Centering culture in the treatment of opioid use disorder with American Indian and Alaska Native Communities: Contributions from a National Collaborative Board

American Indian/Alaska Native (AI/AN) communities are disproportionally impacted by the opioid overdose epidemic. There remains a dearth of research evaluating methods for effectively implementing treatments for opioid use disorder (OUD) within these communities. We describe proceedings from a 2-day Collaborative Board (CB) meeting tasked with developing an implementation intervention for AI/AN clinical programs to improve the delivery of medications to treat OUD (MOUD). The CB was comprised of Elders, cultural leaders, providers, individuals with lived experience with OUD, and researchers from over 25 communities, organizations, and academic institutions. Conversations were audio-recorded, transcribed, and coded by two academic researchers with interpretation oversight provided by the CB. These proceedings provided a foundation for ongoing CB work and a frame for developing the program-level implementation intervention using a strength-based and holistic model of OUD recovery and wellbeing. Topics of discussion posed to the CB included engagement and recovery strategies, integration of extended family traditions, and addressing stigma and building trust with providers and clients. Integration of traditional healing practices, ceremonies, and other cultural practices was recommended. The importance of centering AI/AN culture and involving family were highlighted as priorities for the intervention.     

Prologue: Introduction and Overview to Special Volume

Abstract

The editors provide an overview of the obstacles that prevent us from ending child abuse in the United States and briefly summarize the various articles in this volume that address these obstacles from multiple points of view.     

Do Geographic Regions with Higher Suicide Rates also have Higher Rates of Nonfatal Intentional Self‐Harm?

Fatal and nonfatal intentional self‐harm events in eight U.S. states were compared using emergency department, hospital, and vital statistics data. Nonfatal event rates increased by an estimated 24.20% over 6 years. Case fatality ratios varied widely, but two northeastern states' total event rates (fatal plus nonfatal) were very high (New Hampshire 206.5/100,000 person years; Massachusetts 166.7/100,000). Geographic context did not uniformly impact the likelihood of self‐harm across event types. The state‐level public health burden posed by such acts cannot, therefore, be accurately estimated from either mortality or morbidity data alone.     

Synchronization and knowledge of results in a ventilatory motor task

The ability of healthy subjects to adopt a given value of inspiratory duration (TI) was examined in two different conditions: a knowledge condition in which subjects were informed of their performance on TI and synchronization of subjects' breathing rate to a periodic visual signal. The target value of TI was computed individually, by the same formula for all subjects in both procedures. 40 subjects were tested in a double-transfer design; each subject participated in two sessions 24 hr. apart. In addition to previous results showing better retention of the ventilatory task in subjects following the knowledge procedure after 24 hr., this study also shows better performance in this condition. No transfer could be evidenced, suggesting low similarity between the two tasks in spite of the fact that the resulting breathing patterns were nearly identical. The influence of the magnitude of the target on performance was also investigated.     

Nichtspezifische,funktionelle und somatoforme Körperbeschwerden

In the S3 guidelines on non-specific, functional and somatoform bodily complaints, a broad group of medical and psychological societies as well as patient representatives have for the first time achieved an evidence-based consensus on terminology and care of these patients. This paper summarizes the main background information and recommendations for psychotherapists. For mild courses treatment by the general practitioner with establishment of a biopsychosocial explanatory model and physical as well as social activation is usually sufficient. More severe courses call for cooperative, coordinated management, including regular appointments with the general practitioner, graded activation and psychotherapy, especially cognitive behavioral, in addition to psychodynamic interpersonal or hypnotherapeutic imaginative psychotherapy. In particularly severe courses multimodal and if necessary day clinic or inpatient treatment is needed. Additionally the patient guidelines for affected people and their relatives are presented.     

Relationship between respiratory mortality and self-perceptions of aging

Although there is growing evidence that psychological factors affect an individual's susceptibility to respiratory illnesses, psychological predictors of respiratory mortality have received little attention. This study investigated whether an age-specific psychological factor, older individuals’ beliefs about their own aging, predicted the likelihood of their dying from respiratory causes (ICD-9: 460–519). The sample was composed of 620 individuals, aged 50–87 years at baseline, who participated in a longitudinal study with six waves. Our research found that individuals with higher baseline positive self-perceptions of aging were significantly less likely to die of respiratory causes over the next 23 years, after controlling for age, functional health, gender, loneliness, marital status, self-rated health, and socioeconomic status (hazard ratio?=?0.695; p?<?0.005). This is the first study to link individual beliefs about aging to cause-specific mortality. Future research is warranted to further elucidate the relationship between self-perceptions of aging and resistance to respiratory mortality.