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Yun W. Lu

Bio: Yun W. Lu is an academic researcher. The author has contributed to research in topics: Medicine & Referral. The author has an hindex of 2, co-authored 2 publications receiving 211 citations.

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Journal ArticleDOI
TL;DR: Pain-related diagnoses among patients dependent on narcotic analgesics highlight the need for linkages between primary care and substance abuse treatment and point to the importance of examining comorbid medical conditions and substance Abuse in both primary and specialty care.
Abstract: Background Substance abuse and health problems seem to be inextricably related. Yet, prior research on the health conditions related to substance abuse is largely focused on alcohol and is from patients treated in publicly funded programs, inpatients, and the general population. Methods This study compares the prevalence of medical and psychiatric conditions among 747 substance abuse patients and 3690 demographically matched controls from the same health maintenance organization, and examines whether any heightened prevalence for substance abuse patients (relative to controls) varies according to demographic subgroups and type of substance. Results Approximately one third of the conditions examined were more common among substance abuse patients than among matched controls, and many of these conditions were among the most costly. We also found that pain-related diagnoses, including arthritis, headache, and lower back pain, were more prevalent among such patients, particularly those dependent on narcotic analgesics. Conclusions Our findings point to the importance of examining comorbid medical conditions and substance abuse in both primary and specialty care. Our findings regarding pain-related diagnoses among patients dependent on narcotic analgesics highlight the need for linkages between primary care and substance abuse treatment. Moreover, optimal treatment of many common medical disorders may require identification, intervention, and treatment of an underlying substance abuse disorder.

215 citations

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TL;DR: In a large, real-world population, exposure to young children was strongly associated with less severe CO VID-19 illness, after balancing known COVID-19 risk factors, which suggests endemic coronavirus cross-immunity may play a role in protection against severe COvid-19 outcomes.
Abstract: Significance Epidemiologic data consistently show strong protection for young children against severe COVID-19 illness. Several mechanisms have been proposed to explain this phenomenon, including cross-reactive immunity—in which prior exposure to non-SARS-CoV-2 coronaviruses that commonly infect children confers some resistance to severe COVID-19 illness. We identified 3,126,427 adults (24% [N = 743,814] with children ≤18, and 8.8% [N = 274,316] with youngest child 0–5 years) to assess whether parents of young children—who have high exposure to non-SARS-CoV-2 coronaviruses—may also benefit from potential cross-immunity. In a large, real-world population, exposure to young children was strongly associated with less severe COVID-19 illness, after balancing known COVID-19 risk factors. This epidemiologic signal suggests endemic coronavirus cross-immunity may play a role in protection against severe COVID-19 outcomes.

5 citations

Journal ArticleDOI
TL;DR: This quality improvement study investigates the association of a benzodiazepine-sparing order set at an integrated health care system with medication use and health care outcomes among patients with alcohol withdrawal syndrome.
Abstract: This quality improvement study investigates the association of a benzodiazepine-sparing order set at an integrated health care system with medication use and health care outcomes among patients with alcohol withdrawal syndrome.

5 citations

Journal ArticleDOI
TL;DR: In this article , the causal effects of ABI on 12-month drinking outcomes using longitudinal electronic health records data for 312,056 adults with a positive screening result for unhealthy drinking between 2014 and 2017 in a large healthcare system that implemented systematic primary care-based SBIRT.
Abstract: Alcohol screening, brief intervention and referral to treatment (SBIRT) in adult primary care is an evidence-based, public health strategy to address unhealthy alcohol use, but evidence of effectiveness of alcohol brief intervention (ABI) in real-world implementation is lacking.We fit marginal structural models with inverse probability weighting to estimate the causal effects of ABI on 12-month drinking outcomes using longitudinal electronic health records data for 312,056 adults with a positive screening result for unhealthy drinking between 2014 and 2017 in a large healthcare system that implemented systematic primary care-based SBIRT. We examined effects of ABI with and without adjusting for receipt of specialty alcohol use disorder (AUD) treatment, and whether effects varied by patient demographic characteristics and alcohol use patterns.Receiving ABI resulted in significantly greater reductions in heavy drinking days (mean difference [95% CI] = -0.26 [-0.45, -0.08]), drinking days per week (-0.04 [-0.07, -0.01]), drinks per drinking day (-0.05 [-0.08, -0.02]) and drinks per week (-0.16 [-0.27, -0.04]). Effects of ABI on 12-month drinking outcomes varied by baseline consumption level, age group and whether patients already had an AUD, with better improvement in those who were drinking at levels exceeding only daily limits, younger, and without an AUD.Systematic ABI in adult primary care has the potential to reduce drinking among people with unhealthy drinking considerably on both an individual and population level. More research is needed to help optimize ABI, in particular tailoring it to diverse sub-populations, and studying its long-term public health impact.

3 citations


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TL;DR: Comorbidity of alcohol dependence with other substance disorders appears due in part to unique factors underlying etiology for each pair of disorders studied while comorbidities of alcohol addiction with mood, anxiety, and personality disorders appears more attributable to factors shared among these other disorders.
Abstract: Background Current and comprehensive information on the epidemiology of DSM-IV 12-month and lifetime drug use disorders in the United States has not been available. Objectives To present detailed information on drug abuse and dependence prevalence, correlates, and comorbidity with other Axis I and II disorders. Design, Setting, and Participants Face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule of the National Institute on Alcohol Abuse and Alcoholism in a large representative sample of US adults (N = 43 093). Main Outcome Measures Twelve-month and lifetime prevalence of drug abuse and dependence and the associated correlates, treatment rates, disability, and comorbidity with other Axis I and II disorders. Results Prevalences of 12-month and lifetime drug abuse (1.4% and 7.7%, respectively) exceeded rates of drug dependence (0.6% and 2.6%, respectively). Rates of abuse and dependence were generally greater among men, Native Americans, respondents aged 18 to 44 years, those of lower socioeconomic status, those residing in the West, and those who were never married or widowed, separated, or divorced (all P Conclusions Most individuals with drug use disorders have never been treated, and treatment disparities exist among those at high risk, despite substantial disability and comorbidity. Comorbidity of drug use disorders with other substance use disorders and antisocial personality disorder, as well as dependence with mood disorders and generalized anxiety disorder, appears to be due in part to unique factors underlying each pair of these disorders studied. The persistence of low treatment rates despite the availability of effective treatments indicates the need for vigorous educational efforts for the public and professionals.

2,855 citations

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TL;DR: This essay describes how a basic scientist was thrust into the epicenter, the political cauldron of the authors' national drug control policy, and how the experience altered her professional trajectory and perspective.
Abstract: This essay describes how a basic scientist was thrust into the epicenter, the political cauldron of our national drug control policy, and how the experience altered her professional trajectory and perspective.

918 citations

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TL;DR: SBIRT was feasible to implement and the self-reported patient status at 6 months indicated significant improvements over baseline, for illicit drug use and heavy alcohol use, with functional domains improved, across a range of health care settings and a rangeof patients.

630 citations

Journal ArticleDOI
TL;DR: The exploratory results suggest that multiple episodes of care over several years are the norm and that rather than thinking of multiple episodes in terms of "cumulative dosage," it might be better thought of as further evidence of chronicity and that the authors need to develop and evaluate models of longer term recovery management.

315 citations

Journal ArticleDOI
TL;DR: There is strong evidence to support inequalities in medical care disadvantaging those who have a psychiatric illness or a substance use disorder.
Abstract: Background There has been long-standing concern about the quality of medical care offered to people with mental illness. Aims To investigate whether the quality of medical care received by people with mental health conditions, including substance misuse, differs from the care received by people who have no comparable mental disorder. Method A systematic review of studies that examined the quality of medical care in those with and without mental illness was conducted using robust critical appraisal techniques. Results Of 31 valid studies, 27 examined receipt of medical care in those with and without mental illness and 10 examined medical care in those with and without substance use disorder (or dual diagnosis). Nineteen of 27 and 10 of 10, respectively, suggested inferior quality of care in at least one domain. Twelve studies found no appreciable differences in care or failed to detect a difference in at least one key area. Several studies showed an increase in healthcare utilisation but without any increase in quality. Three studies found superior care for individuals with mental illness in specific subdomains. There was inadequate information concerning patient satisfaction and structural differences in healthcare delivery. There was also inadequate separation of delivery of care from uptake in care on which to base causal explanations. Conclusions Despite similar or more frequent medical contacts, there are often disparities in the physical healthcare delivered to those with psychiatric illness although the magnitude of this effect varies considerably.

299 citations