Kratom Consumption - The Tales of Three Patients.

The rising prevalence of kratom use in the United States has led to increased encounters with individuals who consume kratom and those who develop Kratom Use Disorder (KUD) among healthcare professionals. This case series highlights the need for diverse treatment approaches tailored to the individual motivations for kratom consumption. Three cases are presented: one involving the progression from kratom use for energy to opioid-driven use with subsequent challenges in detoxification and transition to naltrexone necessitating buprenorphine low-dose induction for maintenance; another detailing successful inpatient detoxification using methadone and symptom-driven clonidine, followed by successful maintenance treatment with naltrexone; and a final case involving kratom consumption for pain and anxiety self-management by an individual without a history of addictive disorders, without meeting KUD criteria.

Putting on Academic Armor: How Black Physicians and Trainees Take Stances to Make Racism Visible Amid Publishing Constraints.

As a Black woman medical student at a predominately white institution, a white woman full professor and deputy editor-in-chief of a journal, and a white woman associate professor with a deep interest in language, we understand that medicine and medical education interpellate each of us as a particular kind of subject. As such, we begin with a narrative grounding in our personal stances. While there are a growing number of empirical studies of Black physicians' and trainees' experiences of racism, there are still few accounts from a first-person perspective.

The New Hampshire Hospital Screening and Referral Algorithm (NHHSRA) for Substance Use in People With Serious Mental Illness.

Substance use is a common co-occurrence among psychiatrically hospitalized adults, yet it is especially difficult to identify in those with serious mental illness. Existing screening instruments are not feasible for individuals with serious mental illness, as they rely heavily on subjective self-report. This study aimed to develop and validate an objective substance use screening instrument for use in seriously mentally ill patient populations.

Kratom as an opioid alternative: harm, or harm reduction? A systematic review of literature.

Kratom (Mitragyna speciosa Korth.) products are increasingly endorsed for self-management of multiple ailments, including as opioid substitution. The FDA has expressed that there is no evidence to indicate that this botanical is safe or effective for any medical use.

Colonoscopy utilization and outcomes in older adults: Data from the New Hampshire Colonoscopy Registry.

Background: Colonoscopy is frequently performed in older adults, yet data on current use, and clinical outcomes of and follow-up recommendations after colonoscopy in older adults are lacking.

Methods: This was an observational study using the New Hampshire Colonoscopy Registry of adults age ≥65 years undergoing colonoscopy for screening, surveillance of prior polyps, or evaluation of symptoms. The main outcomes were clinical findings of polyps and colorectal cancer and recommendations for future colonoscopy by age.

Addressing harmful alcohol use in primary care in Colombia: Understanding the sociocultural context.

Harmful alcohol use is a public health problem worldwide, contributing to an estimated 5.1% of the global burden of illness. Screening and addressing at-risk drinking in primary care settings is an empirically supported health care intervention strategy to help reduce the burden of alcohol-use problems.

Network of actors involved in the identification, care, and follow-up of unhealthy alcohol use in primary care in Colombia.

This article explores the structure of the network of actors involved in the care of individuals with unhealthy alcohol use (UAU) at the primary care level in five primary care centers in Colombia between 2017 and 2018. We use the Actor-Network Theory Framework (ANT) which posits that health outcomes are a product of a multitude of relationships between different stakeholders. The article focuses on the network configuration that develops between the actors and its effects on the processes of identification, care, and follow-up of people with UAU.

The DIADA project: A technology-based model of care for depression and risky alcohol use in primary care centres in Colombia.

Introduction: People with mental health conditions frequently attend primary care centers, but these conditions are underdiagnosed and undertreated. The objective of this paper is to describe the model and the findings of the implementation of a technology-based model of care for depression and unhealthy alcohol use in primary care centers in Colombia.

Methods: Between February 2018 and March 2020, we implemented a technology-based model of care for depression and unhealthy alcohol use, following a modified stepped wedge methodology, in six urban and rural primary care centers in Colombia.

Practice Patterns and Predictors of Stopping Colonoscopy in Older Adults With Colorectal Polyps.

Background & Aims: Older adults with colorectal polyps undergo frequent surveillance colonoscopy. There is no specific guidance regarding when to stop surveillance. We aimed to characterize endoscopist recommendations regarding surveillance colonoscopy in older adults and identify patient, procedure, and endoscopist characteristics associated with recommendations to stop.

Validation of the Emotional Tone Index for Families (ETIF): A Multi-Informant Measure of Emotional Closeness.

Despite the importance of emotional closeness (EC) in families, few researchers have accurately measured the construct in a systemic way. Additionally, existing measures rely on ratings from one informant, typically the mother, to provide information on closeness within the entire family system. We examined EC in 140 individuals (37 families) using the Emotional Tone Index for Families (ETIF), a novel, multi-informant measure that obtains bidirectional information about EC within every family relationship.

Impact of Knowledge and Risk Perceptions on Older Adults' Intention for Surveillance Colonoscopy.

Goals: The authors aimed to characterize older adults' intentions for future surveillance colonoscopy, knowledge of polyps, and predictors of colonoscopy plans.

Background: Guidelines recommend that the decision to continue or stop surveillance colonoscopy in older adults with colon polyps be "individualized." Although older adults want to be included in decision making, how knowledge regarding polyps influences decisions is unknown.

A new model of online health care delivery science education for mid-career health care professionals.

Health care delivery science focuses on ways to improve health and health care services provided to individuals and populations. Health care professionals must be trained in health care delivery science in order to diagnose and treat the sources of health care system dysfunction and achieve better outcomes while controlling costs. The ideal model for health care delivery science training has not been fully defined, but doing so is critical especially for frontline mid-career health care professionals whose original clinical training omitted these concepts.

Kratom Withdrawal: A Systematic Review with Case Series.

Recent years have seen a widespread increase in kratom use, not just for the purpose of easing opioid withdrawal, but also for management of emotional and mental health concerns by individuals without histories of opioid use. Chronic use can lead to dependence, tolerance, and withdrawal on cessation, and clinicians are seeing an increasing number of presentations involving the latter. Although there is literature discussing the use of kratom to assist in opioid withdrawal, this article comprehensively examines independent withdrawal from kratom.

In Vivo and Ex Vivo Microscopy: A Business Plan to Justify the Introduction of Similar Emerging Technologies Into Pathology Practice.

Context.—: Our patients are now demanding value for their medical diagnoses and treatment in terms of optimal costs, quality, and outcomes. The financial justification for the introduction of new emerging technologies that may better meet these needs will depend on many factors, even if there is an established reimbursement code.

Barriers to tuberculosis care delivery among miners and their families in South Africa: an ethnographic study.

Setting: South African miners suffer the highest tuberculosis (TB) rates in the world. Current efforts to stem the epidemic are insufficient. Historical legacies and persistent disease burden demand innovative approaches to reshape health care delivery to better serve this population.

Immunogenicity and Protective Efficacy of the DAR-901 Booster Vaccine in a Murine Model of Tuberculosis.

Background: The development of a novel tuberculosis vaccine is a leading global health priority. SRL172, an inactivated, whole-cell mycobacterial vaccine, was safe, immunogenic and reduced the incidence of culture-confirmed tuberculosis in a phase III trial in HIV-infected and BCG immunized adults in Tanzania. Here we describe the immunogenicity and protective efficacy of DAR-901, a booster vaccine against tuberculosis manufactured from the same seed strain using a new scalable method.

The future of global health education: training for equity in global health.

Background: Among academic institutions in the United States, interest in global health has grown substantially: by the number of students seeking global health opportunities at all stages of training, and by the increase in institutional partnerships and newly established centers, institutes, and initiatives to house global health programs at undergraduate, public health and medical schools. Witnessing this remarkable growth should compel health educators to question whether the training and guidance that we provide to students today is appropriate, and whether it will be applicable in the next decade and beyond. Given that "global health" did not exist as an academic discipline in the United States 20 years ago, what can we expect it will look like 20 years from now and how can we prepare for that future?

Discussion: Most clinicians and trainees today recognize the importance of true partnership and capacity building in both directions for successful international collaborations.

Mycobacterium bovis BCG and New Vaccines for the Prevention of Tuberculosis.

Tuberculosis infects millions of people worldwide and remains a leading global killer despite widespread neonatal administration of the tuberculosis vaccine, bacillus Calmette-Guérin (BCG). BCG has clear and sustained efficacy, but after 10 years, its efficacy appears to wane, at least in some populations. Fortunately, there are many new tuberculosis vaccines in development today, some in advanced stages of clinical trial testing.