Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Body image, obesity, and sexual coercion: Impacts on depression among students at a Nigerian university.

IntroductionUniversity students face a variety of challenges, including mental health issues, which are often compounded by societal and individual factors such as body image concerns, obesity, and experiences of intimate partner violence. These factors may adversely affect their mental health and academic performance. Yet, limited research exists on studies evaluating the impact of these factors on depression in Nigerian institutions of higher learning. This study aims to address this gap by examining the impact of these factors on self-reported depression with a focus on the moderating role of sex.ObjectiveTo assess the associations between body image concerns, obesity, intimate partner violence, and sexual coercion with depression among university students in Nigeria and to explore how these relationships vary by sex.MethodologyThis cross-sectional study was conducted over a one-month period among university students in Nigeria. Data was collected through structured, self-administered questionnaires. The primary outcome variables were self-reported depression. Explanatory variables included body image concerns, BMI categories (obese vs. normal BMI), intimate partner violence, and sexual coercion. Sex was examined as a moderator. Inverse probability weighting was used to account for confounding variables, including age, sex, year in school, parental education, household income, smoking and alcohol consumption, and other comorbidities. Multivariable regression analyses were performed to evaluate the relationships between explanatory variables and outcomes, adjusting for potential confounders.ResultsThe study included 501 participants, with 64.5% females and 35.6% males. Most respondents (83.4%) were aged 18-20 years. Obesity was observed in 18.6% of participants, higher in females (20.7%) than males (14.6%). Sexual coercion was reported by 10.8% (males: 5.6%; females: 13.6%), while 3.4% experienced intimate partner violence (IPV), with similar rates in both genders. Depression was reported by 33.5% of participants, more common in females (35.3%) than males (30.3%). Body image concerns increased the risk of depression by 35.3% (95% CI: 13.0%-57.7%, p = 0.002), particularly in males (26.3%, 95% CI: 16.4%-69.1%, p = 0.227). Obesity was linked to significantly higher depression rates in males (25.9%, 95% CI: 1.9%-50.0%, p = 0.035) but not in females. Sexual coercion strongly correlated with higher depression rates in both genders (males: 43.0%, 95% CI: 23.5%-62.6%, p ConclusionThis study highlights the complex interplay between psychosocial factors and their impact on mental health outcomes among university students in Nigeria. Addressing these factors, particularly through gender-sensitive interventions, is crucial for improving student mental health.Policy implicationsThe findings call for the integration of mental health and psychosocial support services in university settings, including counseling and educational programs on body image and intimate partner violence. Policymakers and university administrators should prioritize gender-sensitive approaches to address the unique challenges faced by male and female students. Additionally, strategies to promote healthy lifestyle behaviors and prevent obesity among students should be implemented to enhance their mental health and academic performance