Shikhar Shrestha

Introduction: Approximately 6% of the US population had been diagnosed with attention-deficit hyperactivity disorder (ADHD) in 2023, and approximately 33% of the patients received stimulants to manage it. Recent ADHD medication shortages in the United States have caused substantial disruptions in access to these medications. The objective of our study was to investigate how individuals respond psychologically and behaviorally to ADHD medication shortage in the United States using public discussions on Reddit.Methods: We extracted Reddit threads from “r/ADHD” that consisted of the keyword “shortage.” After identifying relevant threads, we qualitatively analyzed 16 threads relevant to our study to reach thematic saturation. We used a hybrid inductive–deductive thematic analysis grounded in stress and coping theory to perform a qualitative analysis of the posts between August 2021 and February 2024.Results: Our findings show that redditors consuming ADHD medication experienced significant cognitive, emotional, and functional impacts due to medication shortage (primary appraisal). Redditors reported challenges with accessing medication due to complex medical systems, unsupportive healthcare providers, financial strain, and limited understanding of the causes of the shortage (secondary appraisal). Redditors also reported a range of pharmacological (change in dosage/medication, skipping dosage, saving medication, caffeine, and nicotine) and non-pharmacological (meditation and exercise) changes to behavior to manage the shortage (coping strategies). In addition, the Reddit community fostered support, positivity, and resource-sharing to navigate the shortage.Conclusion: Our study highlights the urgent need for healthcare policies that support individuals with ADHD amid shortages, emphasizing the role of transparent communication from pharmacies, healthcare providers, and regulatory bodies.

Introduction: The COVID-19 pandemic has significantly altered maternal healthcare delivery, including breastfeeding practices. Our study investigated the influence of nurses, midwives, and doulas on breastfeeding education and rates, with a specific focus on changes that transpired during the COVID-19 pandemic.Methods: Using a cross-sectional design, we performed a secondary data analysis on a stratified systematic sample of forty-six U.S. states and New York City respondents who completed the Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 7 (2012–2015) and Phase 8 (2016–2020) surveys (n = 193,068). Descriptive analyses and adjusted multivariable logistic regression models reporting adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were used to assess associations between the provision of breastfeeding guidance to mothers from nurses, doulas, or midwife healthcare professionals; breastfeeding/pumping rates; and the COVID-19 pandemic. Cox-proportional hazard models were used to examine the association between breastfeeding guidance and breastfeeding duration.Results: Our findings revealed that participants who received breastfeeding guidance from nurses, midwives, or doulas were twice as likely to have engaged in breastfeeding or milk pumping for their infants than participants who did not receive breastfeeding education (aOR = 1.99, 95% CI: 1.89–2.11, p < 0.0001). Additionally, participants who gave birth during the COVID-19 pandemic were notably less likely to receive breastfeeding education from a nurse, midwife, or doula than were those who gave birth before the pandemic (aOR = 0.92, 95% CI: 0.88–0.96, p < 0.0001). We also find that the hazard of stopping breastfeeding was lower among participants who received breastfeeding guidance (HR = 0.94, 95% CI: 0.91–0.97, p < 0.0001). Additionally, the hazard of stopping breastfeeding was lower during COVID-19 (HR = 0.94, 95% CI: 0.91–0.97, p = 0.001)Discussion: Our study underscores the vital role that healthcare professionals play in educating, advocating for, and promoting breastfeeding behaviors. This further highlights the pressing need for sustained efforts to support breastfeeding initiatives and address disparities in maternal and child health, particularly in the context of the challenges presented by the COVID-19 pandemic.

Objective: Lowell, Massachusetts, has been severely impacted by the opioid-related overdose crisis. Utilizing emergency medical services (EMS) data can inform local interventions by identifying opioid-related incidents (ORIs) with shorter lags in reporting. Our objective was to identify spatial and temporal variation in ORI and investigate its association with underlying socioeconomic indicators by coupling EMS data with Bayesian spatial-temporal analyses. Methods: We obtained data on ORI occurrences within the City of Lowell from January 2011 to June 2022 from Pridestar Trinity EMS. The ORI occurrences were aggregated by month and census tracts. We gathered American Community Survey 5-year estimates (2011-2022) for census-tract percentages of white, black, Hispanic, poverty, unemployed, bachelor’s degree, and rent-burdened populations. Using these data, we constructed a Bayesian spatial-temporal Poisson model to identify associations between quarterly ORI rates and these tract-level measures, along with seasonal effects. Results: ORI rates in Lowell rose from 20 per 10,000 people in 2011 to 93 per 10,000 people in 2018, stabilizing around 60 per 10,000 people from 2019 to 2021, with annual peaks between July through September. Downtown Lowell had consistently higher ORI rates, which extended north-south after 2016. Census tracts with higher percentage of black (relative risk = 1.008; 95% credible interval [1.002, 1.014]) and Hispanic populations (1.014 [1.009, 1.018]) were associated with higher ORI rates. Higher rent burden (1.103 [1.095, 1.11]) and poverty rates (1.02 [1.015, 1.025]) were positively associated with ORI rates, while unemployment rates were inversely associated. Conclusions: ORI rates in Lowell were associated with community-level sociodemographic factors and exhibited clear seasonal patterns. These findings could inform local prevention and response planning strategies for near-real-time ORI spike detection in communities to mitigate the impact of opioid overdose.

Illicitly manufactured fentanyl within the drug supply has substantially increased opioid-related overdose deaths and driven infectious disease outbreaks among people who use drugs (PWUD). Local jurisdictions often lack the data and tools necessary to detect and translate such moments into actionable and effective responses. Informed by a risk environment framework, this case study adopted a mixed-methods design spanning two rapid assessment studies with PWUD in Lowell (n = 90) and Lawrence (n = 40), Massachusetts, during an HIV outbreak (2017, Study 1) and following the outbreak (2019, Study 2). Survey responses (n = 130) were summarized by computing descriptive statistics, ethnographic field notes were reviewed, and qualitative interviews (n = 34) were thematically analyzed to contextualize quantitative findings. Study 1 participants reported constrained syringe access, high injecting frequency, syringe reuse, and unsafe syringe disposal practices, and uncovered entrenched social and structural factors exacerbating existing substance use and HIV risks: housing instability, limited harm reduction supplies and services (e.g., MOUD access), and tensions between law enforcement and PWUD. Following the outbreak and substantial local investments in harm reduction and treatment infrastructures, Study 2 participants indicated lower injection risk reporting fewer syringe reuse episodes, improved syringe disposal practices, high frequency of naloxone administration at recent overdoses, frequent testing for HIV and HCV, and greater engagement with syringe services programs. A rapid assessment approach to fentanyl’s emergence and a concomitant HIV outbreak provided time-sensitive, critical insights and identified needed and local response strategies. However, unless social and structural risk factors are also addressed, community vulnerability to future HIV outbreaks remains.