scholarly journals The Evolution of the Opiate/Opioid Crisis in Cuyahoga County

2017 ◽  
Vol 7 (1) ◽  
pp. 41-49 ◽  
Author(s):  
Thomas P. Gilson ◽  
Hugh Shannon ◽  
Jaime Freiburger
Keyword(s):  
The United States ◽  
Current Crisis ◽  
Adequate Funding ◽  
White Males ◽  
Opioid Drugs ◽  
Fentanyl Analogues ◽  
Cuyahoga County ◽  
Medical Examiners ◽  
Overdose Deaths ◽  
Source Of Information

The United States continues to grapple with an epidemic of opiate/opioid drugs. This crisis initially manifested itself in the use and abuse of opioid pain relievers and has since seen an increase in illicit opiate/opioid drug use mortality. Cuyahoga County (metropolitan Cleveland) has been an area where the crisis has been particularly acute; this paper updates our previous experience. Most notable in the evolution of the drug epidemic has been an increase in mortality associated with fentanyl and an alarming rise in overall deaths, largely attributable to the emergence of fentanyl (a 64% increase in total overdose deaths from 2015 to 2016, with fentanyl increasing 324%). Fentanyl is a synthetic opioid with use in medical analgesia and anesthesia; however, most of the current supply is of clandestinely manufactured origin. Also of concern is the recent appearance of illicit fentanyl analogues, which are briefly described in this report. White males continue to be the most frequent overdose victims in the current crisis. A decrease of age appears to have taken place with the emergence of fentanyl with the most common age group being between 30 and 44 years of age. The majority of decedents are nonurban residents. Educationally, most of these decedents have a high school diploma or less schooling and a significant percentage consists of manual laborers. Medical examiners are an important source of information necessary to develop prevention and interdiction strategies. Challenges faced regarding adequate funding, instrumentation, and staffing are being felt.

scholarly journals Examining concurrent validity between COMLEX-USA Level 2-Cognitive Evaluation and COMLEX-USA Level 2-Performance Evaluation

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Brandon Craig ◽  
Xiaolin Wang ◽  
Jeanne Sandella ◽  
Tsung-Hsun Tsai ◽  
David Kuo ◽  
...  
Keyword(s):  
Performance Evaluation ◽  
Concurrent Validity ◽  
Pearson Correlation ◽  
The United States ◽  
National Board ◽  
Cognitive Evaluation ◽  
Competency Domain ◽  
Medical Examiners ◽  
Pearson Correlations ◽  
Level 2

Abstract Context The Comprehensive Osteopathic Medical Licensing Examination of the United States of America (COMLEX-USA) is a three level examination used as a pathway to licensure for students in osteopathic medical education programs. COMLEX-USA Level 2 includes a written assessment of Fundamental Clinical Sciences for Osteopathic Medical Practice (Level 2-Cognitive Evaluation [L2-CE]) delivered in a computer based format and separate performance evaluation (Level 2-Performance Evaluation [L2-PE]) administered through live encounters with standardized patients. L2-PE was designed to augment L2-CE. It is expected that the two examinations measure related yet distinct constructs. Objectives To explore the concurrent validity of L2-CE with L2-PE. Methods First attempt test scores were obtained from the National Board of Osteopathic Medical Examiners database for 6,639 candidates who took L2-CE between June 2019 and May 2020 and matched to the students’ L2-PE scores. The sample represented all colleges of osteopathic medicine and 97.5% of candidates who took L2-CE during the complete 2019–2020 test cycle. We calculated disattenuated correlations between the total score for L2-CE, the L2-CE scores for the seven competency domains (CD1 through CD7), and the L2-PE scores for the Humanistic Domain (HM) and Biomedical/Biomechanical Domain (BM). All scores were on continuous scales. Results Pearson correlations ranged from 0.10 to 0.88 and were all statically significant (p<0.01). L2-CE total score was most strongly correlated with CD2 (0.88) and CD3 (0.85). Pearson correlations between the L2-CE competency domain subscores ranged from 0.17 to 0.70, and correlations which included either HM or BM ranged from 0.10 to 0.34 with the strongest of those correlations being between BM and L2-CE total score (0.34) as well as between HM and BM (0.28).The largest increase between corresponding Pearson and disattenuated correlations was for pairs of scores with lower reliabilities such as CD5 and CD6, which had a Pearson correlation of 0.17 and a disattenuated correlation of 0.68. The smallest increase in correlations was observed in pairs of scores with larger reliabilities such as L2-CE total score and HM, which had a Pearson correlation of 0.23 and a disattenuated correlation of 0.28. The reliability of L2-CE was 0.87, 0.81 for HM, and 0.73 for BM. The reliabilities for the L2-CE competency domain scores ranged from 0.22 to 0.74. The small to moderate correlations between the L2-CE total score and the two L2-PE support the expectation that these examinations measure related but distinct constructs. The correlations between L2-PE and L2-CE competency domain subscores reflect the distribution of items defined by the L2-PE blueprint, providing evidence that the examinations are performing as designed. Conclusions This study provides evidence supporting the validity of the blueprints for constructing COMLEX-USA Levels 2-CE and 2-PE examinations in concert with the purpose and nature of the examinations.

Preparing pharmacists to increase naloxone dispensing within community pharmacies under the Pennsylvania standing order

2020 ◽  
Author(s):  
Heather M Santa ◽  
Samira G Amirova ◽  
Daniel J Ventricelli ◽  
George E Downs ◽  
Alexandra A Nowalk ◽  
...  
Keyword(s):  
Community Pharmacists ◽  
The United States ◽  
Health Concern ◽  
Community Pharmacies ◽  
Opioid Overdose ◽  
Patient Counseling ◽  
Opioid Use ◽  
Overdose Prevention ◽  
Standing Order ◽  
Overdose Deaths

Abstract Purpose Opioid misuse and overdose deaths remain a public health concern in the United States. Pennsylvania has one of the highest rates of opioid overdose deaths in the country, with Philadelphia County’s being 3 times higher than the national average. Despite several multimodal interventions, including use of SBIRT (screening, brief intervention, and referral to treatment) methods and naloxone distribution, the rate of overdose deaths remains high. Methods To gain insights on strategies for improving access to naloxone and naloxone distribution by pharmacists in Philadelphia County, a study was conducted in 11 community pharmacies (chain and independent) in Philadelphia. Twenty-four pharmacists were recruited and completed SBIRT and naloxone trainings. Each pharmacy elected to have at least 1 pharmacy champion who received additional training on and helped develop pharmacy site–specific naloxone dispensing protocols. Results Pre-post survey results showed a reduction in stigmatizing attitudes regarding naloxone dispensing and an increase in pharmacists’ understanding of the standing order and appropriate naloxone use. There was an increase in pharmacists’ self-reported confidence in their ability to appropriately identify, discuss, and dispense naloxone to patients. All pharmacies increased their average monthly dispensing rate following protocol implementation. Conclusion Pharmacists who received both trainings were more likely to change naloxone dispensing practices, leading to an overall increase in naloxone dispensing by community pharmacists. The study addressed overall gaps in pharmacists’ knowledge, reduced stigma, and prepared pharmacists to address opioid use and overdose prevention with their patients. The described pharmacist-led patient counseling and intervention service for overdose prevention may be explored as a model for other community pharmacies to adopt to improve naloxone dispensing and similar interventions to reduce overdose deaths.

The Opioid Crisis: How Counselors Can and Should Respond

2021 ◽  
Vol 43 (2) ◽  
pp. 112-124
Author(s):  
Kevin S. Doyle
Keyword(s):  
Public Health ◽  
The United States ◽  
Public Health Emergency ◽  
Scope Of Practice ◽  
Professional Activity ◽  
Specialty Area ◽  
Ethical Imperative ◽  
National Public Health ◽  
Overdose Deaths ◽  
Do So

Drug overdose deaths in the United States have reached unprecedented levels in recent years and continue to rise. Counselors are uniquely positioned to respond to this crisis but may be reluctant or not equipped to do so due to a variety of factors, including scope of practice concerns. Responding to this crisis, however, is a clinical necessity and an ethical imperative for all practicing counselors, regardless of specialty area. A review of proposed responses at the macro/systemic, professional, and personal levels is presented, with concrete examples within each level, to assist counselors in identifying and implementing professional activity, advocacy, and engagement to address the unprecedented national public health emergency. Specific considerations for advocacy and for clinical practice are proposed to further assist counselors and motivate action.

The American Perception of the Palestine-Israel Conflict

2021 ◽  
Author(s):  
Israa Daas ◽  
Keyword(s):  
United States ◽  
Middle East ◽  
Political Party ◽  
The United States ◽  
The Us ◽  
The World ◽  
Us Government ◽  
Source Of Information

Abstract The Palestine-Israel conflict is probably one of the most pressing problems in the Middle East. Moreover, the United States has been involved in this conflict since the 1970s. Therefore, the present research aims to learn more about the American perception of the Palestinian-Israeli conflict. It was conducted using a survey that addressed Americans from different backgrounds, focusing on four variables: the American government’s position, solutions, the Israeli settlements, and Jerusalem. The research suggests a correlation between political party and the American perception of the conflict. It appears that Republicans seem to be against the withdrawal of the Israeli settlements, and they believe that the US government is not biased toward Israel. Nevertheless, Democrats tend to believe that the US government is biased in favor of Israel, and they support withdrawing the Israeli settlements. Moreover, there might be another correlation between the American perception and the source of information they use to learn about the conflict. Most of the surveyed Americans, whatever their resource of information that they use to learn about the conflict is, tend to believe that the US is biased in favor of Israel. It is crucial to know about the American perception when approaching to a solution to the conflict as the US is a mediator in this conflict, and a powerful country in the world. Especially because it has a permanent membership in the UN council. KEYWORDS: American Perception, Palestine-Israel Conflict, Jerusalem, Israeli settlements

scholarly journals REFLECTION ON COLLECTIVE MEMORY IN THE MUSEUM

2020 ◽  
Keyword(s):  
United States ◽  
Discourse Analysis ◽  
Collective Memory ◽  
Age Differences ◽  
The United States ◽  
Museum Visitors ◽  
Holocaust Memorial ◽  
Memorial Museum ◽  
The Holocaust ◽  
Source Of Information

The article describes visitors’ interpretation and understanding of the narrative about the Holocaust in the United States Holocaust Memorial Museum. Visitors comments were the material for the analysis, used methodology was discourse analysis. Different discourses were singled out in visitors’ comments. Differences between visitors’ comments given in different years were ascertained. Age differences and differences among narratives of various groups of the Museum visitors were shown. It can be concluded that the Museum fulfills various functions. Besides being a place of commemoration, it accomplishes its educational function and serves as a source of information about the Holocaust.

scholarly journals Incorporating Health Equity and Community Perspectives During COVID-19: Commonalities with Cardiovascular Health Equity Research

2020 ◽  
Vol 30 (3) ◽  
pp. 421-424
Author(s):  
Erica Payton Foh ◽  
Sandra E. Echeverria
Keyword(s):  
Health Equity ◽  
Cardiovascular Health ◽  
The United States ◽  
Current Crisis ◽  
Marginalized Communities ◽  
Social Inequities ◽  
Equity Research ◽  
Health Equity Research ◽  
Structural Inequities ◽  
Health Agenda

 The COVID-19 pandemic is revealing the deeply entrenched structural inequities in health that exist in the United States. We draw parallels between the COVID-19 pan­demic and our cardiovascular health equity research focused on physical activity and diabetes to highlight three common needs: 1) access to timely and disaggregated data; 2) how to integrate community-engaged approaches in telehealth; and 3) policy ini­tiatives that explicitly integrate health equity and social justice principles and action. We suggest that a similar sense of urgency regarding COVID-19 should be applied to slow the burgeoning costs and suffer­ing associated with cardiovascular disease overall and in marginalized communities specifically. We remain hopeful that the current crisis can serve as a guide for align­ing our principles as a just and democratic society with a health agenda that explicitly recognizes that social inequities in health for some impacts all members of society. Ethn Dis. 2020;30(3):421-424; doi:10.18865/ed.30.3.421

Impact of gender on treatment and survival of patients with esophageal cancer in the United States.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 173-173
Author(s):  
Camille Baumrucker ◽  
Dido Franceschi ◽  
Alan S Livingstone ◽  
Francis Igor Macedo
Keyword(s):  
Esophageal Cancer ◽  
The United States ◽  
Small Sample ◽  
Stage I ◽  
Disease Stage ◽  
Cancer Data ◽  
Female Patients ◽  
White Males ◽  
Chi Square Analysis ◽  
The Impact

173 Background: Esophageal cancer (EC) is historically a male-predominant disease. Current available evidence on the impact of gender on clinical presentation and survival outcomes of EC is limited by small sample size or single institutional series. Methods: Patients with EC (stage I-III) were identified in the National Cancer Data Base (NCDB, 2004-2016). Clinicopathologic and treatment characteristics of male and female patients were compared using Chi-square analysis. Overall survival (OS) was estimated using Kaplan-Meier method and Cox proportional hazards regression. Results: Of 62,893 patients included, male gender was predominant (77.7% vs 22.3%). Adenocarcinoma was the most common subtype (66.7%); however, squamous cell carcinoma was more predominant in females (57.1% vs. 26.5%, p<0.001). Females were significantly older (68.5 vs. 66.1 years; p<0.001) and more likely African American (AA) (14% vs. 8.1%; p<0.001). Females were more likely to present with local disease (stage I, 19.6% vs. 18.2%; p<0.001), while males presented more likely with locoregional disease (LRD, stage II/III, 80.4% vs 81.8%, p<0.001). Females had worse OS compared to males (18.1 vs. 19.7 mo; p=0.001; cI: 23.5 vs. 31.9mo, p<0.001; cII/III: 17.2 vs 18.3mo, p=0.473). White females had worse OS than white males (18.6 vs. 20.4mo, p<0.001), while AA females had better OS (13.5 vs. 12.6mo, p=0.001). Among patients with LRD, females less frequently received chemotherapy (CT, 75.4% vs. 82.9%, p<0.001), radiation therapy (RT, 78.9% vs. 82.6%, p<0.001), and esophagectomy (28% vs. 40.5%, p<0.001). Females who underwent esophagectomy had improved OS over males (40.3 vs. 32.7mo; p<0.001). More specifically, white females who underwent esophagectomy had improved OS over white males (47.6 vs 38mo, p<0.001); however, AA males and females who underwent esophagectomy had similar OS (33.8 vs 32.6mo, p=0.452). Female gender, advanced age, AA race, high comorbidity score and clinical stage, and lack of access to CT, RT, and esophagectomy were independent predictors of mortality (Table). Conclusions: Females with EC seem to have less access to CT, RT and esophagectomy, which is associated with worse OS compared to males. Healthcare policies should be implemented to increase access to standard of care treatment for female patients with EC. [Table: see text]

Hospitalizations Due to Firearm Injuries in Children and Adolescents

2017 ◽  
pp. 33-39
Author(s):  
John M. Leventhal ◽  
Julie R. Gaither ◽  
Robert Sege
Keyword(s):  
Children And Adolescents ◽  
Suicide Attempts ◽  
International Classification Of Diseases ◽  
The United States ◽  
Hospitalization Rate ◽  
Firearm Injuries ◽  
White Males ◽  
Classification Of Diseases ◽  
Weighted Number ◽  
Us Children

BACKGROUND AND OBJECTIVE Despite recent national attention on deaths from firearms, little information exists about children and adolescents who are hospitalized for firearm injuries. The objective was to determine the national frequency of firearm-related hospitalizations in the United States in children, compare rates by cause and demographics, and describe hospitalized cases. METHODS We used the 2009 Kids’ Inpatient Database to identify hospitalizations from firearm-related injuries in young people &lt;20 years of age; International Classification of Diseases, Ninth Revision, Clinical Modification, and external-cause-of injury codes were used to categorize the injuries and the causes as follows: assault, suicide attempt, unintentional, or undetermined. Incidences were calculated by using the weighted number of cases and the intercensal population. Risk ratios compared incidences. RESULTS In 2009, 7391 (95% confidence interval [CI]: 6523–8259) hospitalizations were due to firearm-related injuries. The hospitalization rate was 8.87 (95% CI: 7.83–9.92) per 100 000 persons &lt;20 years of age. Hospitalizations due to assaults were most frequent (n = 4559) and suicide attempts were least frequent (n = 270). Of all hospitalizations, 89.2% occurred in males; the hospitalization rate for males was 15.22 per 100 000 (95% CI: 13.41–17.03) and for females was 1.93 (95% CI: 1.66–2.20). The rate for black males was 44.77 (95% CI: 36.69–52.85), a rate more than 10 times that for white males. Rates were highest for those aged 15 to 19 years (27.94; 95% CI: 24.42–31.46). Deaths in the hospital occurred in 453 (6.1%); of those hospitalized after suicide attempts, 35.1% died. CONCLUSIONS On average, 20 US children and adolescents were hospitalized each day in 2009 due to firearm injuries. Public health efforts are needed to reduce this common source of childhood injury.

The ongoing aftermath to the financial crisis and the Great Recession

2019 ◽  
Vol 34 (5) ◽  
pp. 560-570
Author(s):  
Gerardo del Cerro Santamaría
Keyword(s):  
Financial Crisis ◽  
Great Recession ◽  
Liberal Democracy ◽  
The United States ◽  
Historical Period ◽  
Current Crisis ◽  
The West ◽  
The Great Recession ◽  
Contemporary World ◽  
The World

This article discusses the consequences of the financial crisis that started in 2008 in the West, and particularly in the United States, as a manifestation of neoliberal capitalism’s multiple failures. In doing so, it focuses on the scholarly contributions of Manuel Castells and his colleagues in two important books: Aftermath: The Cultures of the Economic Crisis (2012) and Another Economy is Possible (2017). Both books are collective works led and edited by Castells. Also included in the review is a third book by Castells, Rupture: The Crisis of Liberal Democracy (2018), which can be read as a statement on some of the political consequences of the 2008 financial crisis and a report on the current crisis of liberal democracy. The contention is that Castells et al. make an important contribution to the socio-economic literature on the financial crisis, its consequences, and the interpretation of the societal changes that ensued and are key to understand our contemporary world. Such contribution, as observed in the three books under review, can be summarized as follows: (1) Castells and colleagues provide cases and examples from around the world in a broad comparative fashion, thus expanding our understanding of a crisis that was essentially a crisis of the West with ramifications in other countries but never a truly global crisis. (2) The approach of Castells and his colleagues is interdisciplinary and goes beyond purely economic arguments to include sociological, political and cultural ideas and insights that help us understand the complexity of the historical period under analysis; readers develop an awareness of the systemic character of the crisis, where all events were closely interrelated; in particular, both micro and macro processes leading to the crisis converged into a mutually dialectical and reinforcing relationship that warrants the contention by the authors that ‘economies’ are ‘cultures.’ (3) The authors in both Aftermath and Another Economy is Possible focus on the (long) aftermath of the crisis, which is still ongoing as of September 2019 around the world; in fact, one of Castells’ main points is that the financial crisis brought about irreversible societal change, ongoing and clearly visible today, as it triggered a significant restructuring of global informational capitalism. (4) The authors provide a focus on one of the reactive consequences of the crisis: alternative economic practices developing in the aftermath of the crisis, under the premise that we might be witnessing the rise of a new economic model based on new, alternative values. (5) Castells provides a discussion (in Rupture) of aspects of the contemporary political landscape a decade after the outset of the financial crisis and the Great Recession.

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