Patient reported goals for medications for opioid use disorder: A theory of proximal goal attainment.

Background: There exist substantial patient barriers to accessing medications for opioid use disorder (MOUD), including travel distance, stigma, and availability of MOUD providers. Yet, despite these barriers, there exists a subset of patients who possess the requisite motivation to seek and remain adherent to treatment. Objective: To explore patient-derived goals in MOUD treatment-adherent patients. Methods: This study used in-depth interviews with patients receiving methadone who were enrolled in opioid treatment programs (OTPs) across Tennessee. Participants were recruited from 12 different OTPs to participate in telephonic semi-structured interviews to a point of saturation. Participants had to be adherent to treatment, in treatment for 6 months or greater, and English speaking. Analysis occurred inductively using a constructivist approach to Grounded Theory. Results: In total, 17 patient interviews were conducted in the spring of 2021. Participants described goal setting across three general stages of treatment: (1) addressing acute physical and emotional needs upon treatment entry, (2) development of supportive structure and routine to develop healthy skills facilitated by treatment team, and (3) identifying and pursuing future-focused goals not directly linked to treatment. A Proximal Goals in MOUD Framework is introduced. Conclusion: In this qualitative study on patient reported goals in MOUD it was found that goals are transitory and relative to the stage of treatment. Further research is needed to better understand goal evolution over the course of treatment and its impact on treatment retention.

A WNT4- and DKK3-driven canonical to noncanonical Wnt signaling switch controls multiciliogenesis.

Multiciliated cells contain hundreds of cilia whose directional movement powers the mucociliary clearance of the airways, a vital host defense mechanism. Multiciliated cell specification requires canonical Wnt signaling, which then must be turned off. Next, ciliogenesis and polarized ciliary orientation are regulated by noncanonical Wnt/planar cell polarity (Wnt/PCP) signaling. The mechanistic relationship between the Wnt pathways is unknown. We show that DKK3, a secreted canonical Wnt regulator and WNT4, a noncanonical Wnt ligand act together to facilitate a canonical to noncanonical Wnt signaling switch during multiciliated cell formation. In primary human airway epithelial cells, DKK3 and WNT4 CRISPR knockout blocks, whereas ectopic expression promotes, multiciliated cell formation by inhibiting canonical Wnt signaling. Wnt4 and Dkk3 single-knockout mice also display defective ciliated cells. DKK3 and WNT4 are co-secreted from basal stem cells and act directly on multiciliated cells via KREMEN1 and FZD6, respectively. We provide a novel mechanism that links specification to cilium biogenesis and polarization for proper multiciliated cell formation.

Community-Centered Patient Journey Map in Opioid Use Disorder: A Tool to Address Compassion Fatigue among Community Pharmacists.

Community pharmacists have become increasingly exposed to opioid use disorders in recent decades. However, both pharmacist training and traditional practice environments have not been adequate to prepare the pharmacist for both the patient care needs and regulatory barriers of patients experiencing opioid use disorders (OUD). As a result, there is a need to increase pharmacists' awareness of both the overall patient experience as they navigate their OUD and the role of the community pharmacy as a touchpoint within that experience. To this end, a Community-Centered Patient Journey in Drug Addiction Treatment journey map was developed with expert insights, clinical experience, and in-depth interviews (conducted in spring of 2021) with 16 participants enrolled in licensed opioid treatment programs in Tennessee. Patients, policymakers, clinicians, and academic researchers were involved in the map development. Lived experiences of key informants were captured via in-depth interviews. A consensus decision-making approach was used throughout the patient journey map development process. The final patient journey map illustrates a non-linear pathway, describes the central role of the patient's community, and emphasizes three major "pain points" within the system (access, adherence, and affordability). Future research should investigate the impact of such a journey map on pharmacy personnel's knowledge, attitudes, and behaviors.

Preliminary validation of the Diversion Risk Scale (DRS): Using environmental and individual factors to predict opioid-related diversion events.

The standard of care calls for the assessment of patients with chronic pain prior to the initiation of opioids, with one part of this assessment including assessment of the risk of misuse of medications. However, traditional opioid risk assessment tools focus almost entirely on individual factors and on the risk of misuse and addiction to opioids. Diversion of opioid medications has been found to be not uncommon, but to date, there have been no assessment tools specifically designed to assess the risk of diversion. In this study, we developed a measure designed specifically to assess the risk of an opioid medication ending up in the hands of someone other than the chronic pain patient to whom they were prescribed. A 15-item measure, the Diversion Risk Scale, was created and administered to 85 patients at a chronic pain practice. Results found that the measure had acceptable predictive validity. It was moderately correlated with traditional opioid risk assessment tools and showed improved ability to predict specific indicators of diversion. Diversion has been an understudied phenomenon, and the clinical value of an assessment tool that can help predict diversion in the chronic pain population is discussed.

The Role of Impulsivity and Stress Mind-Set in Understanding the Mindfulness-Intimate Partner Aggression Relationship.

Perpetration of relational aggression, which is estimated to occur in 60% to 90% of relationships, has been demonstrated to have lasting negative effects both systemically and for its victims. Relational aggression has also been demonstrated to be impacted, in part by impulsivity, stress mind-set, and mindfulness. The present study examined a path analysis model of the relation between mindfulness and relational aggression, utilizing impulsivity as the mediating variable. Furthermore, the present study incorporated an examination of the potential moderating effects of stress mind-set on the relation between impulsivity and relational aggression. Three hundred eighty-three participants were recruited from across the United States, using Facebook ads. Participants completed online questionnaires assessing key study variables. We hypothesized that the negative urgency aspect of impulsivity would mediate the relation between the five facets of mindfulness and relational aggression, and further that this relationship would be moderated by stress mind-set, such that a stress mind-set which conceptualizes stress as negative would make the relation between impulsivity and relational aggression stronger. We hypothesized that the negative urgency aspect of impulsivity would mediate the relation between mindfulness and relational aggression. Furthermore, we hypothesized that the relation between impulsivity and aggression would be moderated by stress mind-set. Results indicated that the negative urgency component of impulsivity mediated the relation between all five facets of mindfulness and perpetration of relational aggression. Furthermore, stress mind-set moderated the relation between negative urgency and relational aggression, such that a lower stress mind-set was related to a stronger association between negative urgency and aggression. Implications for clinical intervention and future research efforts are discussed.

Exploring Changes in Gang Involvement and Associated Risk Factors for American Indian Adolescents in Reservation Communities.

Reservation communities are among emerging communities for gang activity, in which reports of a rise in youth and/or criminal gangs began occurring after the 1980s. Gang membership has been found to pose a public health risk, strain community resources, and risk a number of individual negative life outcomes. Perceived increases in reservation gang activity have been observed by law-enforcement and community stakeholders, but comparatively little empirical research has focused specifically on these communities. Utilizing data from an existing public dataset, analysis of variance and regression analysis were utilized to examine cross sectional trends in gang involvement among 14,457 American Indian adolescents in reservation communities between 1993-2013. Results of this study failed to establish a consistent pattern of either growth or decline in gang membership across time when examining all reservations communities, with data suggesting that consistent trends may exist only within specific communities. Gang members were found to endorse significantly more alcohol and marijuana use, anger, depressed mood, and victimization as a whole. Only alcohol and marijuana use, violent behavior, and depressed mood demonstrated a significant interaction with time and gang membership. Finally, self-reported substance use, criminal behavior/delinquency, and violence perpetration significantly increased as gang affiliation increased.

A Longitudinal Investigation on the Relation between Self-Compassion and Alcohol Use in a Treatment Sample: A Brief Report.

Alcohol misuse is often a chronic problem such that relapses following treatment are common. One potential protective factor for alcohol misuse is self-compassion, which includes self-kindness, feelings of common humanity, and mindfulness when faced with personal suffering and hardships. This study tested the hypothesis that self-compassion, and specifically self-compassion promoting facets including self-kindness, common humanity, and mindfulness, were longitudinally associated with reduced alcohol use among a sample of men and women in substance use disorder treatment (N = 62). Results partially supported the hypothesis, in that only the mindfulness facet of self-compassion was associated with decreased alcohol use over time. Sex and age differences as they related to the positive facets of self-compassion and alcohol use emerged. These findings suggest that positive facets of self-compassion may be beneficial factors to cultivate in alcohol treatment programs.

The Relationship Between Food Deserts, Farmers' Markets, and Food Assistance Programs in Hawai'i Census Tracts.

Due to inadequate resources and limited access to healthy foods, residents who live in food deserts struggle to maintain a healthful diet. Living in a food desert increases the risk of developing diet-related chronic diseases such as obesity. Local farmers' markets serve as community-level interventions, bringing healthy food options to food deserts. This study explores the relationship between food deserts, placement of farmers' markets, and availability of food assistance programs in the state of Hawai'i. Data are from the 2017 United States Department of Agriculture (USDA) Food Access Research Atlas and the USDA Farmers' Market Directory. Farmers' market addresses were geocoded in ArcGIS 10.3. Descriptive statistics and spatial visualization were used to explore census tract level relationships. Of the Hawai'i census tracts, 10% are food deserts. Sixteen of the 101 registered farmers markets are located within a food desert. Of these markets, 28.7% accept Farmers' Market Nutrition Program coupons, 0% accept Women, Infants, and Children Fruit and Vegetable Checks, and 39.6% accept Supplemental Nutrition Assistance Program benefits. Fewer than 20% of farmers' markets in Hawai'i are located in food deserts, and few accept food assistance programs. Fresh food is less accessible to low-income residents in these areas and lack of access to fresh food is associated with diet-related chronic diseases. To reduce food insecurity, farmers' markets could accept food assistance program funds. Additional farmers' markets could be established in food deserts to increase availability of healthy food, thereby reducing the population's risk of developing obesity and diet-related chronic diseases.

A 20-year study of the bidirectional relationship between anxious and depressive symptomology and pain medication usage.

Aim: To investigate the 20-year relationship between anxiety, depression and pain medication use. Patients: A total of 521 individuals reporting chronic pain from the National Survey of Midlife Development in the USA (MIDUS) study. Methods: Structural equation modeling of 20-year longitudinal survey data. Results: Over 20 years, a bidirectional relationship between depression and anxiety in individuals with chronic pain was indicated. Pain medication utilization predicted later use at 10 years. Pain medication use was not strongly related to later anxiety; however, heightened anxiety was associated with later use. Conclusion: Depression and anxiety show an extensive long-term bidirectional relationship. While there was little indication of a relationship between pain medication use and later negative mood, anxiety was associated with subsequent pain medication use.

The Impact of History of Aggression and Alcohol Use on Aggressive: Responding in the Laboratory.

The current study examines how different levels of past aggression combined with self-reported levels of alcohol use impacted lab-based aggressive responding. Data were collected from 160 male undergraduate college students. Participants completed online measures of drinking (Alcohol Use Disorders Identification Test) and past aggression (Buss Perry Aggression Questionnaire) prior to a lab session assessing aggressive responding [Point Subtraction Aggression Paradigm (PSAP)]. Regression analyses revealed participants with "high" levels of past alcohol use and a history of "high" aggression were more likely to respond aggressively on the PSAP, a trend primarily driven by those with a history of physical aggression. For proactively aggressive participants, the risk for aggressive responding is greater in individuals with a history of physically aggressive behavior as they report higher alcohol use, relative to those "low" in past aggression. The interaction of alcohol use and past aggression was associated with continued aggressive behavior.

Suppression of stromal-derived Dickkopf-3 (DKK3) inhibits tumor progression and prolongs survival in pancreatic ductal adenocarcinoma.

Pancreatic ductal adenocarcinoma (PDAC) has a dismal prognosis, and it is unclear whether its stromal infiltrate contributes to its aggressiveness. Here, we demonstrate that Dickkopf-3 (DKK3) is produced by pancreatic stellate cells and is present in most human PDAC. DKK3 stimulates PDAC growth, metastasis, and resistance to chemotherapy with both paracrine and autocrine mechanisms through NF-κB activation. Genetic ablation of DKK3 in an autochthonous model of PDAC inhibited tumor growth, induced a peritumoral infiltration of CD8+ T cells, and more than doubled survival. Treatment with a DKK3-blocking monoclonal antibody inhibited PDAC progression and chemoresistance and prolonged survival. The combination of DKK3 inhibition with immune checkpoint inhibition was more effective in reducing tumor growth than either treatment alone and resulted in a durable improvement in survival, suggesting that DKK3 neutralization may be effective as a single targeted agent or in combination with chemotherapy or immunotherapy for PDAC.

Neuropsychological Effects of Placebo Stimulants in College Students.

Many college students underestimate or ignore the side-effects associated with nonmedical use of prescription stimulants (NMUPS) and are motivated by hopes of academic enhancement. The present study measured the effect a placebo stimulant and personal expectancies have on subjective physiological changes and cognitive enhancement. Undergraduate college students participated in a two-phase study. Phase 1 (n = 305) involved completing an online survey to gather distal study variables and individual stimulant expectancy data. Phase 2 (n = 166) required students to attend an in-person session where they completed physiological and neuropsychological measures (e.g., Physical Symptom Checklist, Digit Span, Passage Comprehension). Students were randomized to receive a placebo stimulant medication (experimental) or no medication (control). Following a 30-minute absorption period, participants completed another set of physiological and neuropsychological measures. Experimental participants reported significant increases in positive symptoms resulting from the placebo stimulant. Expectancies moderated the impact of the placebo stimulant on Passage Comprehension performance; no other neuropsychological task performance was impacted. Despite subjective reports of feeling the effects of stimulants, task performance was unaffected. Moreover, expectancies may play a small role in perceptions of the effects of stimulants.

Lipocalin-2 Promotes Pancreatic Ductal Adenocarcinoma by Regulating Inflammation in the Tumor Microenvironment.

Lipocalin-2 (LCN2) promotes malignant development in many cancer types. LCN2 is upregulated in patients with pancreatic ductal adenocarcinoma (PDAC) and in obese individuals, but whether it contributes to PDAC development is unclear. In this study, we investigated the effects of Lcn2 depletion on diet-induced obesity, inflammation, and PDAC development. Mice with acinar cell-specific expression of KrasG12D were crossed with Lcn2-depleted animals and fed isocaloric diets with varying amounts of fat content. Pancreas were collected and analyzed for inflammation, pancreatic intraepithelial neoplasia (PanIN), and PDAC. We also used a syngeneic orthotopic PDAC mouse model to study tumor growth in the presence or absence of Lcn2 expression. In addition, to understand the mechanistic role of how LCN2 could be mediating PDAC, we studied LCN2 and its specific receptor solute carrier family 22 member 17 (SLC22A17) in human pancreatic cancer stellate cells (PSC), key mediators of the PDAC stroma. Depletion of Lcn2 diminished extracellular matrix deposition, immune cell infiltration, PanIN formation, and tumor growth. Notably, it also increased survival in both obesity-driven and syngeneic orthotopic PDAC mouse models. LCN2 modulated the secretion of proinflammatory cytokines in PSC of the PDAC tumor microenvironment, whereas downregulation of LCN2-specific receptor SLC22A17 blocked these effects. Our results reveal how LCN2 acts in the tumor microenvironment links obesity, inflammation, and PDAC development. Cancer Res; 77(10); 2647-60. ©2017 AACR.

Trait Anger and Partner-Specific Anger Management Moderate the Temporal Association Between Alcohol Use and Dating Violence.

OBJECTIVE: Research demonstrates alcohol temporally precedes and increases the odds of violence between intimate partners. However, despite an extensive theoretical literature on factors that likely moderate the relationship between alcohol and dating violence, minimal empirical research has examined such moderators. METHOD: The purpose of the present study was to examine two potential moderators of this association: trait anger and partner-specific anger management. Undergraduate men (N = 67) who had consumed alcohol within the past month and were in current dating relationships completed a baseline assessment of their trait anger and partner-specific anger management skills and subsequently completed daily assessments of their alcohol use and violence perpetration (psychological, physical, and sexual) for up to 90 consecutive days. RESULTS: Alcohol was significantly associated with increased odds of physical aggression among men with relatively high but not low trait anger and partner-specific anger management deficits. In contrast, alcohol was significantly associated with increased odds of sexual aggression among men with relatively low trait anger and partner-specific anger management deficits. CONCLUSIONS: Our findings demonstrate important differences in the roles of acute intoxication and anger management in the risk of physical aggression and sexual dating violence. Interventions for dating violence may benefit from targeting both alcohol and adaptive anger management skills.

The Impact of Virtual Reality on Chronic Pain.

The treatment of chronic pain could benefit from additional non-opioid interventions. Virtual reality (VR) has been shown to be effective in decreasing pain for procedural or acute pain but to date there have been few studies on its use in chronic pain. The present study was an investigation of the impact of a virtual reality application for chronic pain. Thirty (30) participants with various chronic pain conditions were offered a five-minute session using a virtual reality application called Cool! Participants were asked about their pain using a 0-10 visual analog scale rating before the VR session, during the session and immediately after the session. They were also asked about immersion into the VR world and about possible side effects. Pain was reduced from pre-session to post-session by 33%. Pain was reduced from pre-session during the VR session by 60%. These changes were both statistically significant at the p < .001 level. Three participants (10%) reported no change between pre and post pain ratings. Ten participants (33%) reported complete pain relief while doing the virtual reality session. All participants (100%) reported a decrease in pain to some degree between pre-session pain and during-session pain. The virtual reality experience was found here to provide a significant amount of pain relief. A head mounted display (HMD) was used with all subjects and no discomfort was experienced. Only one participant noted any side effects. VR seems to have promise as a non-opioid treatment for chronic pain and further investigation is warranted.

Do Alcohol and Marijuana Increase the Risk for Female Dating Violence Victimization? A Prospective Daily Diary Investigation.

OBJECTIVE: Dating violence is a serious and prevalent problem, with females being victimized by partners at high rates with numerous negative health consequences. Previous research has been equivocal on whether substance use on the part of the victim temporally precedes and, thus, increases the odds of victimization. While the sole responsibility for violence is always with the perpetrator, knowing this information could provide useful information for theory as well as interventions designed to keep women safe. METHOD: Participants were female college students in a current dating relationship who had consumed alcohol in the previous month (N = 173). Students completed daily surveys on their violence victimization, alcohol use, and marijuana use for up to 90 consecutive days. RESULTS: On any drinking days, heavy drinking days, and as the number of alcoholic drinks consumed increased, women were more likely to be victimized by psychological, physical, and sexual dating violence. Marijuana use also preceded and increased the odds of sexual victimization. Relationship length moderated some of these temporal associations, such that the odds of victimization on a drinking day, or marijuana use day, were increased for participants in longer relationships. CONCLUSIONS: Findings underscore the importance of considering the role that alcohol and marijuana use play in increasing the risk for dating violence victimization among women. Intervention programs for dating violence may benefit by attempting to decrease substance use in order to reduce risk for female victims.

Being the victim of violence during a date predicts next-day cannabis use among female college students.

AIMS: To determine whether being the victim of violence during a date among female college students on any given day predicted cannabis and alcohol use the following day. DESIGN, SETTING AND PARTICIPANTS: Between August 2010 and January 2013, we conducted a 90-day daily diary study with 174 females who were in current dating relationships from a large university in the Southeastern United States. The mean age of the sample was 18.70 years [standard deviation (SD) = 1.27]; participants were primarily non-Hispanic Caucasian (86.2%). Participants answered questions about contact with their dating partner, being the victim of violence (physical and sexual) during a date, physical perpetration, alcohol use and cannabis use for up to 90 days. The mean number of diaries completed was 54.90 (SD = 27.66). MEASUREMENTS: The primary outcomes were self-reported daily cannabis and alcohol use. Being the victim of violence during a date was assessed each day using self-report items from the Revised Conflict Tactics Scales and Sexual Experiences Survey. FINDINGS: Being the victim of violence during a date predicted cannabis use the following day (odds ratio = 2.25), and this effect held when controlling for contact with a partner, cannabis and alcohol use the previous day, physical perpetration the previous day, alcohol use the same day and the overall likelihood of being the victim of violence during a date, substance use and physical perpetration. Being the victim of violence during a date did not predict next-day alcohol use. Being the victim of sexual and physical violence during a date did not differentially predict next-day substance use. CONCLUSIONS: Among female college students in the United States, being the victim of violence during a date appears to increase the risk for cannabis use the following day.

Alcohol Use, Alcohol-Related Outcome Expectancies, and Partner Aggression Among Males Court-Mandated to Batterer Intervention Programs: A Brief Report.

Additional work is needed to determine how and/or why the relationship between alcohol use and increased risk of partner aggression (PA) exists. Researchers have begun to examine whether alcohol-related outcome expectancies (i.e., beliefs about the cognitive and behavioral effects of alcohol) are associated with PA irrespective of alcohol use. We examined the relationship between alcohol use, alcohol expectancies, and PA among 360 males arrested for a domestic violence offense and court-mandated to treatment. Results indicate that certain alcohol expectancies do play a role in the relationship between alcohol use and some forms of PA.

Development of a Faith-Based Stress Management Intervention in a Rural African American Community.

BACKGROUND: Faith-based mental health interventions developed and implemented using a community-based participatory research (CBPR) approach hold promise for reaching rural African Americans and addressing health disparities. OBJECTIVES: To describe the development, challenges, and lessons learned from the Trinity Life Management, a faith-based stress management intervention in a rural African American faith community. METHODS: The researchers used a CBPR approach by partnering with the African American faith community to develop a stress management intervention. Development strategies include working with key informants, focus groups, and a community advisory board (CAB). RESULTS: The community identified the key concepts that should be included in a stress management intervention. CONCLUSIONS: The faith-based "Trinity Life Management" stress management intervention was developed collaboratively by a CAB and an academic research team. The intervention includes stress management techniques that incorporate Biblical principles and information about the stress-distress-depression continuum.

Emotion Regulation Moderates the Association Between Proximal Negative Affect and Intimate Partner Violence Perpetration.

Negative affect is a central component of many theories of aggressive behavior. Though understudied, it is likely that proximal negative affect increases the odds of aggression perpetration when individuals have poor emotion regulation, but not when individuals have more adaptive emotion regulation. Thus, the current study examined (1) the proximal effect of various indicators of negative affect (e.g., anger, hostility, depression) on intimate partner violence (IPV) perpetration and (2) whether poor emotion regulation moderated these associations. For up to 90 consecutive days, male college students (N = 67) in a current dating relationship completed daily surveys on their negative affect and IPV perpetration. Results demonstrated that emotion regulation moderated many of the associations between proximal negative affect and physical aggression perpetration, such that negative affect was associated with increased odds of violence when poor emotion regulation was high but not low. This is the first study to demonstrate the moderating role of emotion regulation in the link between proximal negative affect and IPV perpetration. As such, these findings have important implications for existing theories of IPV and emotion regulation and suggest that interventions may effectively reduce IPV by targeting emotion regulation.