Responding to COVID-19 : emerging practices in addiction medicine in 17 countries

Following the classification of the Coronavirus disease (COVID-19) as a pandemic by the World Health Organization (WHO), countries were encouraged to implement urgent and aggressive actions to change the course of the disease spread while also protecting the physical and mental health and well-being of all people. The challenges and solutions of providing prevention, treatment, and care for those affected with issues related to substance use and addictive behaviors are still being discussed by the global community. Several international documents have been developed for service providers and public health professionals working in the field of addiction medicine in the context of the pandemic (1–3), however, less is known about country-level responses. In the current paper we, as individual members of the Network of Early Career Professionals working in Addiction Medicine (NECPAM), discuss emerging country-level guidelines developed in the 6 months following the outbreak.The South African Medical Research Councilhttp://www.frontiersin.org/Psychiatryam2022Family Medicin

Tissue fusion for bowel anastomosis

Anastomosis is the critical step in restoring gastrointestinal continuity following bowel resection and has traditionally been accomplished using suture and stapling techniques. However, both technologies can be associated with complications and are particularly difficult to perform in the laparoscopic environment. As a result there has been an increasing interest in developing novel tools and techniques which would permit safe and reliable intestinal anastomoses to be performed whilst minimising potential complications. In recent years, advanced bipolar radiofrequency (RF) energy powered devices, developed to enable more consistent vascular haemostasis, have been proposed as an alternative method for anastomotic construction and is the basis for the research presented. This thesis investigates: (i) the parameters required to form bowel seals with sufficient mechanical strength to withstand physiological pressures; (ii) methods for monitoring the viability of seals and (iii) the ability to construct functional radiofrequency induced small bowel anastomoses. The role of varying electrical parameters and compressive pressures has been investigated and characterised both in vitro and in vivo. Mucosa-to-mucosa and serosa-to-serosa small bowel seals were formed using both commercial and prototype applicator devices powered by a research based electrical generator and bespoke programmable algorithms. The mechanical strength of bowel seals was assessed through ex vivo burst pressure measurements. This demonstrated seals to be capable of withstanding physiological luminal pressures (>25mmHg) before rupturing. Tissue effects of fusion have been examined microscopically through histological assessment. The viability of fused tissue in vivo was determined utilising a multispectral imaging (MSI) system, which measured tissue oxygenation in the peri-fusion areas and allowed for the calculation of relative concentrations of oxy- and deoxyhaemoglobin and hence, overall bowel oxygen saturation (SaO2). The results of these monitoring tools have suggested that the tissue remains viable in the short term using a specific combination of electrical and mechanical parameters. These ex vivo and acute in vivo findings were applied to construct a series of chronic porcine anastomoses, where animals were recovered for a median of seven days, to compare the macro- and microscopic effects of the novel and gold standard techniques. Fifteen small bowel anastomoses were formed using a commercial and prototype radiofrequency sealer in individual animals. In addition five hand-sewn end-to-end and five stapled side-to-side anastomoses were also constructed in individual animals. Three animals in the radiofrequency anastomosis group were terminated early due to clinical evidence of anastomotic leak. Microscopically, the fused bowel showed evidence of healing at the mucosal and sub-mucosal collagen levels, which was comparable to findings using the gold standard methods. The studies performed demonstrate a method for the formation and assessment of radiofrequency induced bowel fusion and confirm its potential to be ultimately used for both bowel resection and anastomosis.Open Acces

Multivariate decomposition analysis of sex differences in functional difficulty among older adults based on Longitudinal Ageing Study in India, 2017–2018

ObjectivesThis study investigates the gender disparities in difficulty in activities of daily living (ADL) and instrumental activities of daily living (IADL) and explores its contributing factors among older adults in India.DesignA cross-sectional study was conducted using country representative survey data.Setting and participantsThe present study uses the data from the Longitudinal Ageing Study in India, 2017–2018. Participants included 15 098 male and 16 366 female older adults aged 60 years and above in India.Primary and secondary outcome measuresDifficulty in ADL and IADL were the outcome variables. Descriptive statistics and bivariate analysis were carried out to present the preliminary results. Multivariate decomposition analysis was used to identify the contributions of covariates that explain the group differences to average predictions.ResultsThere was a significant gender differential in difficulty in ADL (difference: 4.6%; p value&lt;0.001) and IADL (difference: 17.3%; p value&lt;0.001). The multivariate analysis also shows significant gender inequality in difficulty in ADL (coefficient: 0.046; p value&lt;0.001) and IADL (coefficient: 0.051; p value&lt;0.001). The majority of the gender gap in difficulty in ADL was accounted by the male–female difference in levels of work status (18%), formal education (15% contribution), marital status (13%), physical activity (9%), health status (8%) and chronic morbidity prevalence (5%), respectively. Equivalently, the major contributors to the gender gap in difficulty in IADL were the level of formal education (28% contribution), marital status (10%), alcohol consumption (9%), health status (4% contribution) and chronic morbidity prevalence (2% contribution).ConclusionDue to the rapidly increasing ageing population, early detection and prevention of disability or preservation of daily functioning for older adults and women in particular should be the highest priority for physicians and health decision-makers.</jats:sec