Personality profile and Stressful Life Events in Alcohol Relapse Patients.

INTRODUCTION: Alcohol dependence is characterised by craving, compulsion, primacy Of drinking over other activities and a state of neuronal adaptation leading to Physical and mental disturbances on withdrawal. One of the most important Problems in recovery from alcohol and substance abuse is relapse. Clinicians Must always realize and be aware that relapse is a distinct possibility which can Happen to anyone who is and has been dependent on alcohol. About 70 to 90% Of clients with alcohol dependence relapse within three months. (Mc Lellan Et al., 2000). Relapse can be better understood as resulting from an interaction of Client-,family-,social-, and treatment related factors. Researches into the causes Of relapse led to classifying relapse determinants into two broad categoriesintrapersonal And interpersonal determinants. Personality traits are an important Intrapersonal determinant of relapse (Sandahl C, 1984). PERSONALITY AND ALCOHOL RELAPSE Allport defined personality as “the dynamic organization within the Individual of those psychosocial systems that determine his unique adjustment To his environment”. Since long it has been hypothesized that personality bears a two way Relationship with relapse. This relationship has been a topic of continuing Debate and has led to varied and inconclusive results. Theories favouring the existence of a separate ‘alcoholic personality’ Have not stood the test of time. However persons with certain personality traits Are more prone for relapse. Neuroticism, novelty seeking, low ego strength and High ergic tension are the variables commonly associated with alcohol relapse When compared with abstaining individuals albeit inconsistently. Adherence to psychosocial interventions, coping skills, attitude towards Recovery and self perception of the ability to withstand stress are important Variables which depend heavily on personality traits of the individuals. Relapse prevention and its treatment form an integral part of Management of alcohol dependence as relapse is a part of the chronic course of The illness. Relapse prevention strategies incorporate various psycho social Interventions and specific coping skills training in the treatment modality. STRESSFUL LIFE EVENTS AND ALCOHOL RELAPSE Stress is considered a major contributor to the continuation of alcohol Use as well as relapse. The notion that stressful life events can cause susceptible People to relapse to alcohol use has an intuitive appeal. Many studies that have Determined an association between substance use and stress have been unable To establish a causal relationship between the two. While theoretical and Methodological ambiguities have resulted in inconsistent empirical support of The relationship between personally experienced stress and return to drinking (Allan and Cooke, 1985; Hall et al., 1990), findings indicate that personally Threatening and chronic life stressors elevate the risk for relapse (Brown et al., 1990). Studies are inconsistent regarding the ‘tension reduction hypothesis’ Which posits that people use and relapse to alcohol in order to reduce stress. However alcohol dependent individuals frequently experience stress related to Occupational, legal, social and financial problems and negative events in their Life predicted relapse to alcohol use more than positive life events. Hence the Study of interactions between stressful life events and alcohol relapse has Widespread implications for both assessment and treatment of the patients

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