Exploring the functions of chemical substances in individuals' sexual behaviour

Chemical substance abuse and dependence constitute an increasing international and national phenomenon. Individuals, groups and communities are at risk of the mental, biological, legal and environmental implications associated with substance dependence. Human sexual behaviour is no new phenomenon to be studied. Human beings experience sexual behaviour and gratification as important. Sexual behaviour is not vital for the survival of the individual but vital for survival of the species. Sexual behaviour in combination with chemical substance abuse might pose further dangers to a person or group. Sexual behaviour where persons engage in sexual actions when using or abusing chemical substances could construct certain positive functions for persons. Qualitative researchers are interested in discovering the meaning persons attach to experiences. In understanding the dynamics of the phenomenon, possible contributions to the human sciences could be made. Chemical substance abuse and dependency affect the individual, his/her family systems and the community. Depressants and stimulants change the chemical functioning of the human brain and the mental health of the user. Despite the harm caused to the dependent person, abuse of the chemical substance is continued. The substance has various functions that the biological and psychological person becomes dependent on. Sexual behaviour is inherent in human nature, but not chemical substance abuse. It is expected by the researcher that there might be certain function(s) served by chemical substances in the sexual behaviour of persons. A literature study on the topic on the function of chemical substances in the sexual behaviour of persons yielded unsatisfactory results. Little research was found with regard to the function of chemical substances in relation to people’s sexual behaviour. In response to this need the researcher embarked on a qualitative research journey to explore the function of the chemical substances within the context of an individual’s sexual behaviour and practices. Chemical substances have different functions and affect the sexual behaviour, functioning and experiences of the users of such substances. Six objectives were set with the aim of developing an in-depth understanding of the function of chemical substances in sexual behaviour. The research question of this investigation leads to a clear inquiry into the phenomenon that was examined and analysed and yielded useful new information. This qualitative research project is characterised by its inductive features, openness to change and interest in human behaviour. The study is characterised by an interpretive nature as an interpretative investigation. An effort was made towards understanding the phenomenon through observation and exploration. Persons were invited to participate in the research and reported themselves to the researcher, the process of self-selection sampling was utilised. In drawing a sample from the population of patients at a treatment centre an interactive approach to the process was followed by conducting semi-structured and in-depth interviews as a method of data collection. Data analysis and processing was executed according to the eight steps for qualitative data analysis as proposed by Tesch (in Creswell, 2009). Data verification for the assessment of the trustworthiness of the research findings was achieved by utilizing Guba’s model as espoused in Krefting (1991). Informed consent, confidentiality and management of information were some of the ethical considerations adhered to in the planning and execution of this research project. The nature of this study is marked by the person-centred approach in combination with the qualitative methodology and philosophy. The researcher found the two to be appropriate when a sensitive and private topic was to be explored. Participants were able to evaluate the meanings that were attached to their experiences within a psychologically sound environment. Themes became evident through the data analysis process. These themes were contrasted against a body of existing theory. The wholeness of human beings came to the fore and literature from a bio-neurological and humanistic perspective was found to be applicable. The social sciences and, in particular, social workers are concerned with the wellbeing of persons, their relevant systems and context. These dimensions of human beings were addressed by this study and aimed to contribute to further development in the science of psychotherapy and the understanding of the person within the phenomenon being studied. Therapists should be willing and demonstrate a sensitive ability to understand the client’s experiences from the person’s own point of view (Rogers, 1950: 444). In a relationship that is constructed for the purpose the aim should be mainly to understand the whole person (Rogers, 1952: 343). Therapists should develop an ability to see completely through the client’s eyes and adopt the person’s frame of reference. This is the basis for implementing “client-centred” therapy (Rogers 1950: 444). A key role of social work practice is facilitating the empowerment of persons, and their personal and interpersonal strengths according to their own self-determination (Zastrow, 2012:39); the researcher recommends a holistic full understanding of the person in his/her wholeness (Rogers, 1987: 486).Department of Social WorkM.A. (Social Work

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research