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Prescriptions for prenatal substance use disorder treatment fell in US during COVID-19 pandemic

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Researchers have shown that the number of prescriptions issued for treatment-related improved pregnancy outcomes in those with a drug use disorder in the United States has decreased as the 2019 coronavirus disease (COVID-19) pandemic continued.

Prior to the COVID-19 pandemic, there were barriers to access to the combination drug buprenorphine / naloxone during pregnancy, but Ashley O’Donoghue and colleagues at Beth Israel Deaconess Medical Center in Boston, Massachusetts suspected health care was interrupted during pregnancy the pandemic could have exacerbated these barriers.

Using linked national pharmacy claims and medical claims from May 2019 to December 2020, the researchers showed that the number of pregnant people writing prescriptions for treatment increased before the pandemic. However, that growth was lost during the pandemic in both commercial insurance patients and Medicaid patients, the team says.

A pre-print version of the research paper is available on the medRxiv * server while the article is being peer-reviewed.

The prenatal use of medication for opioid use disorders

The number of pregnant women with opioid use disorder (OUD) has quadrupled in the past decade. Antenatal use of OUD medications such as buprenorphine / naloxone has been linked to improved prenatal care compliance and pregnancy outcomes such as lower preterm birth rates and low birth weight, as well as lower rates of maternal relapse and overdose.

Even so, prior to the COVID-19 pandemic, only 55% of pregnant women with OUD were taking medication for their substance use disorder. This could be due to the numerous barriers to accessing treatment, including stigma, fear of legal or child welfare outcomes, and limited access to experts in obstetrics and addiction treatment.

To counter a possible loss of access to medical care during the COVID-19 pandemic, the federal government approved the initiation of buprenorphine / naloxone treatment via telemedicine in June 2020.

Pregnancy offers a crucial opportunity to help women with OUD, but it is not clear how the pandemic has affected access to treatment in this population.

Trends in people completing prenatal buprenorphine / naloxone prescriptions each month from Symphony Health Claims from May 2019 to December 2020. The y-axis represents the number of people completing prenatal buprenorphine / naloxone prescriptions, weighted with the total number of pregnancies for a given month and payer.  This weighting should take into account any seasonality in pregnancies or changing trends in pregnancies during the pandemic, which may differ over time and depending on the payer.  The vertical black line marks March 2020 when the pandemic began in the United States.

Trends in people completing prenatal buprenorphine / naloxone prescriptions each month from Symphony Health Claims from May 2019 to December 2020. The y-axis represents the number of people completing prenatal buprenorphine / naloxone prescriptions, weighted with the total number of pregnancies for a given month and payer. This weighting should take into account any seasonality in pregnancies or changing trends in pregnancies during the pandemic, which may differ over time and depending on the payer. The vertical black line marks March 2020 when the pandemic began in the United States.

What did the researchers do?

O’Donoghue and colleagues used an interrupted time-series design to examine monthly trends in the number of pregnant patients filling prescriptions for prenatal buprenorphine / naloxone before and during the COVID-19 pandemic.

They used linked data on national pharmacy claims and medical claims from May 2019 to December 2020 and defined prenatal buprenorphine / naloxone prescription fillings as those filled out in the six months leading up to delivery.

The researchers weighted the monthly number of prenatal prescriptions for Medicaid patients and commercially insured patients with the total monthly number of pregnancies for that payer. The pre-pandemic level and growth rate (May 2019 to February 2020) were compared to the post-pandemic level (April 2020 to December 2020) and the growth rate of the number of people completing these prescriptions.

What did the study find out?

The study identified 2,947 pregnant patients who completed the prescriptions. More than half (55.5%) of these patients were 21 to 30 years old and most (58.1%) had commercial insurance, 38.9% were Medicaid.

Prior to the COVID-19 pandemic, the monthly growth rate in the number of people filling out prescriptions across all payers was 4.83% (5.35% for Medicaid and 4.06% for commercial policyholders).

At the start of the pandemic, there was no immediate, statistically significant change in the number of people filling out the prescriptions. However, the monthly growth rate for all payers declined by 5.53% over the course of the pandemic, by 7.66% for Medicaid subscribers and by 3.59% for commercial policyholders.

The researchers say the results suggest that prior to the COVID-19 pandemic, the number of pregnant people filling out buprenorphine / naloxone prescriptions had increased.

“However, that growth has been lost during the pandemic in both commercial insurance patients and Medicaid,” the team concludes.

*Important NOTE

medRxiv publishes preliminary scientific reports that are not peer-reviewed and therefore are not considered conclusive, guide clinical practice / health-related behavior, or should be treated as established information.

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Reactive Attachment Disorder: Symptoms, Treatment

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Reactive attachment disorder, also known as RAD, is a mood or behavior disorder that affects babies and children. It includes difficulties with bonding and relationship building, as well as social patterns that are inadequate but without an intellectual disability or profound developmental disorder (such as autism) to explain these characteristics.

In addition, the reactive attachment disorder is caused by some type of caring problem, e.g.

The term “reactive attachment disorder” is sometimes abbreviated to “attachment disorder”, but reactive attachment disorder is actually a type of attachment disorder.

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Reactive attachment disorder vs. disinhibited social attachment disorder

Attachment disorders are sometimes described as inhibited or uninhibited. These terms are used to describe the behavior of babies and young children.

Children who fall into the category of inhibited difficulty regulating their emotions, who do not prefer specific adults or caregivers, do not seek consolation from the caregiver, or show much affection or a combination of these behaviors. On the other hand, children who fall into the category of inhibitions may be evenly or excessively preoccupied with all adults, including strangers, and they do not have a preference for primary caregivers.

The reactive attachment disorder is the inhibited form of the attachment disorder. There used to be only one diagnosis of both inhibited and uninhibited attachment, but that has changed with more recent research. The disinhibited type of attachment disorder is known as disinhibited social engagement disorder, or DSED.

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The characteristics of reactive attachment disorder are the inhibited type, which means that the child behaves in a way that shows little or no attachment to the parents or other caregivers. This is seen in babies and young children. They are unable to form healthy and secure bonds with their parents or primary caregivers.

Symptoms of reactive attachment disorder

Symptoms of RAD include:

  • Avoiding comfort during stress
  • Avoidance of physical contact
  • Difficulty dealing with emotions
  • Don’t be concerned if left alone
  • Avoid making eye contact, smiling, or engaging
  • Emotional distance
  • Excessive rocking or self-calming
  • Inability to show guilt, remorse, or regret
  • Inconsolable crying
  • Little or no interest in interacting with others
  • Must be in control
  • Tantrums, anger, sadness

diagnosis

Reactive attachment disorder can be diagnosed by a psychiatrist such as a child psychiatrist or psychologist. They do this by assessing the child against the diagnostic criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). They then assess the child on how the symptoms affect their ability to function.

Diagnostic criteria for reactive attachment disorders

  • Patterns of not seeking consolation or not reacting to emergency situations
  • Two or more forms of social and / or emotional stress, such as B. minimal engagement with others, limited positive affect, and episodes of inexplicable irritability or anxiety in non-threatening interactions with caregivers
  • A history of unmet needs, changes in caregivers, or an unusual environment that prevents attachment
  • Does not meet diagnostic criteria for an autism spectrum disorder
  • Behavioral symptoms that started before age 5
  • At least 9 months old, measured as developmental age

causes

The specific causes of reactive attachment disorder are not as simple as they may seem. While child abuse and neglect can lead to attachment disorders, there is more to it than that. Children who receive inconsistent care or are placed with new primary caregivers are also at increased risk of reactive attachment disorder. This can happen even when parents and other caregivers mean well and do their best.

Children may experience an event or challenge that is not overtly harmful, such as moving geographically or something that cannot be avoided, such as the death of a family member. Even if they are too young to understand what is happening, they may not feel loved, are insecure, or cannot trust their caregivers.

Causes of a reactive attachment disorder

Possible causes of RAD are:

  • Attention only if the child behaves incorrectly (only negative attention)
  • To be left alone for hours without interaction, touch or play
  • Emotional needs are not consistently met
  • Experiencing trauma or a very frightening, difficult event
  • Having an emotionally unavailable parent
  • Hospitalization
  • Inconsistent care or response to needs
  • Loss of a caregiver or other family member, e. B. a sibling
  • Multiple main caregivers or change of caregivers
  • Neglect or abuse by parents, caregivers, or others
  • Not being comforted when crying or in despair
  • Not being fed for hours if you are hungry
  • Have not changed a diaper for hours
  • Only some needs are met, or needs are only met sometimes
  • Physical needs are not consistently met
  • Separation from parents or other caregivers

treatment

Treatment for reactive attachment disorder goes beyond the child alone. The whole family can be involved to support healthy bonding. The process involves a combination of talk therapy, other therapies, and education that will benefit children as well as parents and other caregivers.

Treatment of reactive attachment disorders

Treatment options for RAD include:

  • Family therapy with child and carer
  • Parent courses to learn effective strategies
  • Play therapy with the child to teach social and other skills
  • Teaching social skills in a different way
  • Special educational offers at schools
  • Talk therapy with the child, the caregivers, or both

Coping

Managing reactive attachment disorder involves strategies to support both the child and the adults who interact with the child. This is because the bond between children and their caregivers involves two or more people, and their interactions can help create a more secure bond. For this reason, coping includes support, self-care, and stress management for adults, as well as healthy eating and adequate sleep and physical activity for children and adults.

A word from Verywell

If your child or someone you know is struggling with attachment issues, help is available. Even if your child is diagnosed with reactive attachment disorder, it does not mean that it was caused by you or that it was your fault. Sometimes things happen that are beyond your control, no matter how hard we try. The main concern is that the child is getting the care they need.

Contact a family doctor, general practitioner, or psychologist for support for the child. It is also important that you and other primary caregivers of the child have all the support they need to care for the child.

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Respiratory illness cases climb, health experts recommend COVID-19, flu vaccines

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As Johnson County sees an increase in COVID-19 cases, public health experts are also seeing increases in RSV, the common cold, parainfluenza and other cases of respiratory illness.

Testing centers and public health experts in Johnson County are seeing more cases of other respiratory diseases year-on-year, while COVID-19 numbers are rising due to the contagious Delta variant.

Johnson County is considered an area with high transmission of COVID-19, according to the Centers for Disease Control and Prevention. The CDC recommends that everyone wear a mask in indoor public spaces.

On October 25, 188 cases were reported in Johnson County in the past seven days, according to the CDC. The fall rate per 100,000 for the county is 124.39 and there is a positivity rate of 5.37 percent.

While those numbers remain high, Bradley Ford, clinical associate professor of pathology at the University of Iowa’s Carver College of Medicine, said cases of other respiratory diseases are also increasing in the community.

“The most remarkable thing about last year is that there were no respiratory viruses, which means there was no flu season,” said Ford. Cases like ever before. “

Ford said this year had a peak of cases going back to 2017 when he started work in the pathology lab at UI Hospitals and Clinics.

Last year there were almost no cases of respiratory syncytial virus, known as RSV, compared to 45 to 50 per day this year, said Ford. RSV acts like the common cold and causes mild symptoms, but it can affect older adults and little ones Children who are not vaccinated can be dangerous, he said.

Johnson County’s disease prevention specialist Jennifer Miller said the county hasn’t seen any flu cases this season but recommends people get the vaccine as soon as possible.

“We have seen more cases of RSV, the common cold and other respiratory viruses than last year,” Miller said. “This shows that people have masked themselves and have been more attentive to social distancing and were more careful about being around other people.”

Despite the rise in respiratory viruses, Miller said this was not a concern. After seeing what Australia and other southern hemisphere countries were experiencing, public health experts expected a surge in respiratory viruses, she said.

According to the Australian Ministry of Health, 550 cases of flu have been reported since April 2020, compared with 3,000 to 25,000 cases per week in recent years.

For people with a runny nose, cough, fever, and other symptoms of respiratory illness, Miller said it was best to contact health care providers. From then on, she said it was important to follow recommendations for testing.

“Most respiratory diseases will look very similar to what we see with COVID,” Miller said. “It’s hard to tell without testing, unless you know you’ve had a specific exposure.”

People should get a flu shot, and it’s widely available in pharmacies, hospitals, and other places, Miller said. Anyone who isn’t insured can schedule an appointment for a free flu vaccine through Johnson County Public Health, she said.

RELATED: Iowa City Schools That Want To Offer Rapid COVID-19 Testing To Students

Lisa James, Assistant Director of Quality Improvement and Strategic Communications at UI Student Health, said UI Student Health has a wide range of Pfizer BioNTech vaccines. Now UI Student Health is waiting for booster doses for Pfizer, Moderna and Johnson & Johnson, she said, which they will hopefully make available soon.

“Everyone should get a COVID shot when we go into the fall and winter flu seasons,” said James. “Students should also get the flu vaccine as recommended by the CDC.”

James said flu vaccinations are available and cost $ 62, which is usually covered by insurance. She said students can also deduct this fee from their U-bill.

Students can go to the Iowa Memorial Union Nurse Care Clinic without an appointment to get their flu shot, James said in a press release. The opening times are Monday to Thursday from 8:30 a.m. to 5:00 p.m. and Friday from 9:30 a.m. to 5:00 p.m.

James said students can call the main clinic in Westlawn, the main health and wellness location for students, to schedule an appointment for a flu shot, which has the same opening hours as the IMU clinic.

With the increase in other respiratory diseases, Ford is hoping for an easier flu season from November to April.

“Nobody can really predict what a respiratory virus season will be like,” said Ford. “Nobody has predictions this year, but we know it’s safest and best to get vaccinated.”

Miller said the best way to protect yourself and your families is to get vaccinated.

“People can get the flu shot and the COVID vaccine at the same time,” Miller said. “Most people who are vaccinated and become infected are likely to have only mild illness compared to people who are not vaccinated.”

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Utah continues to see higher rates of serious COVID-19 illness in younger adults

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A University of Utah health worker is treating patients in the medical intensive care unit at the University of Utah Hospital on July 30th. Utah health officials on Monday confirmed 3,636 new COVID-19 cases since Friday, as well as 21 deaths. (Charlie Ehlert, University of Ut)

Estimated reading time: 3-4 minutes

SALT LAKE CITY – Of the 21 deaths from COVID-19 reported in Utah since Friday, six were between 25 and 44 years old and nine were between 45 and 64 years old as the state continues to see higher rates of serious illness younger adults.

Intermountain Healthcare executives noted last week that hospitals – which continue to have high numbers of coronavirus patients – on average treat patients 20 years younger than the average age of those hospitalized with COVID-19 last year became.

These younger patients are usually not vaccinated, doctors said.

The median age of COVID-19 deaths in Utah has dropped to 72.1 years, according to the Utah Department of Health. That’s compared to November 2020, when the median age of deaths was 73.8.

Last November, over 92% of people who died from COVID-19 were high-risk people, meaning they were over 65 years of age and / or had one or more previous illnesses. Now, 84.6% of patients who die from the virus are considered high-risk patients, according to the data.

Utah health officials also confirmed 3,636 new COVID-19 cases as well as 21 deaths as of Friday.

A breakdown of the daily new cases over the past weekend:

  • Friday: 1.673
  • Saturday: 1.250
  • Sunday: 728

The 7-day rolling average for positive tests is now 1,482 per day, and the average percent positive rate of people tested is now 16.5%, according to a daily update from the Utah Department of Health.

School-age children made up 698 of the cases reported Monday – 351 cases were ages 5 to 10, 153 cases were 11 to 13 years old, and 194 cases were 14 to 18 years old.

Health care workers have administered 20,920 doses of vaccine, including booster shots, since Friday’s report, bringing the total dose administered in Utah to 3,677,561.

In the past 28 days, unvaccinated residents had a 15.4 times higher risk of dying from COVID-19, a 10.9 times higher risk of hospitalization and a 5.4 times higher risk of testing positive for the disease to be considered vaccinated, state health officials said.

As of February 1, unvaccinated people are 8.8 times more likely to die from COVID-19, 7.5 times more likely to be hospitalized, and 3.8 times more likely to be positive test for COVID-19 than vaccinated people.

Of the cases reported on Monday, 913 – or about 25.1% – were considered a “breakthrough,” meaning they were patients who had been fully vaccinated more than two weeks before testing positive. The state confirmed 27 more groundbreaking hospital admissions and no more groundbreaking deaths.

State health officials and doctors have found that receiving the vaccine doesn’t mean someone won’t contract the coronavirus, but in most cases it will protect against serious illness. The vaccine also does not result in a person getting COVID-19.

Since vaccines were made available to the public earlier this year, the state has confirmed 26,372 breakthrough cases in the total of 542,531 positive cases since the pandemic began, or just under 5% of all cases. Utah health officials have also confirmed a total of 1,283 pioneering hospital admissions and 175 pioneering deaths.

525 patients with the coronavirus were hospitalized in the state on Monday, down from five since Friday.

Recent deaths include:

  • Two Washington County women aged 45 to 64 who were hospitalized at the time of their death.
  • An Iron County woman, 45-64, hospitalized.
  • A Weber County man, 25-44, was hospitalized.
  • Two Salt Lake County women, 45-64, were hospitalized.
  • Two Utah County men, 25-44 years old, were hospitalized.
  • A 65-84-year-old woman from Salt Lake County was hospitalized.
  • Two Utah County men, 65-84, hospitalized.
  • Davis County man, 45-64, hospitalized.
  • A Utah County woman, 25-44 year old, was hospitalized.
  • A man from Weber County, 65-84, hospitalized.
  • A woman from Box Elder County, 25-44, was hospitalized.
  • A woman from Washington County, 65-84 years old, was hospitalized.
  • A Box Elder County man, 45-64, was hospitalized.
  • A Sevier County man, 25-44 years old, was hospitalized.
  • A Carbon County man, 65-84, hospitalized.
  • A Utah County man, 45-64, was hospitalized.
  • Cache County woman, 45-64, of unknown hospital status.

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