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  • 1
    Online Resource
    Online Resource
    Patients’ experiences of continued treatment with extended-release naltrexone: a Norwegian qualitative study
    Springer Science and Business Media LLC ; 2022
    In:  Addiction Science & Clinical Practice Vol. 17, No. 1 ( 2022-12)
    Details
    In: Addiction Science & Clinical Practice, Springer Science and Business Media LLC, Vol. 17, No. 1 ( 2022-12)
    Abstract: The opioid antagonist extended-release naltrexone (XR-NTX) in the treatment of opioid use disorder (OUD) is effective in terms of safety, abstinence from opioid use and retention in treatment. However, it is unclear how patients experience and adjust to losing the possibility of achieving an opioid effect. This qualitative study is the first to explore how people with opioid dependence experience XR-NTX treatment, focusing on the process of treatment over time. Methods Using a purposive sampling strategy, semi-structured interviews were undertaken with 19 persons with opioid use disorder (15 men, four women, 22–55 years of age) participating in a clinical trial of XR-NTX in Norway. The interviewees had received at least three XR-NTX injections. Qualitative content analysis with an inductive approach was used. Findings Participants described that XR-NTX treatment had many advantages. However they still faced multiple challenges, some of which they were not prepared for. Having to find a new foothold and adapt to no longer gaining an effect from opioids due to the antagonist medication was challenging. This was especially true for those struggling emotionally and transitioning into the harmful use of non-opioid substances. Additional support was considered crucial. Even so, the treatment led to an opportunity to participate in society and reclaim identity. Participants had strong goals for the future and described that XR-NTX enabled a more meaningful life. Expectations of a better life could however turn into broken hopes. Although participants were largely optimistic about the future, thinking about the end of treatment could cause apprehension. Conclusions XR-NTX treatment offers freedom from opioids and can facilitate the recovery process for people with OUD. However, our findings also highlight several challenges associated with XR-NTX treatment, emphasizing the importance of monitoring emotional difficulties and increase of non-opioid substances during treatment. As opioid abstinence in itself does not necessarily equal recovery, our findings underscore the importance of seeing XR-NTX as part of a comprehensive, individualized treatment approach. Trial registration : Clinicaltrials.gov # NCT03647774, first Registered: Aug 28, 2018.
    Type of Medium: Online Resource
    ISSN: 1940-0640
    URL: Article
    DOI: 10.1186/s13722-022-00317-2
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2492632-2
    SSG: 15,3
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  • 2
    Online Resource
    Online Resource
    ‘Not at all what I had expected’: Discontinuing treatment with extended-release naltrexone (XR-NTX): A qualitative study
    Elsevier BV ; 2022
    In:  Journal of Substance Abuse Treatment Vol. 136 ( 2022-05), p. 108667-
    Details
    In: Journal of Substance Abuse Treatment, Elsevier BV, Vol. 136 ( 2022-05), p. 108667-
    Type of Medium: Online Resource
    ISSN: 0740-5472
    URL: Article
    DOI: 10.1016/j.jsat.2021.108667
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 2027734-9
    SSG: 5,2
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  • 3
    Online Resource
    Online Resource
    High Circulating Levels of the Homeostatic Chemokines CCL19 and CCL21 Predict Mortality and Disease Severity in COVID-19
    Oxford University Press (OUP) ; 2022
    In:  The Journal of Infectious Diseases Vol. 226, No. 12 ( 2022-12-13), p. 2150-2160
    Details
    In: The Journal of Infectious Diseases, Oxford University Press (OUP), Vol. 226, No. 12 ( 2022-12-13), p. 2150-2160
    Abstract: Immune dysregulation is a major factor in the development of severe coronavirus disease 2019 (COVID-19). The homeostatic chemokines CCL19 and CCL21 have been implicated as mediators of tissue inflammation, but data on their regulation in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is limited. We thus investigated the levels of these chemokines in COVID-19 patients. Methods Serial blood samples were obtained from patients hospitalized with COVID-19 (n = 414). Circulating CCL19 and CCL21 levels during hospitalization and 3-month follow-up were analyzed. In vitro assays and analysis of RNAseq data from public repositories were performed to further explore possible regulatory mechanisms. Results A consistent increase in circulating levels of CCL19 and CCL21 was observed, with high levels correlating with disease severity measures, including respiratory failure, need for intensive care, and 60-day all-cause mortality. High levels of CCL21 at admission were associated with persisting impairment of pulmonary function at the 3-month follow-up. Conclusions Our findings highlight CCL19 and CCL21 as markers of immune dysregulation in COVID-19. This may reflect aberrant regulation triggered by tissue inflammation, as observed in other chronic inflammatory and autoimmune conditions. Determination of the source and regulation of these chemokines and their effects on lung tissue is warranted to further clarify their role in COVID-19. Clinical Trials Registration NCT04321616 and NCT04381819.
    Type of Medium: Online Resource
    ISSN: 0022-1899 , 1537-6613
    URL: Article
    DOI: 10.1093/infdis/jiac313
    RVK:
    XA 10000
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 1473843-0
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  • 4
    Online Resource
    Online Resource
    Efficacy and safety of baricitinib in hospitalized adults with severe or critical COVID-19 (Bari-SolidAct): a randomised, double-blind, placebo-controlled phase 3 trial
    Springer Science and Business Media LLC ; 2023
    In:  Critical Care Vol. 27, No. 1 ( 2023-01-10)
    Details
    In: Critical Care, Springer Science and Business Media LLC, Vol. 27, No. 1 ( 2023-01-10)
    Abstract: Baricitinib has shown efficacy in hospitalized patients with COVID-19, but no placebo-controlled trials have focused specifically on severe/critical COVID, including vaccinated participants. Methods Bari-SolidAct is a phase-3, multicentre, randomised, double-blind, placebo-controlled trial, enrolling participants from June 3, 2021 to March 7, 2022, stopped prematurely for external evidence. Patients with severe/critical COVID-19 were randomised to Baricitinib 4 mg once daily or placebo, added to standard of care. The primary endpoint was all-cause mortality within 60 days. Participants were remotely followed to day 90 for safety and patient related outcome measures. Results Two hundred ninety-nine patients were screened, 284 randomised, and 275 received study drug or placebo and were included in the modified intent-to-treat analyses (139 receiving baricitinib and 136 placebo). Median age was 60 (IQR 49–69) years, 77% were male and 35% had received at least one dose of SARS-CoV2 vaccine. There were 21 deaths at day 60 in each group, 15.1% in the baricitinib group and 15.4% in the placebo group (adjusted absolute difference and 95% CI − 0.1% [− 8·3 to 8·0]). In sensitivity analysis censoring observations after drug discontinuation or rescue therapy (tocilizumab/increased steroid dose), proportions of death were 5.8% versus 8.8% (− 3.2% [− 9.0 to 2.7] ), respectively. There were 148 serious adverse events in 46 participants (33.1%) receiving baricitinib and 155 in 51 participants (37.5%) receiving placebo. In subgroup analyses, there was a potential interaction between vaccination status and treatment allocation on 60-day mortality. In a subsequent post hoc analysis there was a significant interaction between vaccination status and treatment allocation on the occurrence of serious adverse events, with more respiratory complications and severe infections in vaccinated participants treated with baricitinib. Vaccinated participants were on average 11 years older, with more comorbidities. Conclusion This clinical trial was prematurely stopped for external evidence and therefore underpowered to conclude on a potential survival benefit of baricitinib in severe/critical COVID-19. We observed a possible safety signal in vaccinated participants, who were older with more comorbidities. Although based on a post-hoc analysis, these findings warrant further investigation in other trials and real-world studies. Trial registration Bari-SolidAct is registered at NCT04891133 (registered May 18, 2021) and EUClinicalTrials.eu ( 2022-500385-99-00 ).
    Type of Medium: Online Resource
    ISSN: 1364-8535
    URL: Article
    DOI: 10.1186/s13054-022-04205-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2051256-9
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  • 5
    Online Resource
    Online Resource
    Students’ top 10 priorities of research uncertainties on students’ sleep: a pragmatic James Lind Alliance approach
    BMJ ; 2021
    In:  BMJ Open Vol. 11, No. 1 ( 2021-01), p. e043697-
    Details
    In: BMJ Open, BMJ, Vol. 11, No. 1 ( 2021-01), p. e043697-
    Abstract: Inspired by the James Lind Alliance (JLA) user involvement approach, the aim of the present study was to identify the top 10 uncertainties for sleep research raised by students in higher education, and to discuss our experiences with adapting the JLA method to a student population. Design The study design is a pragmatic JLA approach, including a priority setting partnership within the field of sleep, collection of sleep-related research uncertainties as reported by students in higher education, sorting of the uncertainties and a final identification of the top 10 uncertainties through collaborative work between researchers, students, stakeholders and experts in the field. Uncertainties were collected using a one-question online survey: ‘as a student, which question(s) do you consider to be important with regards to sleep?’. A variety of approaches were applied to promote the survey to the students, including social media, radio, the university website, stands in university cafeterias and a sleep stunt. NVivo V.12 was used to code and sort the questions. Setting A higher education institution in Norway. Participants 555 students. Results The data collection provided 608 uncertainties, and the following prioritised top 10: (1) screen time, (2) stress, (3) educational achievements, (4) social relations, (5) mental health, (6) physical activity, (7) indoor environment, (8) substance abuse, (9) shift work and (10) sleep quality. Despite successful data collection, we found sleep to be a broad topic, and defining specific questions throughout the sorting and verification process proved difficult. Conclusions We identified the prioritised top 10 research uncertainties as reported by students in higher education, ranking screen time first. However, the process was time and resource consuming. The research uncertainties addressed by the students showed great diversity, characterised by heterogeneity and a lack of specificity, making verification of the uncertainties challenging.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2020-043697
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2599832-8
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  • 6
    Online Resource
    Online Resource
    What is Known About Students and Sleep: Systematic Review and Evidence Map
    SAGE Publications ; 2021
    In:  SAGE Open Vol. 11, No. 3 ( 2021-07), p. 215824402110321-
    Details
    In: SAGE Open, SAGE Publications, Vol. 11, No. 3 ( 2021-07), p. 215824402110321-
    Abstract: Higher education students are considered to belong to a population susceptible to poor sleep health; however, there is a lack of broader evidence reviews. This systematic review aims to map out and categorize the existing literature related to higher education students and sleep. The present evidence map is based on a comprehensive systematic literature search of ten electronic databases, which resulted in 15,286 unique citations. After title/abstract, and full-text screening: 515 studies were included in the final map. Most of the studies were cross-sectional ( n = 357, 69%), while 77 (15%) studies assessed the effectiveness of an intervention. Sixty-eight (13%) studies followed a cohort prospectively over time, and 8 (2%) studies utilized a qualitative design. The most frequent outcome was the proportion of sleep problems, which was reported in 226 (44%) studies. Weekday sleep duration was reported in 156 (30%) studies. Results from this mapping process suggest that evidence about students` sleep health is emerging; however, the evidence base is mostly quantitative and descriptive, and there is a lack of sleep health programs designed for students.
    Type of Medium: Online Resource
    ISSN: 2158-2440 , 2158-2440
    URL: Article
    DOI: 10.1177/21582440211032162
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2628279-3
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