Opioid Overdose After Medication for Opioid Use Disorder Initiation Following Hospitalization or ED Visit.

Importance: Hospitalizations related to opioid use disorder (OUD) represent an opportunity to initiate medication for OUD (MOUD). Objective: To assess whether starting MOUD after a hospitalization or emergency department (ED) visit is associated with the odds of fatal and nonfatal opioid overdose at 6 and 12 months. Design, Setting, and Participants: This population-based cohort study used data from the Oregon Comprehensive Opioid Risk Registry, which links all payer claims data to other administrative health datasets, for individuals aged 18 years or older who had diagnosis codes related to OUD recorded at an index ED visit or hospitalization from January 2017 to December 2019. Data were analyzed between May 2023 and January 2024. Exposures: Receipt of MOUD within the 7 days after an OUD-related hospital visit. Main Outcomes and Measures: The primary outcome was fatal or nonfatal overdose at 6 and 12 months after discharge. Sample characteristics, including age, sex, insurance plan, number of comorbidities, and opioid-related overdose events, were stratified by receipt or nonreceipt of MOUD within 7 days after an OUD-related hospital visit. A logistic regression model was used to investigate the association between receipt of MOUD and having an opioid overdose event. Results: The study included 22 235 patients (53.1% female; 25.0% aged 25-39 years) who had an OUD-related hospital visit during the study period. Overall, 1184 patients (5.3%) received MOUD within 7 days of their ED visit or hospitalization. Of these patients, 683 (57.7%) received buprenorphine, 463 (39.1%) received methadone, and 46 (3.9%) received long-acting injectable naltrexone. Patients who received MOUD within 7 days after discharge had lower adjusted odds of fatal or nonfatal overdose at 6 months compared with those who did not (adjusted odds ratio [AOR], 0.63; 95% CI, 0.41-0.97). At 12 months, there was no difference in adjusted odds of fatal or nonfatal overdose between these groups (AOR, 0.79; 95% CI, 0.58-1.08). Patients had a lower risk of fatal or nonfatal overdose at 6 months associated with buprenorphine use (AOR, 0.50; 95% CI, 0.27-0.95) but not with methadone use (AOR, 0.57; 95% CI, 0.28-1.17). Conclusions and Relevance: In this cohort study of individuals with an OUD-related hospital visit, initiation of MOUD was associated with reduced odds of opioid-related overdose at 6 months. Hospitals should consider implementing programs and protocols to offer initiation of MOUD to patients with OUD who present for care.

Daily reactivity to stress and sleep disturbances: unique risk factors for insomnia.

STUDY OBJECTIVES: To naturalistically measure sleep disturbances following stress exposure (i.e. sleep reactivity) and stress responses following sleep disturbances (i.e. stress reactivity) at the daily level and prospectively examine these reactivity measures as individual risk factors for insomnia. METHODS: The study assessed 392 nurses' sleep and stress for 14 days using daily diaries and actigraphy. Self-reported insomnia symptoms were assessed at the end of the 14 days, as well as 6 and 11 months later. RESULTS: In multilevel modeling, while negative fixed effects indicated that shorter total sleep time (TST) and lower sleep efficiency led to greater stress and vice versa, significant random effects indicated individual variability in sleep reactivity and stress reactivity. In latent score change modeling, greater sleep reactivity (lower diary-determined sleep efficiency following greater stress) and greater stress reactivity (greater stress following shorter diary-determined TST) at baseline were associated with greater insomnia symptoms at 11 months (b = 10.34, p = .026; b = 7.83, p = .03). Sleep reactivity and stress reactivity also interacted to predict insomnia symptoms, such that sleep reactivity was significantly associated with insomnia symptoms for those with high (+1 SD) stress reactivity (b = 17.23, p = .001), but not for those with low (-1 SD) stress reactivity (b = 5.16, p = .315). CONCLUSIONS: Baseline stress reactivity and sleep reactivity independently as well as jointly predict greater insomnia symptoms 11 months later. The findings delineate processes underlying the stress-diathesis model of insomnia and highlight the utility of longitudinal and naturalistic measures of sleep and stress reactivity.

Valuation of emotion underlies cultural variation in cardiovascular stress responses.

Cultural context shapes individuals' valuation of emotions. Although studies have documented cultural differences in beliefs about the utility of negative emotions, little is known about how such cultural valuation is associated with physiological stress responses. In the present work, we examined whether East Asians and European Americans differ in how they value nervousness in a demanding situation and whether such valuation predicts acute cardiovascular responses. We found that East Asians were more likely than European Americans to believe feeling nervous in a demanding situation was useful. Furthermore, greater valuation of negative emotion predicted attenuated cardiovascular responses to a laboratory mental stressor and partially mediated the relationship between culture and cardiovascular stress responses. The present results highlight the importance of valuation of emotions as a psychological mechanism underlying cultural as well as individual differences in stress-evoked cardiovascular responses. We discuss one implication for this line of research, unpacking how cross-cultural differences in valuation of negative emotions may lead to cultural variation in physiological patterns related to health outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Feeling excited or taking a bath: Do distinct pathways underlie the positive affect-health link in the U.S. and Japan?

Feeling good is linked to better health in Western contexts. Recent studies show, however, that the affect-health link is not consistent across cultures. We suggest two reasons for such inconsistency. The first follows from research showing that North American (vs. East Asian) cultures tend to value high arousal positive (HAP) states, for example, excited, more than low arousal positive (LAP) states, for example, calm. The second is one we propose for the first time. Positive affective experience is manifest in internal feelings but also in affective practices, such as taking a bath (a highly valued affective experience in Japan) or a fitness workout (a highly valued affective experience in the United States). We hypothesized that the HAP feelings/practices-health link would be stronger in the United States versus Japan, and the LAP feelings/practices-health link would be stronger in Japan versus the United States. Using survey samples from the United States (N = 640) and Japan (N = 382), we examined how health outcomes are shaped by positive affective feelings and practices varying in arousal. In a first set of analyses, HAP feelings predicted better physical and biological health in the United States but not in Japan. No cultural differences were consistently found for the effect of LAP feelings on health. In addition, engaging in HAP practices predicted better physical and biological health in the United States whereas engaging in LAP practices predicted better physical health in Japan but not in the United States. These findings suggest that the pathways underlying the culture-health link are culturally variable. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Longitudinal Profiles of Psychological Well-Being and Health: Findings From Japan.

Studies have reported relationships between psychological well-being and physical health in Western cultural contexts. However, longitudinal associations between well-being and health have not been examined in other cultures where different values and beliefs about well-being exist. This paper examined whether longitudinal profiles of well-being predict prospective health among Japanese adults. Data came from 654 people who completed two waves of the Midlife in Japan (MIDJA) Study collected 4-5 years apart. Health outcomes were assessed with subjective health, chronic conditions, physical symptoms, and functional health. The results showed that persistently high well-being predicted better health over time. High-arousal positive affect, which is relatively less valued in Japanese culture, was also associated with better health. The findings add cross-cultural evidence to the cross-time link between well-being and health.

Culture and social hierarchy: Self- and other-oriented correlates of socioeconomic status across cultures.

Current theorizing on socioeconomic status (SES) focuses on the availability of resources and the freedom they afford as a key determinant of the association between high SES and stronger orientation toward the self and, by implication, weaker orientation toward others. However, this work relies nearly exclusively on data from Western countries where self-orientation is strongly sanctioned. In the present work, we predicted and found that especially in East Asian countries, where other-orientation is strongly sanctioned, high SES is associated with stronger other-orientation as well as with self-orientation. We first examined both psychological attributes (Study 1, N = 2,832) and socialization values (Study 2a, N = 4,675) in Japan and the United States. In line with the existent evidence, SES was associated with greater self-oriented psychological attributes and socialization values in both the U.S. and Japan. Importantly, however, higher SES was associated with greater other orientation in Japan, whereas this association was weaker or even reversed in the United States. Study 2b (N = 85,296) indicated that the positive association between SES and self-orientation is found, overall, across 60 nations. Further, Study 2b showed that the positive association between SES and other-orientation in Japan can be generalized to other Confucian cultures, whereas the negative association between SES and other-orientation in the U.S. can be generalized to other Frontier cultures. Implications of the current findings for modernization and globalization are discussed. (PsycINFO Database Record

Linking Positive Affect to Blood Lipids: A Cultural Perspective.

Higher levels of positive affect have been associated with better physical health. While positive affect is seen as highly desirable among Westerners, East Asians tend to deemphasize positive affect. Using large probability samples of Japanese and U.S. adult populations, the present study examined the relations of positive affect with serum lipid profiles, known to be strongly predictive of risk for cardiovascular disease, and tested whether their associations depend on cultural contexts. As predicted, positive affect was associated with healthier lipid profiles for Americans but not for Japanese. Further analyses showed that this cultural moderation was mediated by body mass index. This study highlights the role of culture in the link between positive emotions and key biological risk factors of cardiovascular disease.

Positive affect, social connectedness, and healthy biomarkers in Japan and the U.S.

Previous studies have shown that positive affect (PA) and social connectedness predict better health in the United States (U.S.). However, the relevance of such findings for other cultural contexts has been largely ignored. The present study investigated the interplay of PA, social connectedness, and health using large probability samples of Japanese and U.S. adults. Health was measured objectively with biomarkers that represent well-functioning physiological systems: HDL (high-density lipoprotein) and DHEA-S (dehydroepiandrosterone-sulfate). Lower levels of both biomarkers (i.e., less healthy biomarker profile) were found among those in Japan who reported high PA in combination with low social connectedness. In the U.S., the general pattern was that those with greater PA showed healthier HDL levels regardless of social connectedness. The findings highlight cultural variations in the health implications of how PA and social connectedness come together. (PsycINFO Database Record