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

Socio-ecological factors of girl child marriage: a meta-synthesis of qualitative research

Abstract Background Child marriage of girls is one example of human rights violations, and is increasingly recognized as a key obstacle to global public health. Given the importance of a comprehensive understanding of the motivations for child marriage, this study aimed to identify socio-ecological factors contributing to gills child marriage. Methods A comprehensive search was conducted of all English-language studies measuring causes of child marriage between 2000 and October 2022 in the Web of Science, PubMed, Scopus, PsycInfo, ProQuest, Poplin and Google Scholar databases. Girl child marriage is defined as a marriage under the age of 18. In this study, the CASP evaluation checklist was used to collect data. Two independent reviewers reviewed all articles. Results A total of 34 eligible qualitative articles were included. The most salient causes of child marriage among girls include low skills and knowledge, internal and external beliefs and motivations, and physical advantages at the individual level. Family characteristics and structure contribute to child marriage at the interpersonal level, while environmental and economic factors play a role at the community level. Social factors and cultural norms, as well as the shortcomings and weaknesses of legislation, are also contributing factors at the society level. Conclusion The results showed that cultural beliefs supporting gender inequality and economic status were the most important causes of child marriage. These results can help policymakers and decision-makers implement strategies to reduce gender inequality to prevent child marriage

A Study Identifying Causes of Construction Waste Production and Applying Safety Management on Construction Site

Background and purpose: In a recent century, the amount of construction waste has increased significantly. Although the building industry has a considerable role in the development of a society, it is regarded as an environmentally destructive. Source reduction is the highest goal in the waste management hierarchy and is in priority. It also has economic benefits by reducing costs associated with transportation, disposal or recycling of wastes. The present study is aimed to identify activities generating the wastes in design, transportation and storage and procurement of building materials. Materials and Methods: This was questionnaire survey. A total of 94 professionals in the construction industry were attended in this study. To determine the validity and reliability of the instrument, content validity method and Cronbach’s alpha coefficient (0.79) were used. Data were analyzed using SPSS for Windows. Frequencies, percentage, mean and standard deviation were determined in this research. Results: The results showed that handling and storage have been chosen as the most causative factor of waste production in construction activity. Improper material storage was identified major factor in producing waste in handling and storage phase. Usage of low-quality material in design stage and material price changes in procurement were recognized as major causes of waste production in these stages. Conclusion: All studied phases in this research were identified as causative factors in producing of waste. Identifying causes of construction waste production will help us decide better how to control this sort of wastes

Proposing Alternative Solutions to Enhance Natural Ventilation Rates in Residential Buildings in the Cfa Climate Zone of Rasht

Today, renewable resources and the crucial role of passive strategies in energy efficiency in the building sector toward the sustainable development goals are more indispensable than ever. Natural ventilation has traditionally been considered as one of the most fundamental techniques to decrease energy usage by building dwellers and designers. The main purpose of the present study is to enhance the natural ventilation rates in an existing six-story residential building situated in the humid climate of Rasht during the summertime. On this basis, two types of ventilation systems, the Double-Skin Facade Twin Face System (DSF-TFS) and Single-Sided Wind Tower (SSWT), were simulated through DesignBuilder version 4.5. Then, two types of additional ventilation systems were proposed in order to accelerate the airflow, including four-sided as well as multi-opening wind towers. The wind foldable directions were at about 45 degrees (northwest to southeast). The simulation results show that SSWT could have a better performance than the aforementioned systems by about 38%. Therefore, the multi-opening system was able to enhance the ventilation rate by approximately 10% during the summertime

Proposing Alternative Solutions to Enhance Natural Ventilation Rates in Residential Buildings in the Cfa Climate Zone of Rasht

Today, renewable resources and the crucial role of passive strategies in energy efficiency in the building sector toward the sustainable development goals are more indispensable than ever. Natural ventilation has traditionally been considered as one of the most fundamental techniques to decrease energy usage by building dwellers and designers. The main purpose of the present study is to enhance the natural ventilation rates in an existing six-story residential building situated in the humid climate of Rasht during the summertime. On this basis, two types of ventilation systems, the Double-Skin Facade Twin Face System (DSF-TFS) and Single-Sided Wind Tower (SSWT), were simulated through DesignBuilder version 4.5. Then, two types of additional ventilation systems were proposed in order to accelerate the airflow, including four-sided as well as multi-opening wind towers. The wind foldable directions were at about 45 degrees (northwest to southeast). The simulation results show that SSWT could have a better performance than the aforementioned systems by about 38%. Therefore, the multi-opening system was able to enhance the ventilation rate by approximately 10% during the summertime

The effect of cinnamon supplementation on lipid profiles in patients with type 2 diabetes:A systematic review and meta-analysis of clinical trials

Objective: The present systematic review and meta-analysis was performed to evaluate the effect of cinnamon supplementation on blood lipid profiles in patients with type 2 diabetes. Methods: A systematic search (with no language restrictions) was performed in PubMed, Embase, Scopus, Web of Science, and Cochrane Library to identify relevant clinical trials up to 8th March 2020. Weighted mean differences (WMDs) and 95 % confidence intervals (CI) were pooled based on the random-effects model. Heterogeneity, publication bias, and sensitivity analyses were performed based on standard methods. Results: Sixteen studies, involving 1025 participants, were included in the meta-analysis. This study found a significant decrease in triglycerides (TG) (WMD: -26.27 mg/dl, 95 % CI: [-38.93, -13.61], P < 0.001), total cholesterol (TC) (WMD: -13.93 mg/dl, 95 % CI: [-25.64, -2.22], P = 0.020), and low-density lipoprotein cholesterol (LDL-C) levels (WMD: -6.13 mg/dl, 95 % CI: [-10.72, -1.53], P = 0.009), while no change was observed on high-density lipoprotein cholesterol (HDL) concentration (WMD: 0.64 mg/dl, 95 % CI: [-0.18, 1.46], P = 0.128), in patients with type 2 diabetes. The reduction in TG, TC, and LDL-C was greater in; Eastern compared to Western countries, and studies with a duration of < 2 compared to ≥ 2 months. The increase in HDL was greater in; participants with a BMI ≥ 30 compared to <30, Western compared to Eastern countries, and intervention durations of ≥ 2 compared to < 2 months. Conclusions: Cinnamon supplementation significantly decreased serum TG, TC, and LDL-C concentrations, but did not change HDL-C levels, in patients with type 2 diabetes

Additional file 1 of Socio-ecological factors of girl child marriage: a meta-synthesis of qualitative research

Additional file 1: Table S1. Enhancing transparency in reporting the synthesis of qualitative research: the ENTREQ statement. Table S2. Inclusion and exclusion criteria. Table S3. CASP critical appraisal checklist for analytical qualitative studies. Table S4. CASP critical appraisal checklist for analytical qualitative studies

A Study Identifying Causes of Construction Waste Production and Applying Safety Management on Construction Site A Study Identifying Causes of Construction Waste Production and Applying Safety Management on Construction Site

Abstract Background and purpose: In a recent century, the amount of construction waste has increased significantly. Although the building industry has a considerable role in the development of a society, it is regarded as an environmentally destructive. Source reduction is the highest goal in the waste management hierarchy and is in priority. It also has economic benefits by reducing costs associated with transportation, disposal or recycling of wastes. The present study is aimed to identify activities generating the wastes in design, transportation and storage and procurement of building materials. Materials and Methods: This was questionnaire survey. A total of 94 professionals in the construction industry were attended in this study. To determine the validity and reliability of the instrument, content validity method and Cronbach&apos;s alpha coefficient (0.79) were used. Data were analyzed using SPSS for Windows. Frequencies, percentage, mean and standard deviation were determined in this research. Results: The results showed that handling and storage have been chosen as the most causative factor of waste production in construction activity. Improper material storage was identified major factor in producing waste in handling and storage phase. Usage of low-quality material in design stage and material price changes in procurement were recognized as major causes of waste production in these stages. Conclusion: All studied phases in this research were identified as causative factors in producing of waste. Identifying causes of construction waste production will help us decide better how to control this sort of wastes