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

Salon Safety: Community-Engaged Approaches to Workplace Safety Interventions

In California, the salon industry represents a significant small-business sector. Working inthese salons are cosmetologists who are exposed to a wide array of occupational hazards atwork. Toxic chemicals, musculoskeletal disorders, and psychological demands in the workplace are just a few of the hazards experienced by beauty care workers. The beauty products marketed to and used by Black women have been found to contain potentially harmful ingredients.Black hair-salon workers face serious health hazards from these products they useon clients and other health hazards at their work. Knowledge on this issue, as it relates toBlack hair care professionals and potential intervention methods, is extremely limited. This dissertation includes three studies that sought to understand the occupational health statusof Black salon workers in the Los Angeles region, identify workplace intervention strategiestailored to small businesses and pilot a community-engaged intervention program aimed atreducing workplace injuries and illnesses in the salon.Based on the first study, a lack of proper health and safety training and personal protectiveequipment use within the salon worker community was found. Additionally, it wasfound that there was a willingness by stylists to learn more about workplace hazards andhow to mitigate their risks. The conclusion of this study demonstrated a need for additionalcommunity-based studies with Black salon workers on workplace health intervention methods.In the second study, it was found that the process of developing and facilitating an intervention program for small businesses required an understanding of the community beingserved, developing a relationship with the community, building partnerships, and addressingbarriers to information. From this second study the use of community partnerships andintermediates in the promotion of safety and environmental practices was highlighted asinstrumental for success.In the third study, it was found that a community-engaged approach in the developmentof a personal protective equipment use intervention program led to favorable results includingan increase of salon safety knowledge and personal protective equipment use among BlackCosmetologists.Taken together, these research studies provide clear insights into comprehensive approachesfor targeted occupational safety intervention programs aimed at underserved workergroups

Salon Safety: Community-Engaged Approaches to Workplace Safety Interventions

In California, the salon industry represents a significant small-business sector. Working inthese salons are cosmetologists who are exposed to a wide array of occupational hazards atwork. Toxic chemicals, musculoskeletal disorders, and psychological demands in the workplace are just a few of the hazards experienced by beauty care workers. The beauty products marketed to and used by Black women have been found to contain potentially harmful ingredients.Black hair-salon workers face serious health hazards from these products they useon clients and other health hazards at their work. Knowledge on this issue, as it relates toBlack hair care professionals and potential intervention methods, is extremely limited. This dissertation includes three studies that sought to understand the occupational health statusof Black salon workers in the Los Angeles region, identify workplace intervention strategiestailored to small businesses and pilot a community-engaged intervention program aimed atreducing workplace injuries and illnesses in the salon.Based on the first study, a lack of proper health and safety training and personal protectiveequipment use within the salon worker community was found. Additionally, it wasfound that there was a willingness by stylists to learn more about workplace hazards andhow to mitigate their risks. The conclusion of this study demonstrated a need for additionalcommunity-based studies with Black salon workers on workplace health intervention methods.In the second study, it was found that the process of developing and facilitating an intervention program for small businesses required an understanding of the community beingserved, developing a relationship with the community, building partnerships, and addressingbarriers to information. From this second study the use of community partnerships andintermediates in the promotion of safety and environmental practices was highlighted asinstrumental for success.In the third study, it was found that a community-engaged approach in the developmentof a personal protective equipment use intervention program led to favorable results includingan increase of salon safety knowledge and personal protective equipment use among BlackCosmetologists.Taken together, these research studies provide clear insights into comprehensive approachesfor targeted occupational safety intervention programs aimed at underserved workergroups

X-chromosome inactivation and epigenetic fluidity in human embryonic stem cells

With the potential to give rise to all somatic cell types, human embryonic stem cells (hESC) have generated enormous interest as agents of cell replacement therapy. One potential limitation is their safety in vivo. Although several studies have focused on concerns over genomic stability ex vivo, few have analyzed epigenetic stability. Here, we use tools of the epigenetic phenomenon, X-chromosome inactivation (XCI), to investigate their epigenetic properties. Among 11 distinct hESC lines, we find a high degree of variability. We show that, like mouse ESC, hESC in principle have the capacity to recapitulate XCI when induced to differentiate in culture (class I lines). However, this capacity is seen in few hESC isolates. Many hESC lines have already undergone XCI (class II and III). Unexpectedly, there is a tendency to lose XIST RNA expression during culture (class III). Despite losing H3-K27 trimethylation, the inactive X of class III lines remains transcriptionally suppressed, as indicated by Cot-1 RNA exclusion. We conclude that hESC lines are subject to dynamic epigenetic reprogramming ex vivo. Given that XCI and cell differentiation are tightly linked, we consider implications for hESC pluripotency and differentiation potential