RESUMO
BACKGROUND: Identifying patients in primary care services with opioid use disorder and co-occurring mental health disorders is critical to providing treatment. Objectives of this study were to (1) assess the feasibility of recruiting people to screen in-person for opioid use disorder and co-occurring mental health disorders (depression and/or post-traumatic stress disorder) in primary care clinic waiting rooms in preparation for a randomized controlled trial, and (2) compare results of detecting these disorders by universal in-person screening compared to electronic health record (EHR) diagnoses. METHODS: This cross-sectional feasibility and pilot study recruited participants from four primary care clinics, two rural and two urban, from three health care organizations in New Mexico. Inclusion criteria were adults (≥ 18 years), attending one of the four clinics as a patient, and who spoke English or Spanish. Exclusion criteria were people attending the clinic for a non-primary care visit (e.g., dental, prescription pick up, social support). The main outcomes and measures were (1) recruitment feasibility which was assessed by frequencies and proportions of people approached and consented for in-person screening, and (2) relative differences of detecting opioid use disorder and co-occurring mental health disorders in waiting rooms relative to aggregate EHR data from each clinic, measured by prevalence and prevalence ratios. RESULTS: Over two-weeks, 1478 potential participants were approached and 1145 were consented and screened (77.5% of patients approached). Probable opioid use disorder and co-occurring mental health disorders were identified in 2.4% of those screened compared to 0.8% in EHR. Similarly, universal screening relative to EHR identified higher proportions of probable opioid use disorder (4.5% vs. 3.4%), depression (17.5% vs. 12.7%) and post-traumatic stress disorder (19.0% vs. 3.6%). CONCLUSIONS: Universal screening for opioid use disorder, depression, and post-traumatic stress disorder was feasible, and identified three times as many patients with these co-occurring disorders compared to EHR. Higher proportions of each condition were also identified, especially post-traumatic stress disorder. Results support that there are likely gaps in identification of these disorders in primary care services and demonstrate the need to better address the persistent public health problem of these co-occurring disorders.
Assuntos
Transtornos de Estresse Pós-Traumáticos , Adulto , Humanos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Depressão/epidemiologia , New Mexico/epidemiologia , Projetos Piloto , Estudos TransversaisRESUMO
Quantifying the impacts of disturbances such as oil spills on marine species can be challenging. Natural environmental variability, human responses to the disturbance (e.g., fisheries closures), the complex life histories of the species being monitored, and limited pre-spill data can make detection of effects of oil spills difficult. Using long-term monitoring data from the state of Louisiana (USA), we applied novel spatiotemporal approaches to identify anomalies in species occurrence and catch rates. We included covariates (salinity, temperature, turbidity) to help isolate unusual events. While some species showed evidence of unlikely temporal anomalies in occurrence or catch rates, we found that the majority of the observed anomalies were also before the Deepwater Horizon event. Several species-gear combinations suggested upticks in the spatial variability immediately following the spill, but most species indicated no trend. Across species-gear combinations, there was no clear evidence for synchronous or asynchronous responses in occurrence or catch rates across sites following the spill. Our results are in general agreement to other analyses of monitoring data that detected small impacts, but in contrast to recent results from ecological modeling that showed much larger effects of the oil spill on fish and shellfish.