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

Post-traumatic stress and psychiatric disorders in Palestinian adolescents following intifada-related injuries

This study was designed to assess the occurrence of post-traumatic stress disorder (PTSD) and psychiatric disorders (i.e., anxiety and depression) in Palestinian adolescents following intifada-related injuries. It was hypothesized that a combination of pre-trauma variables (e.g., age, geographic location), trauma-specific variables such as trauma recency, type of trauma (deliberately violent vs. accidental), and post-trauma variables (e.g., social support, coping strategies, belief in fate) would be predictive of these psychological sequelae. The participants were 179 boys who were injured during Al-Aqsa intifada and as a result sustained a permanent physical disability. They ranged in age from 12 to 18 years (M = 16.30, SD = 1.64). Questionnaires were administered in an interview format with adolescents at home. Approximately 76.5% of the injured victims qualify as having PTSD and that the disorder had a heterogeneous course, with excess risk for chronic symptoms and comorbidity with other psychiatric disorders such as anxiety and depression. Among all the predictors in the PTSD, anxiety and depression models, only geographical location, fatalism, and negative coping were significant predictors. In conclusion, post-traumatic reactions and psychiatric disorders in adolescents involved in armed conflict injuries can persist for several months. Given the apparent significant relationship between psychological sequelae of intifada-related injuries and certain predictors (i.e., negative coping style and fatalism), treatments such as trauma-focused cognitive behaviour therapy may yield positive results. Negative coping and fatalism should be addressed more directly during therapy.Post-traumatic stress disorder (PTSD) Psychiatric disorders Adolescents Parental support Coping strategies Fatalism Occupied Palestinian territory Armed conflict

Psychological distress among parents of children with mental retardation in the United Arab Emirates

This study was designed to identify predictors of parental stress and psychological distress among parents of children with mental retardation in the United Arab Emirates. It examined the relative contributions of child characteristics, parents' sociodemographics, and family environment to parental stress and psychological distress. Participants were parents of 225 mentally retarded children, of whom 113 were fathers and 112 were mothers. Measures of parental stress (QRS-F), psychiatric symptom index (PSI) and family environment scale (FES) were administered in an interview format. Hierarchical multiple regression was used to predict parental stress and psychological distress. The results indicate that the model containing all three predictor blocks, child characteristics, parents' sociodemographics, and family environment, accounted for 36.3% and 22.5% of parental stress and parents' psychiatric symptomatology variance, respectively. The age of the child was significantly associated with parents' feelings of distress and psychiatric symptom status, and parental stress was less when the child was older. Parents reported more psychiatric symptomatology when the child showed a high level of dysfunction. Fathers' work appeared to be a significant predictor of parental stress, indicating that for fathers who were not working the level of stress was higher than fathers who were working. Lower socioeconomic level was associated with greater symptom rates of cognitive disturbance, depression, anxiety, and despair among parents. Among the family environment variables, only the personal growth dimension stood out as a predictor of parental stress. An orientation toward recreational and religious pursuits, high independence, and intellectual and recreational orientations were associated with lower levels of parental stress. On the other hand, parents in achievement-oriented families showed elevated levels of parental stress. Implications for prevention, and intervention as well as parent training and system-oriented counseling programs are discussed.United Arab Emirates Children Mental retardation Parental stress Psychiatric symptomatology Family environment

Psychological distress and well-being among traumatized Palestinian women during the intifada

Little is known about the ways in which Palestinian women who were subjected to political violence during the intifada coped with stress. This study investigated the extent to which differences in the presence of trauma, political and normative stressors, family resources, family coping, and family hardiness could account for variation in women psychological distress and well-being. Results indicated that normative stressors were more predictive of psychological distress and well-being than was the presence of trauma or political stressors. However, political stressors and normative stressors had albeit different effects on the mental health status of both traumatized and non-traumatized women. While the social-psychological resources of women were found to be negatively related to psychological distress and well-being, the sociodemographic resources had different patterns of relations. Also, family hardiness was evidenced to have an influence on perceived psychological distress among traumatized and non-traumatized women, whereas effective coping and supportive resources may directly affect functioning among traumatized women only. The clinical and policy implications of these conclusions were discussed.Palestinian women stress trauma intifada psychiatric symptomatology

Parental attitudes toward the special education placement of their mentally handicapped children

The purpose of this study was to determine the knowledge level and degree of satisfaction of parents whose mentally handicapped child was receiving special education and/or related services provided by public school systems.One-hundred and thirty parents responded to three instruments constructed for this study.Findings MANOVA results revealed significant differences among the three parental groups (parents of mild, moderate, and severe/profound children) on the attitude measure toward the special education placement of their children. Post hoc tests and mean comparison data indicated that parents of mildly mentally handicapped children were more satisfied with the special education services than were the two other comparison groups.Data analysis using ANOVA indicated that sex of parents and level of retardation of the child had no significant main effect on the knowledge level of services mandated by Public Law 94-142.Pearson correlation coefficient results suggested that the special education program variables indicated higher positive linear correlation with the degree of parental satisfaction with the special education placement of their mentally handicapped children, than did the demographic variables.Conclusions and Recommendations Parents in this study lacked knowledge of their legal rights pertaining to special education programming and related services. Future research should be directed to understand the interactions among factors that might affect parents' knowledge of PL 94-142.Workshops and inservice programs should be organized and on-going to inform parents of their rights and responsibilities under state and federal special education laws, as well as implementing ways for increasing their involvement in supporting their child's education in the least restrictive educational setting.Inservice workshops should be carried out for regular teachers to ensure that those involved with the education of exceptional children possess competencies necessary to perform their jobs adequately. An array of service alternatives and placement options is necessary to meet the varied needs of all young mentally handicapped children.Future research on parental attitudes toward the special education placement of their mentally handicapped children should take into consideration cause-effect relationships, as well as the interrelatedness of child, parent, and program variables.Thesis (D. Ed.)Department of Special Educatio

The impact of structured activities among Palestinian children in a time of conflict

Background:  There is growing evidence of the impact on children's well‐being of exposure to political conflict in such settings as the Palestinian territories. This study examined the impact of child‐focused interventions involving structured activities, supported by provision of equipment and training of facilitators. The focus of interventions was participation in recreational, cultural and other non‐formal activities supporting the development of resilience. Impacts were hypothesised on children's social and emotional well‐being, relationships with parents and degree of future orientation. Methods:  Two hundred and fifty children from the West Bank and 150 children from Gaza took part in the study. Of these 400 children, 300 comprised the intervention group. Fifty children from Gaza and 50 children from the West Bank comprised the comparison group. There were equal numbers of girls and boys in all groups, with