ABSTRACT
Policy Points Workers' compensation agencies have instituted opioid review policies to reduce unsafe prescribing. Providers reported more limited and cautious prescribing than in the past; both patients and providers reported collaborative pain-management relationships and satisfactory pain control for patients. Despite the fears articulated by pharmaceutical companies and patient advocates, opioid review programs have not generally resulted in unmanaged pain or reduced function in patients, anger or resistance from patients or providers, or damage to patient-provider relationships or clinical autonomy. Other insurance providers with broad physician networks may want to consider similar quality-improvement efforts to support safe opioid prescribing. CONTEXT: Unsafe prescribing practices have been among the central causes of improper reception of opioids, unsafe use, and overdose in the United States. Workers' compensation agencies in Washington and Ohio have implemented opioid review programs (ORPs)-a form of quality improvement based on utilization review-to curb unsafe prescribing. Evidence suggests that such regulations indeed reduce unsafe prescribing, but pharmaceutical companies and patient advocates have raised concerns about negative impacts that could also result. This study explores whether three core sets of problems have actually come to pass: (1) unmanaged pain or reduced function among patients, (2) anger or resistance to ORPs from patients or providers, and (3) damage to patient-provider relationships or clinical autonomy. METHODS: In-depth semistructured interviews were conducted with 48 patients (21 from Washington, 27 from Ohio) and 32 providers (18 from Washington, 14 from Ohio) who were purposively sampled to represent a range of injury and practice types. Thematic coding was conducted with codebooks developed using both inductive and deductive approaches. FINDINGS: The consequences of opioid regulations have been generally positive: providers report more limited prescribing and a focus on multimodal pain control; patients report satisfactory pain control and recovery alongside collaborative relationships with providers. Participants attribute these patterns to a broad environment of opioid caution; they do not generally perceive workers' compensation policies as distinctly impactful. Both patients and providers comment frequently on the difficult aspects of interacting with workers' compensation agencies; effects of these range from simple inconvenience to delays in care, unmanaged pain, and reduced potential for physical recovery. CONCLUSIONS: In general, the three types of feared negative impacts have not come to pass for either patients or providers. Although interacting with workers' compensation agencies involves difficulties typical of interacting with other insurers, opioid controls seem to have generally positive effects and are generally perceived of favorably.
ABSTRACT
As the effects of global climate change become more apparent, animal species will become increasingly affected by extreme climate and its effect on the environment. There is a pressing need to understand animal physiological and behavioural responses to climatic stressors. We used the reactive scope model as a framework to investigate the influence of drought conditions on vervet monkey (Chlorocebus pygerythrus) behaviour, physiological stress and survival across 2.5 years in South Africa. Data were collected on climatic, environmental and behavioural variables and physiological stress via faecal glucocorticoid metabolites (fGCMs). There was a meaningful interaction between water availability and resource abundance: when food availability was high but standing water was unavailable, fGCM concentrations were higher compared to when food was abundant and water was available. Vervet monkeys adapted their behaviour during a drought period by spending a greater proportion of time resting at the expense of feeding, moving and social behaviour. As food availability decreased, vervet mortality increased. Peak mortality occurred when food availability was at its lowest and there was no standing water. A survival analysis revealed that higher fGCM concentrations were associated with an increased probability of mortality. Our results suggest that with continued climate change, the increasing prevalence of drought will negatively affect vervet abundance and distribution in our population. Our study contributes to knowledge of the limits and scope of behavioural and physiological plasticity among vervet monkeys in the face of rapid environmental change.
ABSTRACT
BACKGROUND: Gastrointenstinal nematodes (GIN) present a serious challenge to the health and productivity of grazing stock around the globe. However, the epidemiology of GIN transmission remains poorly understood in northern climates. Combining use of serological diagnostics, GIS mapping technology, and geospatial statistics, we evaluated ecological covariates of spatial and temporal variability in GIN transmission among bovine calves pastured in Alberta, Canada. METHODS: Sera were collected from 1000 beef calves across Alberta, Canada over three consecutive years (2008-2010) and analyzed for presence of anti-GIN antibodies using the SVANOVIR Ostertagia osteragi-Ab ELISA kit. Using a GIS and Bayesian multivariate spatial statistics, we evaluated the degree to which variation in specific environmental covariates (e.g. moisture, humidity, temperature) was associated with variation in spatial and temporal heterogeneity in exposure to GIN (Nematodirus and other trichostrongyles, primarily Ostertagia and Cooperia). RESULTS: Variation in growing degree days above a base temperature of 5 °C, humidity, air temperature, and accumulated precipitation were found to be significant predictors of broad-scale spatial and temporal variation in serum antibody concentrations. Risk model projections identified that while transmission in cattle from southeastern and northwestern Alberta was relatively low in all years, rate of GIN transmission was generally higher in the central region of Alberta. CONCLUSIONS: The spatial variability in risk is attributed to higher average humidity, precipitation and moderate temperatures in the central region of Alberta in comparison with the hot, dry southeastern corner of the province and the cool, dry northwestern corner. Although more targeted sampling is needed to improve model accuracy, our projections represent an important step towards tying treatment recommendations to actual risk of infection.
