RACIST MEDICINE IN AMERIKA

Unseen dementia: Study finds high rates of undiagnosed cognitive decline in vulnerable communities

Emory Health Sciences

 

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Ambar Kulshreshtha, MD, associate professor of family and preventive medicine at Emory University School of Medicine and lead author of the study.

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Credit: Emory University

Delayed dementia diagnosis carries serious consequences. Without timely intervention, undiagnosed cognitive impairment can lead to medication errors, falls, and increased caregiver stress. It also limits patients’ access to resources and care services that could improve their quality of life.

A new study led by researchers at Emory University School of Medicine and Indiana University reveals that many older adults receiving primary care at federally qualified health centers (FQHCs) live with undiagnosed cognitive impairments, including mild cognitive impairment (MCI) and dementia. In addition, African American patients were more than twice as likely as white patients to have undiagnosed cognitive issues. These findings highlight a critical gap in early detection within marginalized and underserved communities.

“Unrecognized cognitive impairment and dementia present a serious challenge in the U.S. and worldwide, affecting patients, families, and the health care system,” said Ambar Kulshreshtha, MD, associate professor of family and preventive medicine at Emory University School of Medicine and lead author of the study. “Delayed diagnosis often means patients are identified at later stages, when symptoms are more severe, and care is more complex. It also leads to missed opportunities for early treatment that could slow disease progression.”

Impact on underserved communities

FQHCs are nonprofit health centers primarily serving low-income, medically underserved communities, reaching about 30 million patients in the U.S. Most patients have family incomes below 200% of the federal poverty level, making it difficult to afford specialized medical services that require private insurance or out-of-pocket payments.

Published in JAMA Open Network, the study examined 204 adults aged 65 and older with no prior diagnosis of memory impairment at five FQHCs in Indianapolis from 2021 to 2023. Participants underwent comprehensive assessments, including interviews, medical record reviews, neurological exams, and neuropsychological tests. An interdisciplinary team consisting of a neurologist, geriatrician, and neuropsychologist reviewed the data to diagnose normal cognition, MCI, or dementia.

Researchers found that 75% of participants had undiagnosed cognitive issues: 62% had MCI, and 12.3% had dementia. Only 25% had no evidence of cognitive decline.

The study also revealed significant racial disparities, finding that African American patients were more than twice as likely as white patients to have undiagnosed MCI or dementia. These disparities remained even after adjusting for age, gender, and education, emphasizing the need for improved care pathways for early detection in vulnerable populations. Researchers caution against attributing higher rates among African Americans to biological differences; instead, factors like residential segregation, air pollution, discrimination, and educational quality likely play significant roles in these disparities.

Access barriers and systemic problems—such as limited time, training, and resources for cognitive screening in primary care—further compound the higher rates of undetected MCI and dementia among African Americans.

Removing barriers to dementia screening

“Our findings underscore the need for timely screening among older adults, especially high-risk groups like African Americans,” said Kulshreshtha. “Other minority groups, like non-English speaking individuals and those in rural areas, may face even greater challenges in accessing cognitive screenings. There’s still stigma and misconceptions about dementia, and we need to do more to educate our communities. With new treatment options and lifestyle changes that can help, health care systems must evolve to provide timely, equitable approaches for early detection and intervention.”

For patients without access to a specialist, experts recommend incorporating brief cognitive tests during routine visits as a practical solution for early detection. In Atlanta, where Kulshreshtha practices,  he works to help solve this problem as an advisory board member for Georgia Memory Net, a state-funded program led by Emory to promote early and accurate Alzheimer’s diagnosis through primary care.

New model for dementia care

Recent advancements in dementia treatment include the Centers for Medicare & Medicaid Services’ (CMS) Guiding an Improved Dementia Experience (GUIDE) model, a new payment approach designed for patients on regular (fee-for-service) Medicare to enhance their care and alleviate the burden on unpaid caregivers. Emory Integrated Memory Care in Atlanta—one of the nation's most recognized, nurse-practitioner led primary care practices specifically designed for dementia patients and their caregivers—is the only established GUIDE clinic practice in Georgia already operating this model since July 2024.

“Dr. Kulshreshtha is deeply committed to understanding and addressing the challenges of dementia care – he not only studies the issues, but actively partners to develop solutions,” said Ted Johnson, MD, chair of the department of family and preventive medicine and a supporting physician at Emory Integrated Memory Care. “At the Emory Integrated Memory Care clinic, he is a fully partnered, sponsoring physician for the nurse practitioner-led team. His work in this research study is a prime example of his work alongside other national experts to improve patient outcomes.”

CITATION: Kulshreshtha A, Parker ES, Fowler NR, Summanwar D, Miled ZB, Owora AH, Galvin JE, Boustani MA. Prevalence of Unrecognized Cognitive Impairment in Federally Qualified Health Centers. JAMA Netw Open. 2024;7(10):e2440411. doi:10.1001/jamanetworkopen.2024.40411

FUNDING: This study was funded by the National Institutes of Health, National Institute on Aging (grant R01AG06976).

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Journal

JAMA Network Open

DOI

10.1001/jamanetworkopen.2024.40411 

Method of Research

Observational study

Subject of Research

People

Article Title

Prevalence of Unrecognized Cognitive Impairment in Federally Qualified Health Centers

 

Study: Student absenteeism crisis may be hurting teacher job satisfaction

Researchers warn that rising absenteeism could worsen growing teacher shortages

American Educational Research Association

Washington, November 12, 2024—As student absenteeism reaches record highs in schools across the United States, new research finds that student absences are linked to lower teacher job satisfaction, raising concerns that this may exacerbate growing teacher shortages. The findings were published today in Educational Researcher, a peer-reviewed journal of the American Educational Research Association.

The study, by Michael Gottfried and Colby Woods at the University of Pennsylvania, and Arya Ansari at The Ohio State University, is the first to examine the connection between student absenteeism and teacher satisfaction. Using nationally representative data from the U.S. Department Education on 2,370 kindergarten teachers, the researchers found that when teachers have more absent students, they report feeling less satisfied with their jobs. This was true for new teachers as well as more experienced teachers.

“Our findings show that a lack of good student attendance has the potential to detract from the satisfaction teachers get from instructing and helping their students learn and grow,” said Gottfried, a professor at the University of Pennsylvania Graduate School of Education. “This has important implications for the current educational landscape. Addressing absenteeism is critical not only for improving student outcomes, but also for bolstering the teacher workforce, which faces a host of challenges.”

The study found that student absenteeism had no link to teachers’ feelings about other aspects of school, such as their teaching ability or school climate—just job satisfaction. There was also no indication that teachers who were less satisfied to begin with were being assigned to the students who were more likely to be absent.

“We show that student absenteeism emerges as a teacher challenge, and so there is a need for a more well-rounded approach to addressing the effects of absenteeism in the classroom,” Gottfried said. “Approaches need to go beyond only those that are focused on students. Broader efforts will have the potential to yield positive impacts across teachers, contributing to a more satisfied and engaged workforce.”

Examples of effective efforts include investing in interventions that strengthen teachers’ relationships with students and families, implementing trauma-informed teaching, and professional development to support the diverse needs of students, including those at risk of absenteeism. Absenteeism initiatives could also improve working conditions for teachers. For example, reducing administrative burdens and increasing staffing support to better address absenteeism-related challenges could bolster more regular school attendance and, in turn, improve satisfaction, according to Gottfried.

Study citation: Gottfried, M.A., Woods C. S., & Ansari, A. (2024). Do teachers with absent students feel less job satisfaction? Educational Researcher. Prepublished November 12, 2024.  https://doi.org/10.3102/0013189X241292331

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About AERA
The American Educational Research Association (AERA) is the largest national interdisciplinary research association devoted to the scientific study of education and learning. Founded in 1916, AERA advances knowledge about education, encourages scholarly inquiry related to education, and promotes the use of research to improve education and serve the public good. Find AERA on Facebook, X, LinkedIn, Instagram, Threads, and Bluesky.

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Journal

Educational Researcher

DOI

10.3102/0013189X241292331 

Article Title

Do Teachers with Absent Students Feel Less Job Satisfaction?

Article Publication Date

12-Nov-2024

 

New study examines the impact of peer support on women veterans

Improvements seen in those suffering from PTSD, depression and loneliness

Boston University School of Medicine

(Boston)—Women who serve in the armed forces have a unique life journey. They are a minority during service and a rarity in the civilian population. Their contributions to military service are often unknown, unrecognized, or worse, disregarded. Prior studies show these women may step back further and further from their military identity, which may put them at greater risk for long-term, negative mental health and well-being.

A new study by researchers at Boston University Chobanian & Avedisian School of Medicine has found that women veterans who participated in a peer support program experienced a greater sense of belonging, higher quality of life and less post-traumatic stress disorder (PTSD) and depression.

 

“The loss of belongingness after service can be particularly profound for many women veterans and can result in loneliness and isolation, risk factors for a host of negative mental health outcomes,” said corresponding author Tara Galovski, PhD, professor of psychiatry at the school and director of the Women’s Health Sciences Division of the National Center for PTSD at the Department of Veterans Affairs.

 

Galovski is a cofounder of WoVeN (the Women Veterans Network), a national peer support program developed through Boston University with the support of several foundations. The program, originally developed in 2017 with six peer leaders and 15 women veterans, has since grown to nearly 5,000 women veterans nationwide. This is the first paper to report on the results of the voluntary research study and describes the impact of the program on women veterans, particularly the strong effects on those who suffer from mental health conditions like PTSD and depression.

 

The researchers analyzed survey data of 393 participants in the WoVeN group program collected at baseline, post-group and three-month follow-up. They found that for those who suffered from clinical levels of PTSD and depression (about half the sample), improvements were observed in not only those mental health conditions, but also in their sense belonging and quality of life.

 

According to the researchers, loneliness, isolation and lack of belonging are known risk factors for a host of negative outcomes including PTSD, depression, anxiety and even suicide. “Social support is an established protective factor. However, the extent to which connections, belongingness and social support is measured and tested empirically is negligible. This model of peer-led social support can be easily translated to other vulnerable populations and provide a sustainable and easily replicable model of care for at-risk populations to help move the needle further toward better mental health and greater well-being,” adds Galovski.

 

These findings appear online in a special issue of Medical Care.

 

 

“This study was funded by the Walmart Foundation, May & Stanley Smith Charitable Trust, Bob Woodruff Foundation, and Oak Foundation.  The WoVeN program also has receives support from the VA.”

 

 

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Journal

Medical Care

DOI

10.1097/MLR.0000000000002039 

Method of Research

Data/statistical analysis

Subject of Research

People

Article Title

Measuring What Matters Supplement Evaluating the Impact of a Peer Support Program on Participants’ Well-Being Finding Belongingness Through the Women Veterans Network

Article Publication Date

8-Nov-2024

 

Ouch! Commonalties found in pain vocalizations and interjections across cultures

Study investigates vocalizations and interjections for pain, joy, and disgust across 131 languages.

American Institute of Physics

 

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Vowel density maps reveal that distinct vowel spaces for vocalizations of pain, disgust, and joy remain consistent across languages.

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Credit: Ponsonnet et al.

WASHINGTON, Nov. 12, 2024 – There are an estimated 7,000 languages spoken worldwide, each offering unique ways to express human emotion. But do certain emotions show regularities in their vocal expression across languages?

In JASA, published on behalf of the Acoustical Society of America by AIP Publishing, an interdisciplinary team of linguists and bioacousticians led by Maïa Ponsonnet, Katarzyna Pisanski, and Christophe Coupé explored this by comparing expressive interjections (like “wow!”) to nonlinguistic vocalizations (like screams and cries) across the globe.

Pisanski explained how studying cries, screams, and laughter can shed light on the origins of speech.

“Why did we humans start to speak, and other primates didn’t? We all produce laughter, and hundreds of species produce playlike vocalizations,” said Ponsonnet. “Yet we are the only species that evolved spoken language. Looking at these commonalities across species can help us understand where humans diverged and how.

“Critically, by comparing interjections to vocalizations expressing the same emotions, we can test whether the acoustic patterns we observe in interjections can be traced back to vocalizations.”

The researchers analyzed vowels in interjections from 131 languages, comparing them with nearly 500 vowels from vocalizations produced in joyful, painful, or disgusting contexts.

They predicted that the vocalizations’ acoustic forms reflect their adaptive or social functions. “We believe that many vocal expressions have a function. For example, babies’ cries tend to be loud and harsh, evolving to annoy parents enough to stop the aversive signal. We expect vocal expressions of pain, disgust, and joy to reflect their functions too,” said Pisanski.

The researchers found evidence to support this for vocalizations: Each of the three emotions yielded consistent and distinct vowel signatures across cultures. Pain interjections also featured similar open vowels, such as “a,” and wide falling diphthongs, such as “ai” in “Ayyy!” and “aw” in “Ouch!” However, for disgusted and joyful emotions, in contrast to vocalizations, the interjections lacked regularities across cultures. The researchers expressed surprise at this latter finding.

The team aims to expand this research across more cultures and emotions to better understand how widespread vocal expressions arise and where they come from.

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The article “Vowel signatures in emotional interjections and nonlinguistic vocalizations expressing pain, disgust and joy across languages” is authored by Maïa Ponsonnet, Christophe Coupé, François Pellegrino, Garcia Arasco Aitana, and Katarzyna Pisanski. It will appear in The Journal of the Acoustical Society of America on Nov. 12, 2024 (DOI: 10.1121/10.0032454). After that date, it can be accessed at https://doi.org/10.1121/10.0032454.

ABOUT THE JOURNAL

The Journal of the Acoustical Society of America (JASA) is published on behalf of the Acoustical Society of America. Since 1929, the journal has been the leading source of theoretical and experimental research results in the broad interdisciplinary subject of sound. JASA serves physical scientists, life scientists, engineers, psychologists, physiologists, architects, musicians, and speech communication specialists. See https://pubs.aip.org/asa/jasa.

ABOUT ACOUSTICAL SOCIETY OF AMERICA

The Acoustical Society of America (ASA) is the premier international scientific society in acoustics devoted to the science and technology of sound. Its 7,000 members worldwide represent a broad spectrum of the study of acoustics. ASA publications include The Journal of the Acoustical Society of America (the world’s leading journal on acoustics), JASA Express Letters, Proceedings of Meetings on Acoustics, Acoustics Today magazine, books, and standards on acoustics. The society also holds two major scientific meetings each year. See https://acousticalsociety.org/.

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DOI

10.1121/10.0032454 

Article Title

Vowel signatures in emotional interjections and nonlinguistic vocalizations expressing pain, disgust and joy across languages

Article Publication Date

12-Nov-2024

 

Young coral use metabolic tricks to resist bleaching

Reduced metabolism and increased nitrogen storage allow coral larvae to keep algae around at high temperatures

PLOS

 

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(left) The lead author of the study surveys a coral reef in Kāne‘ohe Bay, Hawai‘i (image: Shayle Matsuda). (middle) Colonies of the study species, Montipora capitata, releasing gametes during a broadcast spawning event in Kāne‘ohe Bay (image: Mariana Rocha de Souza). (right) Close-up view of individual coral polyps releasing egg-sperm bundles during spawning (image: Mariana Rocha de Souza).

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Credit: Shayle Matsuda and Mariana Rocha de Souza (CC-BY 4.0, https://creativecommons.org/licenses/by/4.0/)

Coral larvae reduce their metabolism and increase nitrogen uptake to resist bleaching in high temperatures, according to a study published November 12th in the open-access journal PLOS Biology by Ariana S. Huffmyer of the University of Washington, US, and colleagues.

High ocean temperatures cause coral bleaching, which results from the disruption of the relationship between corals and their symbiotic algae, an increasing concern as global temperatures rise. However, relatively little research has examined the effects of high temperatures during early life stages of corals.

In this study, Huffmyer and colleagues exposed coral larvae to high temperatures at the Hawai‘i Institute of Marine Biology. For three days during their first week of development, the larvae and their algal symbionts were treated to temperatures 2.5 degrees Celsius above ambient temperature, similar to expected changes in seawater due to climate change. The coral larvae showed no signs of bleaching in the heated water, and they were able to maintain rates of algal photosynthesis and the supply of carbon-based nutrition from the algae to the host. However, there was a 19% reduction in coral metabolism, as well as increased uptake and storage of nitrogen by the coral, both of which are apparent strategies that improve coral survival.

Reduced metabolism allows the coral to conserve energy and resources, also seen in adult corals during bleaching.  The change in nitrogen cycling seems to be an adaptation by the coral to limit the amount of nitrogen available to the algae, thus preventing algal overgrowth and the destabilization of the coral-algae relationship.

It remains unclear how effective these strategies are at higher temperatures and for longer durations. Further research into the details and limitations of coral reaction to high temperatures will provide crucial knowledge for predicting coral response and protecting coral reefs as global temperatures continue to rise.

The authors add, “This research reveals that coral larvae must invest in their nutritional partnership with algae to withstand stress, offering key insights into strategies to avoid bleaching in earliest life stages of corals.”

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In your coverage, please use this URL to provide access to the freely available paper in PLOS Biology: http://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.3002875

Citation: Huffmyer AS, Ashey J, Strand E, Chiles EN, Su X, Putnam HM (2024) Coral larvae increase nitrogen assimilation to stabilize algal symbiosis and combat bleaching under increased temperature. PLoS Biol 22(11): e3002875. https://doi.org/10.1371/journal.pbio.3002875

Author Countries: United States

Funding: This research was supported by the National Science Foundation Ocean Sciences Postdoctoral Fellowship (2205966 to ASH), National Science Foundation Rules of Life-Epigenetics (EF-1921465 to HMP), and a gift of the Washington Research Foundation to the University of Washington eScience Institute (eScience Data Science Postdoctoral Fellowship award to ASH). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Journal

PLOS Biology

DOI

10.1371/journal.pbio.3002875 

Method of Research

Experimental study

Subject of Research

Animals

 

New treatment helps children with rare spinal condition regain ability to walk

Innovative spinal stimulation therapy helps children with paralysis from acute flaccid myelitis improve mobility, according to research from Kennedy Krieger Institute

Kennedy Krieger Institute

 

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Example of patient participating in TSS research stury

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Credit: Kennedy Krieger Institute

BALTIMORE, November 12, 2024— Researchers at Kennedy Krieger Institute’s International Center for Spinal Cord Injury (ICSCI) have made a remarkable advancement in treating children with Acute Flaccid Myelitis (AFM), a rare but severe neurological condition that causes sudden paralysis.

A new study, published in the journal Children, demonstrates that a combination of Transcutaneous Spinal Cord Stimulation (TSS) and movement training can help children with AFM improve their ability to walk. TSS is a non-invasive therapy where electrical current is applied through pads placed on the skin to the spine. It amplifies the volume on signals traveling from the brain through the spinal cord, facilitating muscle activation and restoring motor function.

The study involved four children with spinal cord injuries caused by AFM. Over a series of 22 therapy sessions, the patients received TSS while moving on a treadmill as part of their body weight was supported by a harness system. The results were promising—three children showed improvements in walking distance, and two had measurable gains in posture, speed, and overall walking function.

Rebecca Martin, OTR/L, OTD, CPAM, Manager of Clinical Education and Training at ICSCI and primary investigator of the study, says the research shows TSS is a safe, effective intervention that offers a new path for rehabilitation and improved quality of life.

“It’s encouraging to witness the transformations in these children,” said Martin. “TSS is revolutionizing the field of neurorehabilitation, providing a safe alternative to the aggressive surgeries often required for young patients.”

AFM typically follows a viral infection and inflames the spinal cord, leaving children with long-term paralysis in their diaphragm, arms and/or legs. According to the Centers for Disease Control and Prevention, AFM affects approximately one in 1 million children in the United States each year. Because it is so rare, it is often challenging for researchers to gather large sample sizes necessary for comprehensive studies. The research at Kennedy Krieger offers hope to families who often have limited options.

“This treatment is giving families a long-awaited solution when they previously had no answers,” said Martin. “Now our goal is to continue refining this approach and make it more widely available to these rare patients across the country.”

ICSCI at Kennedy Krieger is working to develop therapies that restore function for children living with complex neurological conditions. Click here to learn more about additional research and studies underway at the center.

Patient Standing and Smiling While Participating in TSS Study

Patient Participating in TSS/AFM Study

Credit

Kennedy Krieger Institute

 

About Kennedy Krieger Institute 
Kennedy Krieger Institute, an internationally known, non-profit organization located in the greater Baltimore/Washington, D.C. region, transforms the lives of more than 27,000 individuals a year through inpatient and outpatient medical, behavioral health and wellness therapies, home and community services, school-based programs, training and education for professionals and advocacy. Kennedy Krieger provides a wide range of services for children, adolescents and adults with diseases, disorders or injuries that impact the nervous system, ranging from mild to severe. The Institute is home to a team of investigators who contribute to the understanding of how disorders develop, while at the same time pioneer new interventions and methods of early diagnosis, prevention and treatment. Visit www.kennedykrieger.org/ for more information about Kennedy Krieger.

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Journal

Children

Subject of Research

People

Article Title

Transcutaneous Spinal Cord Stimulation Enables Recovery of Walking in Children with Acute Flaccid Myelitis

 

Children’s Hospital of Philadelphia researchers find community health workers play critical role in coordinating asthma care across home, school and community

Study found statistically significant benefit when health workers made efforts to coordinate asthma care between homes, schools and primary care providers

Children's Hospital of Philadelphia

While great strides have been made to ensure children have access to proper asthma care in their home and community, linking those environments to the care that children receive while in school has been a challenge. In a new study, researchers from Children’s Hospital of Philadelphia (CHOP) demonstrate that community health workers can play a critical role in integrating all environments where children encounter asthma triggers, and care coordination provided by these workers may be a cost-effective way to achieve that. The findings were recently published by JAMA Pediatrics.

There are persistent and concerning disparities in rates of asthma among American children. Black children, for example, have a hospitalization rate three times higher, and a death rate seven times higher, than their white counterparts. However, asthma symptoms can vary for children at different times of the day in different environments. While they may be able to control symptoms at home, children may encounter triggers at school like mice or dusty shelves that can exacerbate their symptoms.

Prior studies have confirmed the impact that community health workers – specially trained lay people who work with local hospital systems and community organizations in both rural and urban communities – can help improve asthma control to close gaps with evidence-based interventions. However, linking the care among different settings – homes, schools, primary care offices and surrounding communities – and coordinating appropriate care across those environments has been a major challenge. To garner a clearer picture of effectiveness, researchers implemented a randomized clinical trial design to properly assess the impact of  community health workers.

“Children are in various environments during the day, and we have to think about a holistic and connected approach to reducing asthma across all environments a child may encounter,” said Tyra Bryant-Stephens, MD, Medical Director of the Community Asthma Prevention Program (CAPP) and Chief Health Equity Officer of the Center for Health Equity at CHOP. “We want to make sure there is evidence-based asthma care, including increased adherence and availability of controller medication, wherever children may be and that everyone is taking steps to make every environment a healthier one.”

This study was a hybrid effectiveness and implementation trial that randomized 36 total Philadelphia area schools with participant-level randomization into clinic-based community health worker intervention. The intervention took place in CHOP primary care offices, homes and 36 public and charter schools in West Philadelphia between May 2018 and June 2022. Children, aged 5 through 13, with uncontrolled asthma were recruited from local primary care practices and were followed for up to 12 months

Asthma management, trigger remediation, and care coordination took place in school, home and primary care settings. The Yes We Can Children’s Asthma Program, Open Airways for Schools Plus and school-based asthma therapy were implemented.

In total, 626 study participants were analyzed, with 96% of them self-identifying as Black and 98% as non-Hispanic. All groups had statistically significant improvements in asthma control from baseline to 12 months. The study experienced interruptions during the pandemic. However, an analysis from the pre-pandemic interval demonstrated that children in the combined home-clinic-school intervention had a statistically significant improvement in asthma control scores compared with the control group.

“This study demonstrated the feasibility and effectiveness of community health workers connecting these environments to make care more accessible for kids, and future work will make sure that everyone has a seat at the table when making decisions concerning asthma prevention,” Bryant-Stephens said.

This study was supported by grants U01HL138687 and K23HL136842 from the National Heart, Lung and Blood Institute.

Bryant-Stephens et al, “Community Health Workers Linking Clinics and Schools and Asthma Control: A Randomized Clinical Trial.” JAMA Pediatr. Online October 21, 2024. DOI: 10.1001/jamapediatrics.2024.3967.

About Children’s Hospital of Philadelphia:  

A non-profit, charitable organization, Children’s Hospital of Philadelphia was founded in 1855 as the nation’s first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, the hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. The institution has a well-established history of providing advanced pediatric care close to home through its CHOP Care Network, which includes more than 50 primary care practices, specialty care and surgical centers, urgent care centers, and community hospital alliances throughout Pennsylvania and New Jersey, as well as the Middleman Family Pavilion and its dedicated pediatric emergency department in King of Prussia. In addition, its unique family-centered care and public service programs have brought Children’s Hospital of Philadelphia recognition as a leading advocate for children and adolescents. For more information, visit https://www.chop.edu. 

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Journal

JAMA Pediatrics

DOI

10.1001/jamapediatrics.2024.3967 

Method of Research

Randomized controlled/clinical trial

Subject of Research

People

Article Title

Community Health Workers Linking Clinics and Schools and Asthma Control

 

A toolkit for unraveling the links between intimate partner violence, trauma and substance misuse

Despite increased attention to the opioid crisis, trauma and intimate partner violence continue to be neglected as contributors to opioid use disorder. A new digital toolkit aims to change that.

Medical University of South Carolina

 

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Dr. Tanya Saraiya (left) and Dr. Amber Jarnecke (right) of the Medical University of South Carolina were awarded grant funds from the National Institute on Drug Abuse to study the link between opioid use, post-traumatic stress disorder, and intimate partner violence.

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Credit: Medical University of South Carolina. Photograph by Julie Taylor.

The opioid crisis has left an estimated 2.5 million people 18 and older in the U.S. with opioid use disorder, or OUD. Despite increased attention to the heavy toll taken by OUD, key risk factors such as intimate partner violence (IPV) and post-traumatic stress disorder (PTSD) are often overlooked. Both increase the risk of OUD and complicate recovery efforts.

A team of MUSC researchers led by clinical psychologists Amber Jarnecke, Ph.D., and Tanya Saraiya, Ph.D., both of the Department of Psychiatry and Behavioral Sciences, secured critical funding of up to $5 million expected over six years from the National Institute on Drug Abuse to address the overlooked link between IPV, PTSD and OUD, which is known to contribute to higher treatment dropout rates and poorer outcomes for OUD treatment.

“People who experience PTSD may use substances like opioids to cope, and similarly, people who experience IPV may numb the pain with opioids,” said Saraiya. “In some cases, partners use opioids together, and one may encourage – or even force – the other to participate. This dynamic can quickly create a complex and overwhelming storm of IPV, opioid use and PTSD.”

Jarnecke and Saraiya are developing and implementing a digital toolkit to screen patients being treated for OUD for IPV and PTSD and point them to the necessary resources and support for long-lasting recovery.

Such a toolkit is badly needed in South Carolina, which has a very high rate of IPV.

“The state has consistently ranked in the top 10 states for intimate partner violence for the past 20 years,” noted Saraiya.

In 2021, there were 68 IPV-related homicides in South Carolina, 69% of which were committed using a firearm, according to the Bloomberg School of Public Health at Johns Hopkins University.

As the researchers develop the toolkit, they are assembling a community advisory board of IPV survivors, family members and clinicians from across South Carolina to guide them and ensure that they meet the needs of all stakeholders. The toolkit will prioritize patient safety, providing clinicians guidance on creating a safety plan for patients, when needed, which identifies their personal safety network and connects them with local domestic violence centers and shelters. As part of the plan, patients are asked to identify “safe spaces” away from where firearms are stored and are advised to move to those safe areas before violence escalates. Patients are also encouraged to lock away knives and guns if at all possible. In addition to protecting patients, the toolkit must also be simple enough to fit into regular screenings without overwhelming clinicians.

When finished, the digital toolkit will include a series of questionnaires to identify co-occurring PTSD and other mental health conditions as well as IPV risk and its severity. It will also provide clinicians with recommended ways to follow up with their patients based on their screening results, including providing suggestions for evidence-based treatments. Finally, it will provide a list of local resources to facilitate referrals. Before being rolled out, the toolkit will be beta-tested by clinicians and patients.

After beta testing, the toolkit will be tested in a large randomized clinical trial in three substance use treatment centers across South Carolina, including the Center for Drug and Alcohol Programs at MUSC in Charleston, Behavioral Health Services of Pickens County and Shoreline Behavioral Health Services in Conway.

Patients receiving treatment for OUD will be asked to enroll in the study and will be screened for IPV, PTSD and other mental health conditions through measures in the digital toolkit. Clinicians will discuss which treatment options are best for patients based on their screening results and available local resources. After the initial screening, enrolled patients will complete toolkit questionnaires regularly to track whether they have followed up on the treatment recommendations for PTSD and IPV and if doing so has made them more likely to stick to their OUD treatments.

Once the trial is completed, Jarnecke and Saraiya plan to make the toolkit available to other states and to tailor it to address other substance use disorders. They also intend to adapt it for use in other countries and raise awareness about IPV to promote advocacy and policy reform.

“We’re hoping that the sheer number of positive screens for IPV and PTSD in patients with OUD detected through our toolkit might help to inform more policy and advocacy work,” said Jarnecke. “If we want to make headway against the opioid crisis, it is important that we provide adequate resources for family and relationship health.”

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Research reported in this press release is supported by the National Institute on Drug Abuse of the National Institutes of Health under award number R61DA061371. The content in the underlying article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.