A Study on Internet and Gaming Addiction, Hikikomori Trait and Insomnia Status among Medical Undergraduates at one of Cities of Western India

Background: College students appear more vulnerable in developing a dependence on the internet. Individuals with hikikomori are frequently reported to have social contact predominantly via the internet. Objectives: To find the prevalence of Internet addiction, gaming Addiction, Hikikomori Trait and Insomnia amongst medical undergraduates and to study their association with various determinants. Methodology: The present Cross-Sectional study was conducted among first to final-year medical students studying at various medical colleges in Indian City from February to May 2021. Data collection was done after obtaining the ethical permission of the Institute. A total of 400 students who gave consent were sent an electronic questionnaire. Results: The mean age of study participants was 20 ± 1.58 years. Internet addiction was present in 189(47.2%) participants, gaming addiction in 128 (32%) students and Hikikomori Trait was found in 98(24.5%) students. There was a statistically significant association between different grades of insomnia and internet, gaming addiction, and hikikomori trait (<?0.0001) in the present study. Conclusion: Internet addiction was present in almost half of the medical students while gaming addiction was seen in nearly one third of the students. Male gender and hostel stay had a statistically significant association with internet addiction, gaming addiction, insomnia and hikikomori trait

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