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Many older adults are discharged from skilled nursing facilities (SNFs) at functional levels below those needed for safe, independent home and community mobility. There is limited evidence explaining this insufficient recovery. The purpose of this secondary analysis was to determine predictors of physical function change following SNF rehabilitation. Secondary analysis of a prospective observational cohort study. Across 4 SNFs, data were collected from 698 adults admitted for physical rehabilitation following an acute hospitalization. Physical function recovery was evaluated as change from admission to discharge in Short Physical Performance Battery (SPPB) scores (N = 698) and gait speed (n = 444). Demographic and clinical characteristics collected at admission served as potential predictors of physical function change. Following imputation, a standardized model selection estimator was calculated for predictors per physical function outcome. Predictor estimates and 95% CIs were calculated for each outcome model. Higher cognitive scores [standardized β (β STD) = 0.11, 95% CI: 0.0004, 0.20] and higher activities of daily living (ADL) independence at admission (β STD = 0.22, 95% CI: 0.05, 0.34) predicted greater SPPB change; higher SPPB scores at admission (β STD = −0.26, 95% CI: −0.35, −0.14) predicted smaller SPPB change. Higher ADL independence at admission (β STD = 0.17, 95% CI: 0.01, 0.37) predicted greater gait speed change; faster gait speed at admission (β STD = −0.30, 95% CI: −0.44, −0.15) predicted smaller gait speed change. Admission cognition, ADL independence, and physical function predicted physical function change following post-hospitalization rehabilitation. Inverse findings for admission physical function and ADL independence predictors suggest independence with ADL is not necessarily aligned with mobility-related function. Findings highlight that functional recovery is multifactorial and requires comprehensive assessment throughout SNF rehabilitation. [ABSTRACT FROM AUTHOR]

There emerges increasing doubt regarding whether the policy composite indicators are applicable to the COVID-19 pandemic. A few early studies demonstrate that the association between some composite indicators of policy preparedness and the risk of COVID-19 is statistically insignificant, and the relation between any composite indicators and recovery process (e.g., vaccination coverage) remains unexplored. To examine the relation between composite indicators and pandemic risk (as well as the vaccination coverage) with robustness, this study applies different policy preparedness indicators by using data from multi-sources. A cross-sectional analysis was performed. Regression analysis is adopted to examine the relation between four policy preparedness indicators (i.e., [1] International Health Regulations core capacity index, [2] Global Health Security Index, [3] epidemic preparedness index, and [4] World Governance Index) and COVID-19-confirmed cases/death/vaccination coverage at different time points. The linear regression is performed, and the spatial distribution of indicators are illustrated. Countries with higher ranking in policy preparedness indexes can experience less severity of pandemic risk (e.g., confirmed cases and mortality) and faster recovery process (e.g., higher vaccination coverage). However, slight disparity in effectiveness exists across different indicators. Results show that the policy preparedness indicators have predictive value of the confirmed cases, mortality, and vaccination coverage of COVID-19 pandemic, given sufficiently long-time span is observed. [ABSTRACT FROM AUTHOR]

There is growing interest in the role of social support during the recovery after hip fractures. The research to date has been mainly focused on structural support, with few studies concerned with functional support. This study examined the effects of both functional and structural aspects of social support on rehabilitation outcomes among older adults with hip fracture surgery. Prospective cohort study. Consecutive older adults (≥60 years) with hip fracture surgery who underwent inpatient rehabilitation in a post-acute care facility in Singapore between January 11, 2021, and October 30, 2021 (n = 112). We administered the Medical Outcome Study–Social Support Survey (MOS-SSS) to assess perceived functional support of patients and used living arrangement as an indicator for structural support. Participants were followed up over the inpatient stay at the post-acute care facility until discharge; thereafter, rehabilitation efficiency (REy) and rehabilitation effectiveness (REs) were evaluated. Multiple linear regressions were performed to examine the associations of MOS-SSS score and living arrangement with REy and REs, respectively, adjusting for age, gender, ethnicity, comorbidity, body mass index, prefracture function, type of fracture, and length of stay. Perceived functional support had positive associations with rehabilitation outcomes. A 1-unit increase in MOS-SSS total score was associated with 0.15 units (95% CI 0.03–0.3, P =.029) greater gain in physical function after a typical 1-month stay, and 0.21 units (95% CI 0.01–0.41, P =.040) higher achievement in potential functional improvement upon discharge. In contrast, no association was observed between structural support and rehabilitation outcomes. Perceived functional support may significantly impact the recovery of older adults with hip fracture during the inpatient rehabilitation process, independent of structural support. Our findings suggest the potential of incorporating interventions enhancing perceived functional support of patients into the post-acute care model for hip fracture. [ABSTRACT FROM AUTHOR]

Examine differences in multidimensional well-being from before (January 2020) to three timepoints during the COVID-19 pandemic (June 2020, January 2021, January 2022). Repeated cross-sectional design. Nationally representative cross-sectional cohorts of US adults completed the Secure Flourish Index before (January 2020 cohort: N = 1010) and during the COVID-19 pandemic (June 2020 cohort: N = 3020; January 2021 cohort: N = 3366; January 2022 cohort: N = 2598). We estimated differences in indicators, domains, and composite well-being between the January 2020 cohort and each of the subsequent cohorts. We also explored whether changes in well-being between January 2020 and January 2022 varied based on age, gender, and race/ethnicity. Initial declines in well-being observed by June 2020 were largely followed by a return to prepandemic levels in January 2022, with some exceptions. Notably, general declines in mental health have persisted through to January 2022. On the other hand, there was evidence of general improvements in character & virtue that exceeded prepandemic levels in January 2022. Young adults and racial/ethnic minorities reported lower financial & material stability in January 2022 compared to before the COVID-19 pandemic. Although there are promising signs that the well-being of US adults has mostly recovered to prepandemic levels, a coordinated response is urgently needed to support population mental health and the financial security of vulnerable groups. As society continues the journey toward postpandemic recovery, continued tracking of multidimensional well-being will be important for making informed decisions about public health priorities. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has led to changes in behaviours, which may have different health effects in population subgroups. We investigated whether within-individual changes in health behaviours from before to during the pandemic differ by socio-economic deprivation, age or sex. Prospective cohort study. Participants were recruited from the existing UK Fenland cohort study with measurements of health behaviours twice prepandemic (2005 to February 2020) and three times during the pandemic (July 2020 to April 2021). Health behaviours included daily servings of fruit and vegetables, units of alcohol consumed per week, smoking status, sleep duration and total and domain-specific physical activity energy expenditure. Sociodemographic information (English indices of multiple deprivation, education, occupation and ethnicity) and COVID-19 antibody status were also collected. Participants were grouped into three categories based on their English indices of multiple deprivation score: most, middle and least deprived. Participants were included if they had completed at least one measurement during the pandemic and one prepandemic (n = 3212). Fruit and vegetable consumption, total physical activity energy expenditure and smoking prevalence decreased during the pandemic compared with prepandemic, whereas average sleep duration increased and alcohol consumption did not change. Decreases in fruit and vegetable intake and physical activity energy expenditure were most pronounced in the most deprived group compared with the least deprived group and were greater in women than men. Socio-economic inequalities in health behaviours have worsened during the pandemic. As the country emerges from the COVID-19 pandemic, strategies to reduce health inequalities need to be put at the forefront of recovery plans. [ABSTRACT FROM AUTHOR]

There is considerable heterogeneity within populations regarding the effects of the COVID-19 pandemic on mental health. This study aimed at identifying latent groups of individuals within the older Austrian population that differ in their mental health trajectories across three phases of the pandemic. Data were gathered from a longitudinal survey study among a sample of older adults in Austria. The survey was carried out in May 2020 (N 1 = 556), March 2021 (N 2 = 462), and December 2021 (N 3 = 370) via either computer-assisted web or telephone interviewing. Latent class growth analysis was conducted to explore different homogenous groups in terms of non-linear trajectories of loneliness, depressive symptoms, and anxiety symptoms as well as potential correlates thereof. We identified four latent classes. The vast majority of individuals belong to two classes that are either resilient (71%) or that have recovered relatively quickly from an initial COVID-19 shock (10.2%). Deterioration in mental health after the first phase of the pandemic (13.4%) or a generally high mental health burden (5.4%) characterizes the other two classes. About 19% of individuals showed increasing or elevated levels in loneliness, depressive symptoms, and anxiety symptoms across the COVID-19 pandemic. The feeling of being socially supported and in control over one's own life emerged as potentially protective factors. [ABSTRACT FROM AUTHOR]

Introduction: Proinflammatory cytokines released from nerve endings and surrounding injured tissue after nerve damage can prolong the inflammation process, delay nerve healing or result in poor quality nerve healing. In this case, due to the loss of function in the muscles innervated by the damaged nerve, the patient may have neurological and functional difficulties which may reduce the patient's quality of life and create an economic burden. Although the attempts of many pharmacological agents to heal crush injury of peripheral nerves have been recorded in literature, a drug that can provide adequate recovery of the crushed nerve and can be applied in daily life has not been defined as yet. This study aimed to assess the effects of calcium dobesilate on sciatic nerve crush injury in a rat model.Methods: A total of 26 male Wistar albino rats were separated into four groups as follows: CONTROL group (healthy subjects, n=6); SHAM group (crush injury was created, n=6); MP group (after created crush injury, methylprednisolone was administered, n=7); and CAD group (after created crush injury, calcium dobesilate was administered, n=7). A crush injury was created, then the electrophysiological findings and sciatic nerve functional index (SFI) were recorded before euthanasia. After the euthanasia of all the rats, samples of the crushed nerve and gastrocnemius muscle were evaluated histopathologically, immunohistochemically, and biochemically.Results: Both pharmacological agents were histopathologically effective in axon regeneration and repair. Calcium dobesilate did not preserve total muscle mass but was seen to prevent atrophy microscopically. Immunohistochemistry and biochemistry results showed that calcium dobesilate and methylprednisolone had anti-inflammatory, anti-oxidant, anti-apoptotic, and anti-autophagic activity in the crushed sciatic nerve. Neither calcium dobesilate nor methylprednisolone improved the nerve conductance level. SFI values obtained on day 30 from the CAD group were numerically closer to the values of the healthy animals but not at a statistically significant level.Conclusion: The study results demonstrated that calcium dobesilate could suppress inflammatory processes and provide histopathological and functional improvements in the injured nerve in rats. Therefore, further clinical studies are recommended to investigate in detail the therapeutic effects of calcium dobesilate on peripheral nerve crush injury. [ABSTRACT FROM AUTHOR]

Background and Purpose: Numerous studies have detailed the potential benefits of inpatient geriatric rehabilitation for older adults with hip fractures. However, data regarding effect of fracture type (femoral neck, intertrochanteric, or subtrochanteric) on rehabilitation outcomes are limited. This study assessed whether the anatomical type of proximal hip fracture affects rehabilitation outcomes among disabled older adults.Methods: A population-based study was conducted comparing all patients with a recent hip fracture who were admitted to a geriatric rehabilitation facility in Israel. Data were collected retrospectively from an electronic database during a 5-year period (2014-2019). The Functional Independence Measure (FIM) was used to assess physical and cognitive function at admission and discharge.Results: The analyses included 624 older adults with hip fractures. We found significant differences in motor FIM score at admission, as patients with femoral neck fracture performed better than patients with intertrochanteric and subtrochanteric fracture did. The disparity in motor FIM score remained consistent through discharge, with all groups achieving a median gain of 14 points. Within one month of rehabilitation, about a third of all patients achieved a higher functional level.Conclusions: Patients with femoral neck fracture have better motor ability than do those with intertrochanteric and subtrochanteric fractures, which were retained throughout the course of rehabilitation; yet, the level of improvement remained similar. Clinicians should be aware of such differences in functional ability when discussing goals of care with older adults with hip fractures and consider them when implementing individual rehabilitation programs . [ABSTRACT FROM AUTHOR]

Although the results on acute and late toxicity of ultrahypofractionation are encouraging, data on safety in prostate cancer patients with a medical history of transurethral resection of the prostate (TURP) or adenomectomy remain scarce, especially in cases of repeated procedures. The aim of the present study was to report on long-term toxicities after stereotactic body radiotherapy (SBRT) of prostate cancer patients with previous surgical treatment of benign prostatic hyperplasia. Among 150 patients treated with SBRT (median dose 36.25 Gy in five fractions) realised from 2014 to 2019 in a single-centre institution, data of 24 men with a history of TURP (n = 19) or adenomectomy (n = 5) were analysed. Repeated TURP was carried out in three patients, with a median time between surgery and SBRT of 54 months. Genitourinary toxicity was assessed using the Common Terminology Criteria for Adverse Events v4.0 grading scale. With a median follow-up of 45 months, 10 of 24 (42%) patients experienced at least one episode of transient haematuria. One patient (4%) with three previous TURP presented a grade 3 acute non-infective cystitis. Late grade 2 and 3 genitourinary toxicities were observed in eight (33%) and four patients (17%) (two treated with adenomectomy, one with multiple TURP and one with a 140 cm3 prostate size), respectively, with no grade ≥4 adverse events. A complete recovery of grade 3 genitourinary toxicities was observed for all patients after hyperbaric oxygen therapy. Prostate SBRT is feasible and well-tolerated in patients with a medical history of surgical treatments of benign hyperplasia. Patients with prior adenomectomy or multiple TURP are at higher risk of developing severe genitourinary toxicity and should be carefully evaluated before SBRT treatments. • Prostate SBRT is feasible and safe in patients with a previous TURP or adenomectomy. • Increased genitourinary toxicity is observed in patients with multiple TURP. • Intraprostatic postsurgical cavity volume is correlated with genitourinary toxicity rate. • HBOT allows significant recovery of genitourinary symptoms after prostate SBRT. [ABSTRACT FROM AUTHOR]

Background: Anatomical custom-made prostheses make it possible to reconstruct complicated bone defects following excision of bone tumors, thanks to 3D-printed technology. To date, clinical measures have been used to report clinical-functional outcome and provide evidence for the effectiveness of this new surgical approach. However, there are no studies that quantified the achievable recovery during common activities by using instrumental clinical-functional evaluation in these patients.Research Question: What is the motor performance, functional outcome and quality of life in patients with custom-made 3D-printed pelvic prostheses following bone tumor?Methods: To analyze motor performance, six patients performed motion analysis during five motor activities at follow-up of 32 ± 18 months. Joint angles, ground reaction forces and joint moments of the operated and contralateral limbs were compared. On-off activity of lower-limb muscles were calculated from electromyography and compared to a healthy matched population. To analyze functional outcome and quality of life, differences in measured hip abductor strength between limbs were evaluated, as well as clinical-functional scores (Harris Hip Score, Barthel Index, Musculoskeletal Tumor Society score), and quality of life (SF-36 health survey).Results: We found only slight differences in joint kinematics when comparing operated and contralateral limb. The activity of gluteal muscles was normal, while hamstrings showed out-of-phase activities. Ground reaction forces and hip moments showed asymmetries between limbs, particularly in more demanding motor activities. We found a mean difference in hip abductor strength of 48 ± 82 N between limbs, good clinical-functional scores, and quality of life scores within normative.Significance: Our study showed optimal long-term results in functional recovery, mainly achieved through recovery of the gluteal function, although minor impairments were found, which may be considered for future improvement of this innovative surgery. The effect of a more loaded contralateral limb on internal loads and long-term performance of the implant remains unknown and deserves further investigation. [ABSTRACT FROM AUTHOR]

Background: Recovery trajectories of clinically unresponsive patients with acute brain injury are largely uncertain. Brain activation in the absence of a behavioural response to spoken motor commands can be detected by EEG, also known as cognitive-motor dissociation. We aimed to explore the role of cognitive-motor dissociation in predicting time to recovery in patients with acute brain injury.Methods: In this observational cohort study, we prospectively studied two independent cohorts of clinically unresponsive patients (aged ≥18 years) with acute brain injury. Machine learning was applied to EEG recordings to diagnose cognitive-motor dissociation by detecting brain activation in response to verbal commands. Survival statistics and shift analyses were applied to the data to identify an association between cognitive-motor dissociation and time to and magnitude of recovery. The prediction accuracy of the model that was built using the derivation cohort was assessed using the validation cohort. Functional outcomes of all patients were assessed with the Glasgow Outcome Scale-Extended (GOS-E) at hospital discharge and at 3, 6, and 12 months after injury. Patients who underwent withdrawal of life-sustaining therapies were censored, and death was treated as a competing risk.Findings: Between July 1, 2014, and Sept 30, 2021, we screened 598 patients with acute brain injury and included 193 (32%) patients, of whom 100 were in the derivation cohort and 93 were in the validation cohort. At 12 months, 28 (15%) of 193 unresponsive patients had a GOS-E score of 4 or above. Cognitive-motor dissociation was seen in 27 (14%) patients and was an independent predictor of shorter time to good recovery (hazard ratio 5·6 [95% CI 2·5-12·5]), as was underlying traumatic brain injury or subdural haematoma (4·4 [1·4-14·0]), a Glasgow Coma Scale score on admission of greater than or equal to 8 (2·2 [1·0-4·7]), and younger age (1·0 [1·0-1·1]). Among patients discharged home or to a rehabilitation setting, those diagnosed with cognitive-motor dissociation consistently had higher scores on GOS-E indicating better functional recovery compared with those without cognitive-motor dissociation, which was seen as early as 3 months after the injury (odds ratio 4·5 [95% CI 2·0-33·6]).Interpretation: Recovery trajectories of clinically unresponsive patients diagnosed with cognitive-motor dissociation early after brain injury are distinctly different from those without cognitive-motor dissociation. A diagnosis of cognitive-motor dissociation could inform the counselling of families of clinically unresponsive patients, and it could help clinicians to identify patients who will benefit from rehabilitation.Funding: US National Institutes of Health. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of early necrotizing soft-tissue infections of the genitalia (NSTIG) component separation, primary wound closure (CSC). We hypothesized that early CSC would be safe, decrease the need for split-thickness skin grafting (STSG) and decrease wound convalescence time.Materials/methods: Management of consecutive NSTIG patients from a single institution were evaluated. Three cohorts emerged: 1) those managed/closed by a reconstructive urologist (URO) using CSC principles (wide genital tissue mobilization with primary closure, when possible, +/- STSG), 2) those managed/closed by the general surgery/burn service, and 3) those managed conservatively with secondary closure. Total NSTIG anatomic extent (AE) was determined by assessing involvement of the penis, scrotum, perineum and suprapubic region, and ranged from 1 (<50% involvement of one area) to 8 (>50% involvement in all 4 areas).Results: Of 84 FG patients meeting study criteria, 48 (57%) were closed primarily and 36 were left to heal by secondary intention. AE was greatest in patients managed by general surgery/burn service (4.5 ± 1.5), followed by URO (2.7 ± 1.8) and secondary intention cases (1.3 ± 0.5). Secondary procedure rates were similar between closure/non-closure cohorts (6.3% v 11%; P = 0.67). STSG use was predicted by wound size (though not time to closure)-specifically with suprapubic and/or penile wounds of >50% involvement. Wound convalescence time decreased by 64% when wounds were closed versus left open, controlling for AE.Conclusion: Early, same-admission primary closure of stable NSTIG wounds is safe and decreases wound convalescence time by over 60%. [ABSTRACT FROM AUTHOR]

Background: The optimal management for Achilles tendon (AT) ruptures is controversial and still continues to encourage debate. Conventionally, operative repair was favoured secondary to its lower rates of re-rupture, however in more recent years, we have seen promising results and a reduction in complications with conservative management. One reason for this improvement may be due to the introduction of a functional weight-bearing orthosis, however, results for complete AT ruptures is still unclear. This study aims to evaluate the functional outcomes of early weight bearing in a functional orthosis for conservatively managed, complete AT ruptures.Methodology: This study was done at East Kent Hospital University Foundation Trust in between 2019-2020. In this prospective study, we have analysed data from 41 patients with US diagnosed compete AT ruptures, with a gap less than 5 cm. Every patient was treated in a functional weight-bearing orthosis (VACOped®) for 8 weeks with early weight-bearing following a specific treatment protocol, followed by rehabilitation with a trained physiotherapist. All patients received a final follow-up at 1 year post injury, where we recorded the following functional outcome measurements on each leg: calf girth, single leg heel raise height, single leg heel raise repetitions and the ATRS score.Result: Our study population was predominantly male with an average age of 50 (range 22-79). The majority of the cohort were physically active, with more than 75% involved in a form of sporting activity pre-injury and 15% involved in higher level activity and competitive sport. The mean ATRS score was 82.1, with a re-rupture rate of only 2%. The average calf bulk difference was 1.6 cm, average heel raise height difference was 1.8 cm and a heel raise repetition difference of 6. There was a statistically significant correlation between ATRS score and calf muscle girth (p = 0.02). However, there was no significant correlation between ATRS score and heel raise height or single heel raise repetitions.Conclusion: Early weight-bearing in a functional orthosis provides excellent functional outcomes for conservatively managed, complete AT ruptures, and is associated with very low re-rupture rates. However, a multidisciplinary approach with a guided rehabilitation programme is essential for optimising functional outcome. [ABSTRACT FROM AUTHOR]

Background Context: In the acute postinjury setting, the prognostic value of sensory sparing among motor complete spinal injury patients has been well demonstrated. However, once final AIS grade is achieved 1 year postinjury, the value of sensory sparing alone has not been elucidated. We hypothesized that sensory sparing would lead to better outcomes in AIS B over AIS A patients at long-term, postrecovery follow-up.Purpose: To evaluate for differences in medical, Physical and Social outcomes between AIS A and B patients at least 1 year postinjury.Study Design: Retrospective Cohort.Patient Sample: Adults over the age of 18 with AIS A or B spinal cord injury sustained between January 1, 1995 and September 13, 2019. Data Collected from the Spinal Cord Injury Model Systems Database.Outcome Measures: Self-reported Measures: PHQ-9 score; SCI-QOL Resilience Short Form score; VAS pain score; Life Satisfaction Score; Self-reported depression and sleep disturbances. Physiologic Measures: Body Mass Index, Diabetes Mellitus, Hypertension, Hyperlipidemia, Mortality, Incidence of Pressure Sores. Functional Measures: Bowel and Bladder Management; Illicit Substance use; Level of Education; Marital Status; Rehospitalization Rate.Methods: Patient data from the Spinal Cord Injury Model Systems Database were extracted for patients with a final, recovered American Spinal Injury Association Impairment Scale (AIS) grade of A or B at 1-year postinjury. Variables related to physical, mental and social functioning were compared between the two groups.Results: A total of 2,562 AIS A and 675 AIS B patient met inclusion criteria. Occurrence of pressure ulcers was 7% less in AIS B versus A (34.5% vs. 41.9%, p=.003). There were no statistical differences between groups in pain, bowel or bladder accidents, urinary tract infections, or the level of assistance for bowel or bladder management. There was no statistical difference for PHQ-9 depression scores, SCI-QOL Resilience Scores, rates of suicidality or sleep disturbance. There was no difference for illicit drug or alcohol abuse, life satisfaction scores, perceived health, and marriage or divorce rates.Conclusions: Except for a 7% reduction in pressure ulcer occurrence, there is no apparent long-term outcome advantage for motor complete spinal cord injury patients with AIS B sensory sparing over AIS A sensory complete. All other physical function domains were not different, nor were mental and social outcomes. [ABSTRACT FROM AUTHOR]

Spinal cord injury is a severely disabling neurological condition leading to impaired mobility, pain, and autonomic dysfunction. Most often, a single traumatic event, such as a traffic or recreational accident, leads to primary spinal cord damage through compression and laceration, followed by secondary damage consisting of inflammation and ischaemia, and culminating in substantial tissue loss. Patients need appropriate timely surgical and critical care, followed by neurorehabilitation to facilitate neuronal reorganisation and functional compensation. Although some neurological function might be regained, most patients with initially complete lesions have severe, irreversible neurological impairment. Cell-based and stem-cell-based therapies are recognised as promising candidates to promote functional recovery. However, no trials of these therapies in patients have yet provided reproducible evidence for clinical efficacy, challenged by small effect sizes, low immune suppression, and low sensitivity study designs. Nevertheless, in the past decade, clinical trials have shown the feasibility and long-term safety of cell transplantation into the injured spinal cord. This crucial milestone has paved the way to consider refinements and combined therapies, such as the use of biomaterials to augment the effects of cell transplantation. In the future, emerging cell types, scaffolding, and cell engineering might improve cell survival, integration, and therapeutic efficiency. [ABSTRACT FROM AUTHOR]

Andiroba seed oil (Carapa guianensis Aubl.) is widely used by traditional populations in tropical countries, especially in the Brazilian Amazon, because of its anti-inflammatory, antirheumatic, antiseptic, healing and antipyretic properties, among others, which makes it useful for the treatment, mainly, of skin afflictions and wounds. To describe the modulation of the immune system by andiroba oil (Carapa guianensis Aubl.) in inflammation and wound healing. A scoping review was performed, following the recommendations of the Joanna Briggs Institute (JBI) and PRISMA for Scoping Reviews (PRISMA-ScR). As inclusion criteria, in vitro , in vivo , ex vivo, and clinical studies were selected, in Portuguese, English, or Spanish, in thirteen databases of published studies, gray literature, and references of the included studies, which deal with immune modulation by andiroba oil in the context of the various therapeutic applications that make use of its anti-inflammatory and wound healing properties. The selection of information sources was carried out by two independent reviewers between November 2022 and January 2023. The process of data extraction and evidence analysis was conducted by four pairs of independent reviewers between January and February 2023. 22 sources of evidence were included in this scoping review, mostly scientific articles published between 2005 and 2021 with in vivo sampling. The evidence suggests that andiroba oil reduces inflammation and promotes the healing of wounds of multiple etiologies by reducing leukocyte infiltration, increasing phagocytic activity, enhancing interleukin and inflammatory cytokine activity, promoting fibroblast recovery, increasing growth factors, reducing apoptotic cells, promoting reepithelialization, as well as promoting angiogenesis, reducing edema, and stimulating the production of glucocorticoids that alleviate pain. Additionally, different formulations of the oil (such as nanoemulsions, films and gels) are more effective in modulating inflammation and wound healing compared to in natura oil. Evidence in the literature suggests that andiroba oil (Carapa guianensis Aubl.) has positive effects on immune modulation in inflammation and wound healing, which makes it a biocompound with high therapeutic potential. [Display omitted] • Andiroba oil (Carapa guianensis Aubl.) reduces inflammatory infiltrate in wounds and increases phagocyte activity. • Andiroba oil promotes wound healing and increases traction strength. • Andiroba oil systemically induces the production of glucocorticoids and reduces pain and severity of injuries. • Pure andiroba oil pure and its different presentations increase the effectiveness of inflammation, wound healing therapies. [ABSTRACT FROM AUTHOR]

Harmful drinking is associated with significant negative health and social outcomes, but drinkers are reticent to recognise personal drinking problems, hindering natural recovery or help-seeking. Recent evidence suggests that social identity as a drinker is associated with various drinking-related factors but has not been examined in relation to likelihood of problem recognition. In a group of ninety-six harmful drinkers (61 females, M age = 34 years) we explored how identity components associated with ingroup self-investment and ingroup self-definition in combination with implicit identity as a drinker accounted for degrees of problem recognition. In addition to demographic information, addiction experience and drinking behaviour (AUDIT), respondents completed measures of ingroup self-investment (identity centrality, solidarity, and satisfaction), ingroup self-definition (ingroup homogeneity and self-stereotyping), a "self as drinker" identity implicit association test and problem recognition (four items from the Stages of Change Readiness and Treatment Eagerness Scale). After controlling for possible covariates (age, gender and alcohol addiction experience) increased problem recognition was accounted for by explicit and not implicit identity components. More specifically, increasing perceived chronic saliency of one's drinker identity (self-investment in the drinker ingroup) and not an implicit association between the self and being a drinker was related to increased likelihood of problem recognition. This suggests that how chronically and explicitly accessible the identity of the drinker is for individuals might operate to stimulate the willingness or motivation to recognise potential drinking related harm. • Identities are related to problem recognition in harmful drinkers. • Problem recognition is accounted for by explicit identity components. • Higher problem recognition is related to in-group self-investment. • Saliency of drinker identity is associated with higher problem recognition. • Addiction experience is associated with higher problem recognition. [ABSTRACT FROM AUTHOR]

To document the trajectory of early childhood stuttering longitudinally for 14. years with a consideration on the features of overt and covert stuttering related to recovery status. Thirty-eight participants were observed longitudinally at three different time points: early childhood (Occasion 1), middle childhood (Occasion 2), and late adolescence (Occasion 3). Data collection involved speech samples and reports of stuttering experiences. Recovery on Occasion 3 was estimated through analysis of speech samples, parent and expert judgments, and self- judgement. Two categories of persistence were used: persistent-subjective (no observable stuttering) and persistent-objective (observable stuttering). The recovery rate was 65.6 %. The majority of the participants showed minimal disfluent speech with 88 % showing less than 1 % syllables stuttered and 97 % showing less than 3 % syllables stuttered in the collected speech samples. All participants classified as persistent reported covert symptoms of stuttering. No relapses in recovery were observed between Occasion 2 and Occasion 3. Late recovery was only observed for those classified as persistent-subjective on Occasion 2. About 64 % of the participants showing observable stuttering (persistent-objective) on Occasion 2 showed no observable stuttering (persistent-subjective) on Occasion 3. Children continue to recover from early childhood stuttering as they age.The inclusion of self-reports adds to the understanding of recovery especially concerning the covert stuttering behaviours. The presence of overt symptoms of stuttering in the speech samples of children aged 7 to 13 years seems to be associated with the likelihood of late recovery of stuttering • A long-term investigation of the recovery of early stuttering. • The recovery rate of early stuttering was 65.6 % after 14 years. • 97 % of participants showed less than 3 % syllables stuttered in speech samples. • All participants classified as persistent reported covert symptoms of stuttering. • Children continued to recover from early childhood stuttering during adolescence. [ABSTRACT FROM AUTHOR]

Research indicates that sexual minority (SM) individuals with alcohol and other drug use disorders may underutilize recovery resources generally but be more likely to use recovery community centers (RCCs). To inform recovery supports, this study characterized SM and heterosexual RCC members by demographics and clinical and recovery support service utilization. Cross-sectional secondary analyses compared SM and heterosexual RCC members in the northeastern U.S. (n = 337). Qualitative analyses coded the top three recovery facilitators. Of the 337 participants (Mean age [ SD ] = 40.98[12.38], 51.8 % female), SM RCC members were more likely than heterosexuals to endorse lifetime psychiatric diagnoses and emergency department mental health treatment (p <.01). RCC service utilization and qualitatively derived recovery facilitators were mostly consistent across groups. RCCs engaged SM individuals in recovery in ways consistent with heterosexuals. Despite otherwise vastly similar demographic characteristics across sexual identity, findings suggest a need for additional mental health resources for SM individuals in recovery. • SM and heterosexuals reported similar demographics and RCC utilization trends. • SM in RCCs reported more lifetime psychiatric diagnoses than heterosexuals. • AOD recovery facilitators are similar between SM and heterosexual RCC members. • SM in RCCs more often cited spirituality, education, and loss as facilitative. [ABSTRACT FROM AUTHOR]

Some individuals seeking recovery from alcohol use disorder (AUD) attend Alcoholics Anonymous (AA) while others choose newer alternatives such as Self-Management and Recovery Training ("SMART" Recovery). Some even attend both, while some choose not to attend either. Little is known about why people choose which pathway(s), and what they like, dislike, and find helpful. Greater knowledge could provide insights into the phenomenology of recovery experiences and enhance the efficiency of clinical linkage to these resources. Cross-sectional, qualitative, investigation (N = 80; n = 20 per condition; 50%female) of individuals attending either AA-only, SMART-only, both, or neither. Participants were asked why they initially chose that pathway, what they like and dislike, and what helps. Responses were coded using an inductive grounded theory approach with utterances recorded and categorized into superordinate domains and rank-ordered in terms of frequency across each question and recovery pathway. AA participants reported attending due to, as well as liking and finding most helpful, the common socio-community aspects, whereas SMART attendees went initially due to, as well as found most helpful, the different format as well as the CBT/science-based approach. Similar to AA, however, SMART participants liked the socio-community aspects most. "Both" participants reported liking and finding helpful these perceived relative strengths of each organization. "Neither" participants reported reasons for non-attendance related to lower problem severity – perceiving no need to attend, and anxiety about privacy, but reported using recovery-related change strategies similar to those prescribed by AA, SMART and treatment (e.g., stimulus control, competing behaviors). Common dislikes for AA and SMART centered around irritation due to other members behaviors, a need for more SMART meetings, and negative experiences with SMART facilitators. Common impressions exist among individuals selecting different recovery pathway choices, but also some differences in keeping with the group dynamics and distinct approaches inherent in AA and SMART. AA attendees appear to go initially for the recovery buoyancy derived from the social ethos and camaraderie of lived experience and may end up staying for the same reason; those choosing SMART, in contrast, appear to attend initially for the CBT/science-based content and different approach but, like AA participants, may end up staying due to the same camaraderie of lived experience. Those participating in both AA and SMART appear to capitalize on the strengths of each organization, suggesting that some can psychologically accommodate and make use of theoretically distinct, and sometimes opposing, philosophies and practices. • Common experiences exist among individuals using different recovery pathways. • Attendees choose AA for the camaraderie of lived experience. • Attendees choose SMART for the CBT/science-based content. • Attendees in both AA and SMART like the camaraderie and lived experience most. • Those participating in both AA and SMART appear to capitalize on strengths of each. [ABSTRACT FROM AUTHOR]

Goiters are enlargements of the thyroid gland and are a global public issue. Quemeiteng granule (QMTG) is a traditional Chinese medicine (TCM) formula used to treat goiter in Yunnan Province. However, the effectiveness and underlying mechanism of these treatments have not been fully elucidated. This study aimed to investigate the therapeutic effects of QMTG on goiter and the downstream regulatory mechanisms. In this study, we first evaluated the antigoiter efficacy of QMTG through biochemical indices [body weight, thyroid coefficient, triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH)] and hematoxylin-eosin (HE) staining in a Propylthiouracil (PTU)-induced model. Based on microRNA sequencing (miRNA-seq) and bioinformatics analysis, key miRNA was screened out. A dual-luciferase reporter assay was performed to confirm the transcriptional regulation of the target gene by the miRNA. The viability of rat thyroid microvascular endothelial cells (RTMECs) and human thyroid microvascular endothelial cells (HTMECs) was assessed using the CCK-8 assays. The migration and angiogenesis of RTMECs and HTMECs were visualized through tube formation and wound scratch assays. Proteins involved in angiogenesis and the ERK pathway were assessed via Western blotting. QMTG significantly increased body weight, decreased the thyroid coefficient, increased the levels of T3, T4, FT3 and FT4 and reduced TSH levels in rats with goiter. QMTG also promoted the morphological recovery of thyroid follicles. MiR-217-5p was identified as a key miRNA. Our studies revealed that miR-217-5p directly targets FGF2 and that QMTG promotes the recovery of thyroid hormone (TH) levels and morphological changes in the thyroid, suppresses thyroid microvascular endothelial cell vitality, tube formation and migration, and reduces the expression of VEGF, Ang-1 and VCAM-1 triggered by miR-217-5p, thereby inhibiting the Ras/MEK/ERK cascade through FGF2. Our experiments demonstrated that the QMTG had therapeutic effects on goiter. These effects were attributed to the inhibition of ERK pathway-induced proliferation and angiogenesis through the targeting of FGF2 by miR-217-5p. [Display omitted] [ABSTRACT FROM AUTHOR]

The roots of Asarum heterotropoides F. Maekawa var. mandshuricum F. Maekawa (AR) is a traditional herbal medicine used across Asia, including Korea, China, and Japan. AR exhibits a range of biological activities, such as anti-inflammatory, anti-cancer, cold treatment, and anti-nociceptive effects. Various extraction methods, including decoction, which utilizes traditional knowledge and techniques. The AR decoction extract expected to contain fewer toxicants and have reduced toxicity due to the use of hot water in the extraction process. However, scientific evidence on the toxicity of AR decoction extracts is lacking, necessitating further studies for safe usage. This study aimed to evaluate the genotoxicity and toxicity of single and repeated administration of AR decoction extracts. The genotoxicity was assessed using a bacterial reverse mutation (Ames test), an in vitro mammalian chromosome aberration test (CA test), and an in vivo micronucleus test (MN test) in Sprague-Dawley (SD) rats. The general toxicity was evaluated through single-dose and 13-week repeated-dose toxicity studies. In the single-dose toxicity study, 40 SD rats were orally administered AR decoction extract at doses of 1000, 2000, and 5000 mg/kg. In the 13-week repeated-dose toxicity study, 140 SD rats received daily oral doses of 0, 250, 500, 1000, 2000, and 5000 mg/kg of AR decoction extract. The genotoxicity tests revealed that AR decoction extract was not genotoxic. The single-dose toxicity study showed no changes in body weight, clinical pathology, or macroscopic findings, with the approximate lethal dose (ALD) exceeding 5000 mg/kg. The 13-week repeated-dose toxicity study demonstrated no treatment-related changes in body weight, general symptoms, hematology, clinical chemistry, or urinalysis. Histopathological findings revealed hyperplasia of squamous cells in the forestomach after AR decoction extract administration, a treatment-related effect that resolved during the recovery period. The no observed adverse effect level (NOAEL) for both male and female rats was estimated to be 2000 mg/kg. This study establishes the non-toxic dose of AR decoction extract, providing a foundation for further non-clinical and clinical evaluations AR safety. [Display omitted] • The roots of Asarum heterotropoides var. mandshuricum (AR) decoction extract does not induce genotoxicity. • The approximate lethal dose of the AR decoction extract was greater than 5000 mg/kg. • The NOAEL of AR decoction extract was 2000 mg/kg in both males and females. • AR decoction extract did not contain known toxicant found in AR powder. [ABSTRACT FROM AUTHOR]

Lung resection is the standard of care for patients with clinical stage I/II non-small cell lung cancer. This surgery reduces both the duration and quality of patients' daily ambulatory activities 1 month after surgery. However, little is known about physical activity after lung resection in patients with lung cancer. To evaluate the recovery process of physical activity with pulmonary rehabilitation in patients after lung resection and examine whether physical activity is affected by age. In this prospective, observational study, we measured and analysed participants' postoperative physical activity using a uniaxial accelerometer daily from postoperative day 1 to 30. We analysed 99 patients who underwent thoracic surgery. The number of walking steps significantly increased until day 4 and then reached a plateau thereafter. The duration of exercise at <3 metabolic equivalents significantly increased until day 3, and no significant difference was observed thereafter. Exercise at >3 metabolic equivalents significantly increased until day 4 and reached a plateau thereafter. A significant correlation was observed between age and number of steps after day 4. Compared with video-assisted thoracoscopic surgery, thoracotomy significantly decreased the number of steps from day 3 to 4. We found that the level of physical activity varied by index in patients with non-small cell lung cancer who underwent lung resection. Age and surgical procedure affect different periods with the increase in post-operative walking steps. • Physical activity level can recover during the early postoperative period. • The physical activity level varies by index in patients who underwent lung resection. • Age and surgical procedure affect different periods with the post-operative steps. [ABSTRACT FROM AUTHOR]

Community-based Mental Health (MH) organisations in the United Kingdom (UK) are facing challenges for sustaining in-person service delivery. Without empirical evidence that demonstrates the value of a place-based approach for MH recovery, and the types of resources needed to build nurturing spaces for peer support, community-based MH organisations will struggle to maintain their physical spaces. We present empirical insights from a case study involving interviews with 20 students accessing peer support services at the Recovery College Collective, a community-based MH organisation located in the North East of England. The interview study aims to evidence how a place-based approach can afford MH recovery. We draw from discourses on place-making and interpret our interview findings through an established framework that highlights four mechanisms through which place impacts recovery: place for doing , being , becoming and belonging. We use this framework to structure our findings and highlight key qualities of place for establishing and maintaining MH recovery. Our contribution is two-fold: we address a gap in the literature by providing empirical understandings of how place influences MH recovery, whilst extending previous research by considering the role that place plays in community-based organisations. This is timely because of the challenges faced in securing in-person service delivery post-pandemic, and a shift towards remote service provision models. We highlight key implications: (i) Accessing a physical place dedicated to MH support is vital for people who do not have anywhere else to go and are socially isolated due to their health conditions; (ii) Connecting through peer-to-peer interaction is an integral part of the recovery process, and learning from people with lived experience can inform a place-based approach that best suit their needs; and (iii) Recognising the value of place for MH support, and the resources needed for peer support delivery in the community, will help secure places that our research participants described as lifesaving. • Places for peer support are critical in fostering mental health recovery. • Resources for sustaining a place-based approach need to be better recognised. • More contextual understandings of people's experience of place are needed. • Future service delivery should consider recovery as a lifelong journey. [ABSTRACT FROM AUTHOR]

A growing literature indicates bidirectional associations between pain and tobacco use. Cigarette smokers are at increased risk for chronic pain, and observational and experimental studies indicate that pain increases motivation to smoke. Tobacco use disorder frequently co-occurs with other substance use disorders, which are also associated with chronic pain vulnerability. Despite evidence that pain significantly predicts smoking and relapse, associations between smoking history/trajectory and changes in pain over the course of treatment have not been characterized. The objective of the study was to determine the association between in-treatment smoking trajectory, pack-years (i.e., number of cigarette packs smoked per day multiplied by smoking duration), pain-related interference in daily activities, and pain intensity over the course of residential treatment. In this study, 280 adult smokers in a residential SUD treatment center in North Central Florida completed questionnaires assessing cigarette use, pain intensity, and pain interference at treatment entry and discharge (Mean = 80.3 days, SD = 25.6). Most participants were diagnosed with alcohol use disorder (66.1 %). Opioid (27.9 %) and cannabis use disorders (29.6 %) were also common. Participants were grouped by whether their smoking increased (n = 36), decreased (n = 46), or stayed the same (n = 133) from entry to discharge. Analyses indicated a positive association between pack-years and pain intensity at both baseline (r = 0.185, p = 0.018) and discharge (r = 0.184, p = 0.019). Smoking trajectory was associated with pack-years, with those decreasing smoking having greater pack-years than those sustaining or increasing use [F(2,136) = 8.62, p < 0.01, η2 p = 0.114]. Mixed general linear models indicated pain intensity [F(1,274) = 44.15, p < 0.0001, η2 p = 0.138] and interference in day-to-day activities [F(1,276) = 31.79, p < 0.0001, η2 p = 0.103] decreased significantly over time. However, there was no main effect of smoking trajectory on pain intensity [F(2,212) = 2.051, p = 0.131, η2 p = 0.019] or of smoking trajectory by time interaction [F(2, 212) = 1.228, p = 0.295, η2 p = 0.011]. Overall, findings provide evidence that smoking behavior influences pain within the context of residential substance use treatment. Given that pain is associated with urge to use substances and risk of return to use, more consistent and rigorous assessment of pain and proactive pain management is likely to enhance substance use treatment outcomes among people who smoke. • The trajectory of pain intensity and pain interference in day-to-day activities over SUD treatment was explored. • Reduction in pain over time was observed. • There was a positive association between pack years and pain intensity at treatment entry and discharge. • Patients decreasing smoking over the course of treatment had greater pack years than those sustaining or increasing use. [ABSTRACT FROM AUTHOR]

People with substance use disorders (SUDs) frequently use emergency department (ED) services. Despite evidence demonstrating that post-discharge SUD treatment linkage effectively reduces the number of ED re-presentations, relatively few hospitals have implemented interventions to identify and connect patients with SUDs to appropriate care. ED-based peer recovery support specialist (PRSS) interventions have emerged as a promising approach for hospitals, but more research is needed to understand the extent to which these interventions meet the needs of patients who present to the ED for different reasons and with various underlying concerns. A retrospective cohort analysis used data from a telehealth PRSS program in 15 EDs within one Indiana hospital system. The study included 2950 ED patients who engaged with telehealth PRSS services between September 2018 and September 2021. Latent class analysis identified patterns of patient characteristics associated with post-discharge PRSS engagement and ED re-presentations. Covariate predictors and distal outcomes were assessed to examine the associations between class membership, demographic factors, and patient outcomes. The study team selected a six-class model as the best fit for the data. Class 1, representing patients with opioid use disorder and mental health diagnoses who presented to the ED for an opioid overdose, was used as the reference class for all other statistical tests. Multinomial logistic regression analysis demonstrated significant associations between covariate predictors, outcomes, and class membership. Regression results also demonstrate PRSSs had greater success contacting patients with prior year ED use and patients with a successful post-discharge PRSS contact were less likely to re-present to the ED. Results highlight the heterogeneity of patients with SUDs and emphasize the need for tailored interventions to address patient-specific needs more effectively. They also provide support for the perceived utility of PRSS engagement for ED patients. • Emergency department (ED) peer interventions are scaling nationally. • LCA identified 6 classes of ED patients engaged in peer services. • Patients presenting for opioid overdose were the least responsive to peer intervention. • Understanding patient heterogeneity can improve peer service design and delivery. [ABSTRACT FROM AUTHOR]

People engaged in treatment for opioid use disorder (OUD) report struggling with whether and how to disclose, or share information about their OUD history and/or treatment with others. Yet, disclosure can act as a gateway to re-establishing social connection and support during recovery. The current study describes a pilot randomized controlled trial of Disclosing Recovery: A Decision Aid and Toolkit, a patient decision aid designed to facilitate disclosure decisions and build disclosure skills. Participants (n = 50) were recruited from a community-based behavioral health organization in 2021–2022 and randomized to receive the Disclosing Recovery intervention versus an attention-control comparator. They responded to surveys immediately after receiving the intervention as well as one month following the intervention at a follow-up appointment. Primary outcome analyses examined indicators of implementation of the intervention to inform a future efficacy trial. Secondary outcome analyses explored impacts of the intervention on the decision-making process, disclosure rates, and relationships. Participants were successfully recruited, randomized, and retained, increasing confidence in the feasibility of future efficacy trials to test the Disclosing Recovery intervention. Moreover, participants in the Disclosing Recovery intervention agreed that the intervention is acceptable, feasible, and appropriate. They additionally reported a higher quality of their decision-making process and decisions than participants in the comparator condition. At their follow-up appointment, participants with illicit opioid use who received the Disclosing Recovery intervention were less likely to disclose than those who received the comparator condition. Moreover, significant interactions between illicit opioid use and the intervention condition indicated that participants without illicit opioid use who received the Disclosing Recovery intervention reported greater closeness to and social support from their planned disclosure recipient than those who received the comparator condition. The Disclosing Recovery intervention appears to be an acceptable, feasible, and appropriate patient decision aid for addressing disclosure processes among people in treatment for OUD. Moreover, preliminary results suggest that it shows promise in improving relationship closeness and social support in patients without illicit opioid use. More testing is merited to determine the intervention's efficacy and effectiveness in improving relationship and treatment outcomes for people in treatment for OUD. • People in opioid use disorder (OUD) treatment struggle with disclosure decisions. • Disclosing Recovery is a patient decision aid for disclosure decisions and skills. • It appears to be acceptable, appropriate, and feasible. • Future trials should examine its impacts on relationship and treatment outcomes. [ABSTRACT FROM AUTHOR]

Cataract is the most common cause of blindness worldwide, a visual disorder caused by a clouded lens that seriously affects People's Daily lives. Age-related cataract (ARC) is the most common type of cataract due to long-term combined effects of many factors, and its pathogenesis is varied. At present, the surgery is the main treatment for cataracts, but it is still limited to the prevention, treatment of early cataracts and the postoperative complications care. While, its drug treatments are still in the stage of exploration and research. Traditional Chinese Medicine (TCM), a unique resource in China, is conceived under the guidance of traditional Chinese medicine theory and has little toxicity and side effects, but it has made great progress in the treatment and prevention of ARC. This review presents an overview of the pathogenesis of ARC in both traditional and modern medicines and summarizes the history and therapeutic effect of TCM on ARC including their formula, crude drugs and active components, and also the other auxiliary methods. A number of recognized databases like SciFinder, PubMed, Science Direct, Google Scholar, and China National Knowledge Infrastructure (CNKI) were extensively explored by using keywords and phrases such as "cataract", "age-related cataract", "traditional medicine", "ethnopharmacology", "herbs", "medicinal plants", or other relevant terms, and the plants/phytoconstituents that are evaluated in the models of age-related cataract. As well as the current TCM adjuvant therapy used in the clinical treatment were summarized. TCM revealed to plays an active role in treating age-related cataract, via multi-pathway and multi-target, and can treat or delay ARC by inhibiting abnormal glucose metabolism, antioxidant damage, inhibiting LEC apoptosis, and so on, which is in concordance with the good effects of the global use of TCM in clinical application. Concerning the early prevention and treatment of cataract and postoperative complications, TCM and auxiliary methods remain to achieve better clinical effects. ARC belongs to the category of "Yuan Yi Nei Zhang" in TCM theory, showing that there are many causes of ARC including aging, and kidney-yang, spleen, sperm and blood deficiencies. At the same time, the viscera gradually decline, as well as yin or yang progressively become weak, especially in the elder people. So, TCM could be mainly based on liver, kidney, and spleen syndrome differentiation, personalizing diagnosis and treatment, following multiple targets, regulating fundamentally yin and yang, and thus justifying the advantages of Chinese medicine in the prevention and treatment of ARC. [Display omitted] • This review presents an overview of the pathogenesis of Age-Related Cataract in both modern and traditional medicines. • The review summarizes the therapeutic effect of traditional Chinese medicine on Age-Related Cataract. • The purpose of this review is to carry forward the advantages of traditional Chinese medicine treatment based on syndrome differentiation, putting people and lives first. [ABSTRACT FROM AUTHOR]

therapy based on non-immersive virtual reality (VRT) comprises a technique of interaction between the user and the interface system that allows the creation of an environment in which functional and motivational activities can be performed, while training with restricted blood flow (RBF) is an intervention modality that has been used in individuals who do not have good tolerance to high intensities of exercise. Among the various training modalities for the elderly population, both therapies have easy applicability and low financial cost. However, there are no studies on the combination of such interventions in relation to the autonomic outcome in elderly women. To evaluate the behavior of cardiac autonomic modulation after VRT with or without RBF in elderly women. This is a cross-over clinical trial composed of 17 elderly women with a mean age of 66.82±4.11 years who underwent three conditions: VRT-RBF, VRT only and control. The VRT was performed using a Nintendo Wii® videogame with the games Hulla Hoop, Free Run and Free Step with a total duration of 21 minutes approximately. For VRT-RBF, occlusion occurred in the proximal thigh and was set at 40% of the absolute occlusion pressure. The control group received an educational session of the same duration as the other conditions. For all groups, initially at rest (20 minutes), during the conditions, and in the recovery period (60 minutes analyzed every 10 minutes), RR intervals were collected for analysis of linear indices of heart rate variability (HRV) in the time domain (RR interval, SDNN, and rMSSD). Descriptive statistics were used and analysis of variance for repeated measures with two factors and significance level of p<0.05 was used for comparisons. There was no effect between conditions and interaction conditions vs. moments for all analyzed indices (p>0.05). There was an effect of moment for the RR intervals in the VRT-RBF condition in which the values showed a significant reduction from the baseline moment (95%CI 666-765) until 30 minutes [10′ (95%CI 599-725; p<0.05), 20′ (95%CI 618-719; p<0.05) and 30′ (95%CI 637-741; p<0.05)] of the recovery period. VRT with or without RBF did not promote autonomic imbalance in the recovery period. VRT-RBF can be an exercise alternative for the elderly population, due to its low financial cost and easy applicability that can promote the reduction of the deleterious effects of aging and sedentarism, providing an activity through playful games and favoring motivation and adherence in rehabilitation programs. [ABSTRACT FROM AUTHOR]

Post-stroke individuals should have immediate and full access to rehabilitation services after hospital discharge. This access must be obtained in the first six months of the event, a period where the chances of recovery are greater. Thus, it becomes relevant to know the barriers and facilitators of this access. However, studies on this topic were not found in developing countries such as Brazil. To identify barriers and facilitators to access to rehabilitation services for post-stroke individuals discharged from a stroke unit of a public hospital in Brazil in the first six months of recovery. A cross-sectional and descriptive study was developed. Sociodemographic and clinical-functional data were collected in the hospital during the acute phase. Six months after discharge, data on barriers and facilitators to access to rehabilitation services were collected, considering 20 aspects related to the economic conditions and displacement to rehabilitation services, quality, and organization of rehabilitation services, as well as individual's personal conditions. 174 individuals (62±21 years old) were included. Among the 20 aspects analyzed, 17 (85%) were most frequently pointed out as facilitators. The main facilitators pointed out was the patient's expectation of the treatment and the quality of care offered, identified by the vast majority (>79%) of the individuals. In addition, all aspects related to the quality of rehabilitation services were pointed out as facilitators by the majority of the subjects. Three (15%) aspects were most frequently pointed out as barriers: income available for health care (49.4%), waiting time to make an appointment and be attended (47.2%), and scheduling process (45.4%). More facilitators than barriers were pointed out. That is, in the first six months of recovery, aspects related to economic conditions and displacement to rehabilitation services, organization of rehabilitation services, quality of rehabilitation services and personal conditions of the individual, have, for the most part, positively influenced the access to rehabilitation services for post-stroke individuals. Considering the identified barriers, public policies to subsidize health costs and optimize the waiting time and scheduling process in rehabilitation services should be considered relevant tools to facilitate access to rehabilitation services for post-stroke individuals. Likewise, human, and financial resources must be directed towards promoting the enabling factors. [ABSTRACT FROM AUTHOR]

Knee osteoarthritis causes structural joint damage. The resultant symptoms can impair the ability to recover from unexpected gait perturbations. This study compared balance recovery responses to moderate gait perturbations between individuals with knee osteoarthritis and healthy individuals. Kinematic data of 35 individuals with end-stage knee osteoarthritis, and 32 healthy individuals in the same age range were obtained during perturbed walking on a treadmill at 1.0 m/s. Participants received anteroposterior (acceleration or deceleration) or mediolateral perturbations during the stance phase. Changes from baseline in margin of stability, step length, step time, and step width during the first two steps after perturbation were compared between groups using a linear regression model. Extrapolated center of mass excursion was descriptively analyzed. After all perturbation modes, extrapolated center of mass trajectories overlapped between individuals with knee osteoarthritis and healthy individuals. Participants predominantly responded to mediolateral perturbations by adjusting their step width, and to anteroposterior perturbations by adjusting step length and step time. None of the perturbation modes yielded between-group differences in changes in margin of stability and step width during the first two steps after perturbation. Small between-group differences were observed for step length (i.e. 2 cm) of the second step after mediolateral and anteroposterior perturbations, and for step time (i.e. 0.01–0.02 s) of first step after mediolateral perturbations and the second step after outward and belt acceleration perturbations. Despite considerable pain and damage to the knee joint, individuals with knee osteoarthritis showed comparable balance recovery responses after moderate gait perturbations to healthy participants. • Knee osteoarthritis may contribute to an increased risk of falling. • We studied responses to moderate gait perturbations in individuals with knee osteoarthritis. • Individuals with knee osteoarthritis showed few limitations in balance recovery responses. [ABSTRACT FROM AUTHOR]

• The social integration processes that play a major role in giving recovery home residents access to available recovery-related social capital that is associated with better outcomes. • We found that recovery residents who associated with peers who have higher recovery scores tend to improve their own recovery scores over time. • Yet, recovery home residents most in need of relational support from more recovered housemates are the least likely to obtain it. • We discuss possible pathways to creating more ties between high and low-recovered residents. Recovery homes are a widespread source of support for those attempting to maintain abstinence. For those who are able to remain in these settings for at least 6 months, outcomes tend to be favorable; however, many leave prematurely. There is a need to better understand the social integration processes that play a major role in giving recovery home residents access to available recovery-related social capital that is associated with better outcomes. The current study involved Oxford House recovery homes in 3 states and examined the strength of relationship ties among house members. We found that those who associated with peers who have higher recovery scores tend to improve their own recovery scores over time. However, we also found that those with higher recovery scores tended to create "strong" ties with similarly high-scoring alters; likewise lower-scoring individuals preferentially formed strong ties with each other. These findings suggest a conundrum: recovery home residents most in need of relational support from more recovered housemates are the least likely to obtain it. We discuss possible pathways to creating more ties between high and low-recovered residents. [ABSTRACT FROM AUTHOR]

Peer recovery support services (PRSS) for substance use disorder (SUD) are a flexible and evidence-based intervention employed across multiple settings and for a variety of populations. These services have expanded over the past two decades, but there is little research on recruitment and training of prospective peer workers – the peer to career pipeline. This study observed training outcomes for applicants to a peer worker scholarship program in Texas. A total of 448 participants provided baseline personal history information, and a subset of participants (n = 239) completed optional psychosocial surveys. Logistic regression analysis tested associations of personal history and psychosocial variables with three training stage completion outcomes: classroom training completion, placement at an internship site, and full certification. The greatest decline in advancement between stages occurred in the transition between classroom training (78.1 % of participants completed) and internship placement (43.3 % of participants completed). Participants were diverse in terms of race/ethnicity and life experiences salient to the peer worker role, but Hispanic/Latinx peer workers were under-represented. Past work with a SUD peer worker, age, and having a bachelor's degree were each positively associated with training stage completion across multiple models, while having basic technological access, being a woman, and veteran status were each positively associated with training stage completion in only one model. Years since recovery initiation date, non-monosexual orientation, White race, and quality of life were each negatively associated with training stage completion in only one model. The existing peer workforce may be a key source of recruitment for new peer workers; thus retention of existing workers is key to ensuring continued expansion of these services. Additional support may be required to recruit and retain younger peer worker trainees, men trainees, Hispanic/Latinx trainees, trainees who lack basic technological access, or trainees without bachelor's degrees. Unanswered questions about the peer workforce remain and must be addressed to ensure that an appropriately diverse workforce is recruited, that disparities in training outcomes are minimized or prevented, and that existing peer workers are well-supported. • Securing an internship is the greatest barrier in the peer to career pipeline. • Current peer workers may be an important source of training support. • Several key groups are under-recruited or may need more support during training. [ABSTRACT FROM AUTHOR]

Family Treatment Courts (FTCs) serve child welfare-involved parents with substance use issues who are working toward recovery and reunification with their children. Research has linked FTCs to successful outcomes such as treatment access and completion and family reunification, but there has been less attention to factors that hinder and facilitate program implementation and client engagement. Moreover, little is known about how the shift to virtual services during the COVID-19 pandemic impacted FTC programs and the families they serve. This study examined interview data gathered from staff in six FTCs located in different regions of the country to investigate the impact of the pandemic on programs and the clients they serve. Interviews conducted with clients from one FTC in the Midwest reinforce the data. FTC programs and professionals adjusted to the pandemic by attempting to replicate face-to-face services in an online environment. Virtual services were vital for sustaining FTCs and mitigating barriers to client engagement during the pandemic. At the same time, FTCs were compelled to navigate new barriers to online program implementation as well as acute challenges that clients faced such as greater isolation and reduced treatment access. We discuss implications from these findings with an eye toward maximizing FTC implementation and impact through the intentional use of both in-person programming and online technology after the pandemic. • Isolation, diminished peer support, and reduced treatment access affected recovery • Facilitators to programming included ease of access and reduced anxiety • Barriers to programming included technology issues and diminished perceived support [ABSTRACT FROM AUTHOR]

The opioid epidemic has strained the US criminal justice system. Law enforcement frequently encounters persons with substance use disorder (SUD). Law enforcement–led, pre-arrest diversion programs linking individuals with SUD to addiction treatment instead of arrest and prosecution has the potential to reduce crime, overdoses, and other community harms. We implemented a pre-arrest diversion-to-treatment program—the Madison Addiction Recovery Initiative (MARI)—from September 2017 to August 2020, and describe the key components of MARI's effective implementation. Adults who committed an eligible, drug use–related crime were offered a 6-month MARI participation with referral to treatment in lieu of arrest; criminal charges for that crime were "voided" upon the successful MARI completion. Formative evaluation, with stakeholder feedback and team meeting minutes, assessed key factors influencing implementation. Process evaluation consisted of tracking participant referrals, enrollment, and engagement. Police officers, MARI participants, and treatment center staff members were surveyed about program experiences and attitudes. The study used descriptive statistics to describe quantitative survey responses; thematic qualitative analysis identified major themes in qualitative responses. Of 263 participants, 160 initiated program engagement, with 100 successfully completing MARI. Interim evaluations and community partner feedback informed program protocol adjustments to increase participant enrollment, retention and diversity, streamline the referral processes, and transition to telehealth during the COVID-19 pandemic. Rigorous evaluation and community partner feedback are essential components of effective implementation and sustainability of a law enforcement–led pre-arrest diversion-to-treatment program, which has the potential to both reduce crime and overdose, and change the lives of people with SUD. [Display omitted] • A law enforcement-led, pre-arrest program linked adults to addiction treatment. • Offering treatment instead of arrest could be life-changing for those with addiction. • Involvement of diverse community partners was critical to the program's success. [ABSTRACT FROM AUTHOR]

Despite significant efforts to improve access to medications for opioid use disorder (MOUD), uptake remains low relative to the scope of the problem in the United States. A growing body of quantitative and qualitative research has documented consistent barriers to MOUD treatment access and retention, at the level of individuals, institutions, and society at large. Stigma - surrounding both people who use opioids (PWUO) and treatment using MOUD – is among the most-cited barriers by patients and providers alike, yet few studies have examined provider-based stigma specifically, or considered its interaction with other impediments to OUD care. This paper employs a qualitative approach to the analysis of provider-based stigma among professionals involved in the treatment or supervision of individuals with OUD. We conducted and analyzed interviews with 19 professionals as part of a larger mixed methods study on stigma among substance use treatment providers and court personnel in Pennsylvania. Beyond capturing providers' perceptions of PWUO and MOUD, the authors asked participants to describe barriers to recovery, and the effective delivery of care within this population. Interviewees enumerated multiple entrenched barriers that sometimes operated at different levels, such as criminal-legal involvement, which weakened PWUO's social networks and employment prospects, while undermining providers' attempts at continuity of care; moreover, participants cited the "War on Drugs" as an overarching impediment to effective substance use treatment, not least for its role in perpetuating stigma against PWUO. Interestingly, while an overwhelming majority of participants named stigma as a barrier to treatment at every level, most also articulated stigmatizing beliefs around PWUO. Namely, providers evoked one element of stigma – blameworthiness – in their contention that many PWUO are inadequately motivated to recover. In addition to adding further complexity to MOUD barriers research, this study troubles the notion that professional training and education on the disease model of addiction serve to eradicate stigma. • Uptake of medications for opioid use disorder remains low despite efforts to expand access. • Individual, institutional, and systemic barriers to MOUD interact to reduce usage. • Treatment providers identify stigma as a primary barrier to MOUD effectiveness at all levels. • Many treatment providers also express conceptions of people who use opioids as "blameworthy." [ABSTRACT FROM AUTHOR]

The gut microbiota can affect the intestinal barrier and other physiological functions. Tangerine pith contains various citrus pectins, which modulate the gut microbiota in a structure-dependent manner. We hypothesized that tangerine pith extract (TPE) has prebiotic effects on gut dysbiosis in antibiotic-treated mice. TPE was prepared via acid hydrolysis and isolated using an ultrafiltration method. Gut dysbiosis was induced through treatment with antibiotic cocktail for 7 days in mice. After spontaneous recovery or being supplemented with 0.5 mL TPE for 14 days, the gut microbiota composition and other parameters were examined. The 16s ribosomal DNA high-throughput sequencing and analysis confirmed that TPE positively improved the gut microbiota. The relative abundance of some probiotics such as [Ruminococcus]_torques_group, [Clostridium]_innocuum_group , and Enterorhabdus were significantly increased and harmful bacteria such as Alistipes were decreased in TPE-supplemented mice. Furthermore, the production of propionate and butyrate in the colonic contents were significantly enhanced in the TPE-treated mice. Serum D-lactic acid and diamine oxidase activity were increased in the antibiotic treatment group and reversed in the TPE-treated group. Moreover, protein expression of intestinal occludin was significantly increased by TPE. In conclusion, TPE is effective in restoring the gut microbiota in mice after antibiotic treatment and may act as a prebiotic in combatting gut dysbiosis. [Display omitted] [ABSTRACT FROM AUTHOR]

In order to optimize functional outcomes following radical prostatectomy (RP), early rehabilitation programs should be stablished in the clinical practice. A multidisciplinary approach to assess the patient's mental, physical and social well-being are as important as the implementation of pharmacological and mechanical interventions. In current article of the seminar, we focus on strategies to improve erectile function (EF) after surgery. These strategies have been grouped into 4 main categories: pharmacologic and mechanical interventions, psychosocial interventions, hormonal assessment and a final section dedicated to strategies under research. [ABSTRACT FROM AUTHOR]

Objective: To compare perioperative and oncologic outcomes of intracorporeal (ICNB) and extracorporeal neobladder (ECNB) following robot assisted radical cystectomy (RARC) from a multi-institutional, prospectively maintained database, the International Robotic Cystectomy Consortium (IRCC).Methods: A retrospective review of IRCC database between 2003 and 2020 (3742 patients from 33 institutions across 14 countries) was performed (I-79606). The Cochran-Armitage trend test was used to assess utilization of ICNB over time. Multivariate logistic regression models were fit to evaluate variables associated with receiving ICNB, overall complications, high-grade complications, and readmissions after RARC. Kaplan Meier curves were used to depict recurrence-free, disease-specific, and overall survival.Results: Four hundred eleven patients received neobladder, 64% underwent ICNB. ICNB utilization increased significantly over time (P <.01). Patients who received ICNB were readmitted and received neoadjuvant chemotherapy more frequently (36% vs 24%, P = .03, 35% vs 8%, P <.01, respectively). ICNB was associated with older age (OR 1.04, 95% CI 1.01-1.07, P = .001), receipt of neoadjuvant chemotherapy (OR 4.63, 95% CI 2.34-9.18, P <.01), and more recent RARC era (2016-2020) (OR 12.6, 95% CI 5.6-28.4, P <.01). On multivariate analysis, ICNB (OR 5.43, 95% CI 2.34-12.58, P <.01), positive surgical margin (OR 4.88, 95% CI 1.29-18.42, P = .019), longer operative times (OR 1.26, 95% CI 1.00-1.58, P = .048), and institutional annual RARC volume (OR 1.09, 95% CI 1.05-1.12, P <.01) were associated with readmissions.Conclusion: Utilization of ICNB increased significantly over time. Patients who underwent RARC and ICNB had shorter hospital stays and fewer 30-d reoperations but were readmitted more frequently compared to those who underwent ECNB. [ABSTRACT FROM AUTHOR]

Social pain is ubiquitous and has deleterious effects on people's health. Thus, identifying how to promote social pain recovery is important. Across three studies (N = 989), we examined whether a self-administered online awe-intervening approach could help people recover from social pain. With participants from the United States and China, we found that the online awe-intervening approach helped people recover from social pain associated with both cyber-social exclusion (Study 1) and real-life social exclusion events (Studies 2 and 3). Moreover, we found a significant mediating effect of the global sense of connectedness (Studies 2 and 3). We further demonstrated that the awe-intervening approach's effect on social pain recovery and the mediating effect of the global sense of connectedness were distinct from general positive emotions, exposure to nature, self-diminishment, and distraction (Study 3). Taken together, our findings endorse the online awe-intervening approach as an effective social pain reliever. • Online awe-intervening approach promotes social pain recovery. • Extended awe's benefits from intrapersonal to interpersonal problems. • Global connectedness mediated this effect. [ABSTRACT FROM AUTHOR]

Peer workers operating within health care settings can offer unique perspectives based on their own lived experience. Within alcohol and other drug (AOD) rehabilitation services, the potential value of peer work is becoming increasingly recognised. This qualitative study aimed to evaluate a newly implemented peer worker program located across three rehabilitation services in Tasmania, Australia. Online interviews were conducted with eight clients, seven peer workers, and five non-peer worker employees with varied experience with peer worker programs. All interviews were audio-recorded and transcribed verbatim. Guided by an overarching exploratory-descriptive methodological framework, thematic analysis generated three overarching themes: 1) Enhancing and supporting client experiences (what peer workers did in their role to improve client experiences, 2) Changing experiences with AOD rehabilitation (the unique benefits and changes that peer work brings to AOD rehabilitation services) and 3) Finding organizational value (how defining peer work and the feasibility of the peer worker role was challenged by different organizational factors). Overall, peer work was viewed as a positive addition to all rehabilitation services that was able to enhance client experiences through various mechanisms, such as by sharing their own stories, assisting with understanding, and creating safety. Peer work was also able to create change in AOD services, by instilling hope and reducing stigma. However, ongoing challenges with defining the peer worker role in a way that offers organizational recognition and financial security remain. Peer workers offer a unique and valuable perspective when working within rehabilitation services. Through their own lived experience peer workers were able to support clients and assist them in their recovery. These findings highlight the potential benefit of peer work programs within AOD rehabilitation services. • Implementing effective Alcohol and Other Drug (AOD) rehabilitation programs is essential. • Peer workers operating within AOD treatment settings are able to support clients by providing a unique perspective. • Establishing organizational value and role stability for peer workers is important for the longevity of these programs. [ABSTRACT FROM AUTHOR]

The ongoing opioid misuse epidemic has had a marked impact on American Indian/Alaska Native (AI/AN) communities. Culture- and gender-specific barriers to medically assisted recovery from opioid use disorder (OUD) have been identified, exacerbating its impact for AI/AN women. Wiidookaage'win is a community-based participatory research study that aims to develop a culturally tailored, moderated, private Facebook group intervention to support Minnesotan AI/AN women in medically assisted recovery from OUD. The current study assessed the preliminary feasibility and acceptability of the intervention in a beta-test to inform refinements before conducting a pilot randomized controlled trial (RCT). The intervention was beta-tested for 30 days. Moderators were trained prior to delivering the intervention. Study assessments were conducted at baseline and post-intervention. The post-intervention assessments included substance use (self-report and urine drug screen), treatment acceptability, mental health, and spirituality outcomes. We examined intervention engagement patterns using Facebook metrics and qualitatively explored common topics that emerged in participant posts and comments. Ten AI/AN women taking medication for OUD (MOUD) were accrued (age range 25–62 years). Participants had been in opioid recovery a mean of 15.2 months (SD = 16.1; range = 3–60). The study participation rate (accrued/eligible) was 91 %. Nine participants completed the post-intervention survey assessment and eight completed a UDS. Acceptability was high based on the mean treatment satisfaction score (M = 4.8, SD = 0.2 out of a possible 5.0), Facebook group engagement, and positive qualitative feedback. All participants retained at post-intervention continued their MOUD treatment, and none had returned to opioid use. The beta-test indicated that the Facebook platform and study procedures generally worked as intended and that the intervention was largely acceptable to study participants. The results of this study phase provided valuable insights to inform refinements prior to conducting a pilot RCT to further assess the feasibility, acceptability, and potential efficacy of the intervention. [Display omitted] • A Facebook group intervention to support AI/AN women in OUD recovery was developed. • Beta-testing indicated the group worked as intended. • Feedback from participants showed high acceptability of the group. • All retained participants remained in recovery post-intervention. • A CBPR approach was critical to intervention development and success. [ABSTRACT FROM AUTHOR]

• Trauma-Informed Approach: Prioritizes understanding and addressing deep interpersonal trauma in returning children. • Unified Response: Advocates for harmonized approaches across military, healthcare, and social welfare. • Participation: Emphasizes active involvement of returning children, reclaiming their rights and roles. • Protracted Recovery: Acknowledges ongoing challenges post-captivity, requiring sustained efforts. • Broader Context: Reintegration extends beyond personal growth to encompass conflict aftermath. The UN Convention on the Rights of the Child, signed by 195 countries globally, symbolizes a collective commitment to safeguarding children's rights. Despite this, children have become pawns in contexts such as political violence and armed conflict, abducted and held hostage, exploiting their vulnerability. Born out of Israel's recent experience with the Hamas terror organization's abduction of 40 Israeli children aged 9 months to 18 years, this paper proposes a comprehensive framework that could be useful to other countries in addressing the complex challenges associated with the return of children abducted in contexts of armed conflict and political violence. This framework is rooted in four theoretical prisms—trauma, development, context, and children's rights, and spans five critical stages: the preparation stage, the first 24 h, the first week, and the first month after a child's return. It also provides general guidance on longer-term support and providing support to multiple key figures and contexts in the child's life. By outlining key concepts and guidelines within the framework, this manuscript provides a unique insight into potential response to this distressing phenomenon. While it is our fervent hope that no country will need to implement such a framework, the unfortunate reality is that evil knows no limits. [ABSTRACT FROM AUTHOR]

Substance use disorder (SUD) is often considered a chronic illness in which prolonged recovery, in terms of abstinence, is uncommon. Personality has been found to predict recovery, but not much is known about its long-term predictive ability as the majority of previous studies have had short follow-up periods (≥ one year). The current longitudinal cohort study therefore investigated whether personality traits predict short- (STR) as well as long-term recovery (LTR) in SUD patients. Treatment-seeking patients with SUD (n = 123) completed the NEO Personality Inventory – Revised. STR and LTR categories were defined as scoring <8 on the Alcohol Use Disorders Identification Test – C and <2 on the Drug Use Disorder Identification Test – C at the one-year and 6–8-year follow-up, respectively. Whether personality traits predicted outcome was investigated by two-tailed independent samples t -tests, α < 0.05. Additional analysis was conducted with latent growth curve model. Neuroticism (inversely, p =.004, d = 0.55) and Extraversion (p =.04, d = 0.38) predicted STR (n = 114). Although not significant the effect size for Conscientiousness was above the cut-off for a practical significant effect (d = 0.31). No traits predicted LTR category. Still, the effect sizes for LTR regarding Neuroticism (d = 0.36), Extraversion (d = 0.21) and Conscientiousness (d = 0.27) indicated that these traits have relevance for LTR. The latent growth curve model indicated that these traits predicted the short-term use of drugs and long-term use of alcohol in this cohort dominated by patients suffering from severe poly-SUD. Personality traits predict recovery. The effect sizes indicate that more studies with larger samples on personality traits and LTR are required to understand their possible influences on the recovery process. • Low Neuroticism and high Extraversion predicted short-term recovery category. • No significant findings for long-term recovery category. • Effect sizes and additional analyses indicate that Neuroticism, Extraversion and Conscientiousness affects both short- and long term recovery. [ABSTRACT FROM AUTHOR]

Recovery support services (RSS), while not yet precisely defined, nevertheless have a longstanding role in managing chronic illnesses including substance use disorders (SUDs). This exploratory study is the first to identify the amounts of money that states invest from Substance Abuse and Mental Health Services Administration (SAMHSA) Block Grants; SAMHSA discretionary grant and state-appropriated sources; the types of organizations from which RSS are purchased; and the non-financial supports states provide for RSS. The study is a mixed method exploratory analysis, based on three data sources: content analysis of all 51 (Washington, D.C. included) Substance Abuse Block Grant (SABG) state applications; in-depth interviews with a purposive sample of ten states and one territory; and a structured electronic survey sent to all SABG recipients. Forty states and 2 territories returned a total of 42 questionnaires from 56 possible states and territories (75%). Thirty-two of the responding states provided complete FY2022 financial data. States reporting financial data spent $412 million from SABG, SAMHSA discretionary grants, and state appropriations for RSS. An estimate based on extrapolating regionally grouped per capita spending averages to non-responding state populations projected $775 million spent from these sources for all states. The study also calculated per capita and SUD prevalent population expenditures from these sources for each state. States purchase services from recovery community organizations and SUD treatment organizations in equal proportions, as well as from statewide recovery support organizations, educational institutions, hospitals, community health centers, and justice system organizations. Purchased services are not uniformly defined, but include community centers, peer staff, housing, and other support services. States provide non-financial support in forms that include technical assistance, community engagement, practice guidelines, and regulatory frameworks. This first report of states' investments establishes a baseline to serve as a reference point for future analysis of these expenditures, as well as a foundation to which other sources of RSS funding such as Medicaid and other state and federal (e.g. HRSA, CDC, DOJ) dollars may be added. Uniform definitions for RSS will be necessary to support future reporting, accountability, and research. Finally, newly formed peer-based provider organizations need particular attention in order to be sustainable. • States (32) spent $412M from Substance Abuse Block Grants, SAMHSA Grants and State appropriations for Recovery Support Services. • $775M was spent by all states on RSS from these sources based on applying regional spending averages to non-responding state populations. • States purchase services from recovery community and SUD treatment organizations in the same proportions. • State non-financial supports include: technical assistance; community engagement; practice guidelines; and regulatory frameworks. • The absence of standard definitions and specifications for recovery support services impedes reporting, accountability and research. [ABSTRACT FROM AUTHOR]

When patients are brought to the emergency room with a traumatic injury to the spinal cord, the road to recovery is long and uncertain. In minutes, their lives have been irreversibly altered. Time will tell if the paralysis to the limbs is permanent or if some degree of mobility or sensation can be reacquired. To many patients, the first weeks feel almost unreal. They find themselves in a state of shock, and feelings of uncertainty and loss of control are dominating. Spinal cord injuries are treated in multiple specialized hospital units. Each unit is accountable for providing the best possible treatment within their area of expertise. While continuity in care has been a hot research topic for the past 20 years, few studies provide empirical data on patients' perspectives on long-term hospital treatments. This study examines how patients with tetraplegia experience continuity in care when they journey across multiple hospital units over the course of several months. This paper is based on a study of patient pathways for patients with tetraplegia caused by high spinal cord injuries. Semi-structured interviews were conducted with nine patients, seven next of kin and thirteen healthcare professionals in Copenhagen University Hospital. Data from the interviews were analyzed using patient journey mapping, to uncover variations in patients' experience during various stages of their admission. The study finds that patients are struggling to maintain a sense of control over their life as they continuously engage in negotiations of perceptions of their body, of the physical surroundings and of their perception of time and the future. The study concludes that health care professionals should be mindful of these key themes to support the patients' empowerment and active participation during recovery. • Patient Journey Mapping was used to capture patients' experience of long-term hospital stays. • Traumatic Spinal Cord Injuries have highly complex and heterogenous trajectories. • Patients seek empowerment from a powerless position by negotiating personal preferences. • Central themes are perceptions of the body, of personal space, of time and of the future. • Transfers across hospital units challenge interpersonal relationships and patient empowerment. [ABSTRACT FROM AUTHOR]

Strong and ever-growing evidence highlights the effectiveness of recovery housing in supporting and sustaining substance use disorder (SUD) recovery, especially when augmented by intensive support that includes assertive linkages to community services. This study aims to evaluate a pilot intensive recovery support (IRS) intervention for individuals (n = 175) entering certified Level II and III recovery residences. These individuals met at least three out of five conditions (no health insurance; no driving license; substance use in the last 14 days; current unemployment; possession of less than $75 capital). The study assesses the impact of the IRS on engagement, retention, and changes in recovery capital, compared to the business-as-usual Standard Recovery Support (SRS) approach (n = 1758). The study employed quasi-experimental techniques to create weighted and balanced counterfactual groups. These groups, derived from the Recovery Capital assessment tool (REC-CAP), enabled comparison of outcomes between people receiving IRS and those undergoing SRS. After reweighting for resident demographics, service needs, and barriers to recovery, those receiving IRS exhibited improved retention rates, reduced likelihood of disengagement, and growth in recovery capital after living in the residence for 6–9 months. The results from this pilot intervention indicate that intensive recovery support, which integrates assertive community linkages and enhanced recovery coaching, outperforms a balanced counterfactual group in engagement, length of stay, and recovery capital growth. We suggest that this model may be particularly beneficial to those entering Level II and Level III recovery housing with lower levels of recovery capital at admission. • Creation of weighted and balanced counterfactual groups through Inverse Probability Weighting Regression Adjustment. • Comparison of intensive and standard recovery groups revealed differences in demographics and baseline recovery capital. • The intensive intervention led to a 17.8 percentage points decrease in disengagement rate from recovery residences. • Residents receiving intensive support showed longer retention in recovery housing (estimated average increase of 48 days). • The intensive group's recovery capital scores steadily increased over time and eventually surpassed the standard group. • These findings suggest that the intensive intervention positively affects engagement, retention, and recovery capital growth. [ABSTRACT FROM AUTHOR]

High rates of delay discounting (DD), or the preference for immediate rewards over delayed rewards, is associated with substance use disorder (SUD). Lower rates of DD predict better treatment outcomes, and thus strategies that reduce DD may support SUD recovery. The process of vividly imagining a future event, known as episodic future thinking (EFT), may be a particularly viable approach to reduce DD. Some limited research has examined delivery of EFT in treatment settings, using verbal prompts that are typical of studies in non-treatment settings. We propose that the creation of visual art represents a unique alignment of the purpose of EFT with an innovative delivery modality in treatment settings. This single arm, proof-of-concept trial evaluated art-delivered EFT (ArtEFT) to reduce DD in a sample of women (N = 39) in a residential SUD treatment center. Participants engaged in a single, 1-h ArtEFT session during which they engaged in EFT and created a visual representation using art materials. The study collected DD measures for hypothetical money ($50 and $1000 magnitude conditions) before and after ArtEFT. Using area-under-the-curve (AUC ord) as the index of DD, the study observed predicted changes following the ArtEFT session. The ANOVA revealed statistically significant main effects of both magnitude [ F (1,38) = 11.184, p =.002] and time [ F (1. 38) = 4.731, p =.036], with a non-significant interaction [ F (1,38) = 3.821, p =.058]. This study reveals promising preliminary indicators that art may be an effective modality to deliver EFT, with particular advantages for implementation given the popularity of art programming in SUD treatment programs. • Innovative modalities to deliver episodic future thinking may support SUD recovery. • The creation of visual art presents a unique alignment with episodic future thinking. • Art-delivered episodic future thinking may be well-suited for treatment settings. • Art-delivered episodic future thinking was examined in a proof-of-concept trial. • The results indicate that art-delivered EFT reduces delay discounting. [ABSTRACT FROM AUTHOR]