Peripherality as key to understanding opportunities and needs for effective and sustainable climate - change adaptation: a case study from Viti Levu Island, Fiji

A study of various defining aspects of 11 rural communities along the cross-island road on Viti Levu (Fiji) shows diversity attributable largely to their peripherality, proxied by distance along this 200-km long road. Strong relationships are found between peripherality and both community size and the dependency ratio (percent of young/old dependents), as well as traditional medicine usage (and percent traditional healers), and autonomous community coping after disasters. Two measures are calculated to capture community autonomy, both of which proxy peripherality. Results show the usefulness of peripherality as a way of measuring community diversity in developing-country contexts. Peripherality also correlates with community autonomy, more-peripheral communities having greater autonomous coping abilities/capacity than near-core (less-peripheral) communities. Results also show the unhelpfulness of the default ‘“one-size-fits-all’” approach to communities implicit in many external assistance programs. Yet while traditional coping in such communities may not be able to fully overcome future climate-change challenges, the conservation of the traditional knowledge underpinning this should be encouraged, mainly because of the likelihood that external funding for future adaptation in such communities will be inadequate. The best hope for effective and sustainable adaptation to future climate change, focused on sustaining livelihoods, lies in strengthening autonomous community coping

Home lands: island and archipelagic states’ policymaking for human mobility in the context of climate change

Climate change related migration and displacement are already a reality for many people around the world. A growing body of research suggests that the number of people affected will rise over the coming decades, which will create additional risks for the achievement of the Sustainable Development Goals. This trend and the related issues are an increasing topic of discussion at international policy fora. The Task Force on Displacement under the United Nations Framework Convention on Climate Change (UNFCCC) and the Platform on Disaster Displacement (PDD) are addressing these policy challenges. The Global Compact for Safe, Orderly and Regular Migration (GCM) is calling for the development of “coherent approaches to address the challenges of migration movements in the context of sudden-onset and slow-onset natural disasters”. This report reflects what is currently known about the impacts of climate change on people living in island nations and highlights the necessity to develop policies that address human mobility dynamics resulting from adaptation to these changes. By looking at island and archipelagic states as diverse as Kiribati, Saint Lucia and the Philippines, the various political frameworks within which they operate and the different response mechanisms they have adopted can be examined. First-hand interviews with experts from across the regions show the multiplicity of challenges governments are facing: from difficulties in distribution of relief goods to land scarcity, aid dependency, insufficient data and personnel capacities. Yet the key interviewees underline ways in which governments can capitalise on the strengths inherent to island and coastal communities to further build resilience using existing and innovative practices

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