of relapse of their patients.

What’s next

Although physicians may modify treatment for patients with a high risk of relapse, no studies have been conducted to determine the optimal strategies. “We need new clinical trials that test different treatment modifications among high-risk individuals,” Luo says.

More long-term follow-up data also are needed to estimate timing and probability of relapse beyond the 12-week treatment phase.

The need

The medications methadone, buprenorphine, and extended-release injection naltrexone are effective for many patients, but many patients return to opioid use during the 12-week treatment program.

When treating chronic conditions, physicians often use risk scores to predict the likelihood of future health events and use those scores to guide treatment. But no such risk score is available for opioid use disorder treatment.

“Once a patient relapses and drops out of medication treatment, they are in danger, including risk of overdose, and can be hard to locate and re-engage,” says Columbia psychiatrist Edward Nunes, MD, who co-led the new study. “If physicians know in the first few weeks of treatment who is in danger, they can respond early and hopefully head off trouble.”

Using machine learning to build a predictor

To build a predictor that estimates a patient’s risk of returning to drug use, the researchers applied machine learning techniques to data from previous clinical trials that tested three medications for opioid use disorder. A method called LASSO automatically constructed predictive models using the most informative patient characteristics. The models were then tested on an independent validation subset of the harmonized dataset to assess for model performance. 

Using patient data available at the start of treatment, the best model had a performance of around 70%. Model performance improved substantially when results of urine drug tests in the first three weeks of treatment were incorporated.

When the urine drug tests results are included, the model predicts that patients with no positive or missed drug tests in the first three weeks have a 13% risk of returning to use, whereas those with three positive or missed tests have an 85% risk of return to use.

Why it matters

“Our model now gives clinicians a way to quantify a patient’s risk of relapse early on in treatment and treatment modifications can be considered,” Luo says. “Medication doses can be increased and more frequent monitoring and psychotherapy options introduced for higher risk patients.”

More information

The study, titled "Individual-Level Risk Prediction of Return to Use During Opioid Use Disorder Treatment," was published in JAMA Psychiatry on October 4.

Sean X. Luo, MD, PhD, is assistant professor of psychiatry at Columbia University Vagelos College of Physicians and Surgeons Luo and treats patients with addictions in his private practice.

All study authors: Sean X. Luo (Columbia), Daniel J. Feaster (University of Miami), Ying Liu (Columbia), Raymond R. Balise (Miami), Mei-Chen Hu (Columbia), Layla Bouzoubaa (Miami), Gabriel J. Odom (Florida International University), Laura Brandt (City College of New York), Yue Pan (Miami), Yih-Ing Hser (University of California, Los Angeles), Paul VanVeldhuisen (Emmes Company), Felipe Castillo (Columbia), Anna R. Calderon (Miami), John Rotrosen (New York University), Andrew J. Saxon (University of Washington), Roger D. Weiss (Harvard University), Melanie Wall (Columbia), and Edward V. Nunes (Columbia).

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DOI

10.1001/jamapsychiatry.2023.3596 

METHOD OF RESEARCH

Computational simulation/modeling

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Individual-Level Risk Prediction of Return to Use During Opioid Use Disorder Treatment

COI STATEMENT

Edward Nunes has served as a consultant without compensation for Indivior, Camurus, and Pear Therapeutics and has received in-kind donations of medication or digital therapeutics from Alkermes, Braeburn-Camurus, Indivior, Pear Therapeutics, and CHESS Health. No other disclosures from Columbia authors were reported.

Stigma felt by opioid-dependent moms impacts the health care received by their babies

Findings from University of Missouri study can help emphasize messages of compassion and support toward opioid-dependent mothers

Peer-Reviewed Publication

UNIVERSITY OF MISSOURI-COLUMBIA

 

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PREGNANT WOMAN

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CREDIT: UNIVERSITY OF MISSOURI

COLUMBIA, Mo. -- The rate of opioid use among pregnant women in the United States quadrupled between 1999 and 2014 and continues to rise — an alarming trend that researchers from the University of Missouri and University of Iowa say has exposed the stigma felt by opioid-dependent mothers and how their shame has negatively impacted the health care received by their infants.

Jamie Morton led a study, which was a metasynthesis of existing literature on the topic, as a doctoral student at the MU Sinclair School of Nursing. She said the findings can help ensure health care providers, family members, friends and community members emphasize messages of support and compassion toward opioid-dependent mothers during the perinatal stage, which in this study was defined as one year prior to conception, pregnancy, and up to 18-24 months postpartum.

“We found that because the mothers were made to feel badly about themselves, they would withdraw themselves from receiving health care,” Morton said.

Morton added that since the mothers were often not getting any emotional or social support from health care providers, family, friends or community members, they felt self-blame and would internalize the stigma.

“What was surprising was the stigma was also transferred to the baby, a term known as associative stigma. The moms felt their infants were not given the same level of care or were treated differently,” Morton said. “The moms would just withdraw from even receiving health care in the first place in an effort to protect their child from being stigmatized, so they were less likely to take their baby to the pediatrician and less likely to take advantage of developmental services for their baby.”

Morton explained that this sometimes led to the mothers being referred to as “noncompliant” or “bad mothers.”

The researchers analyzed and synthesized 18 qualitative studies involving women of childbearing age in the U.S. who expressed feeling stigmatized due to their opioid dependence during the perinatal stage, as well as how the stigma impacted the health care they received for themselves and their babies.

“How often do we hear the phrase ‘the apple doesn’t fall far from the tree’?” Morton said. “Personally, I think everyone should be given a chance and treated with the same kindness and compassion as anyone else.”

Morton formerly worked in a newborn nursery and remembers mothers that would be very withdrawn.

“I made it a point to just treat them as any other mom, because all moms deserve our support as nurses and health care providers,” Morton said. “We just need to promote the opportunity for them to still be at the center of their health care decisions regarding both them and their babies as well as promoting their role as a mom.”

The research could potentially lead to more formalized education that could include trauma-informed care, topics such as trust, active listening, unconscious bias, and not judging based off assumptions. This could result in opioid-dependent mothers feeling more comfortable accessing care for themselves, taking their baby to the pediatrician or taking advantage of developmental services for their baby. This would ultimately improve both the mom’s and the baby’s long-term health outcomes.

“This expands way beyond nurses and health care providers, who, in general, do a great job of showing support, kindness, and compassion to the patients they serve,” Morton said. “This expands to the importance of family, friends, community members and the general public showing support, kindness and compassion. It is an honor and privilege to elevate the voices of these vulnerable women because their voices are not typically heard, but they need to be so we can meet their health care needs.”

“Stigma experienced by perinatal women with opioid dependency in the United States: A qualitative metasynthesis” was recently published in the Western Journal of Nursing Research. Funding was provided by the National Institutes of Health through a training grant awarded to the MU Sinclair School of Nursing.

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JOURNAL

Western Journal of Nursing Research

DOI

10.1177/01939459231182495 

METHOD OF RESEARCH

Literature review

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Stigma experienced by perinatal women with opioid dependency in the United States: A qualitative metasynthesis