Reimagining global health Farmer, Paul; Kleinman, Arthur; Kim, Jim ...
2013., 20130918, 2013, 2013-09-07, Letnik:
26
eBook
Bringing together the experience, perspective and expertise of Paul Farmer, Jim Yong Kim, and Arthur Kleinman, Reimagining Global Health provides an original, compelling introduction to the field of ...global health. Drawn from a Harvard course developed by their student Matthew Basilico, this work provides an accessible and engaging framework for the study of global health. Insisting on an approach that is historically deep and geographically broad, the authors underline the importance of a transdisciplinary approach, and offer a highly readable distillation of several historical and ethnographic perspectives of contemporary global health problems. The case studies presented throughout Reimagining Global Health bring together ethnographic, theoretical, and historical perspectives into a wholly new and exciting investigation of global health. The interdisciplinary approach outlined in this text should prove useful not only in schools of public health, nursing, and medicine, but also in undergraduate and graduate classes in anthropology, sociology, political economy, and history, among others.
To investigate the effects of discharge opioid supply after surgery for musculoskeletal injury on subsequent opioid use.
Instrumental variables analysis of retrospective administrative data.
Data ...were acquired on 1039 patients treated operatively for a musculoskeletal injury between 2011 and 2015 at 2 level I trauma centers. State registry data were used to track all postoperative opioid prescription fills. Discharge surgical resident was identified for each patient. We categorized residents in the top one-third of opioid prescribing as high-supply residents and others as low-supply residents, with adjustment for service attending physician and month. The primary outcome was subsequent opioid use, defined as new opioid prescriptions and cumulative prescribed opioid supply 7 to 8 months after injury.
On average, patients of high-supply residents received an additional 96 morphine milligram equivalents (MME) at discharge (95% CI, 29-163 MME; P < .01), or 16% more, compared with patients of low-supply residents, which is equivalent to an additional 2-day supply at a typical dosage. In the seventh or eighth month after surgery, patients of high-supply residents received a greater total MME volume than patients of low-supply residents (difference, 13.0 MME; 95% CI, 3.1-22.9 MME; P < .01) despite receiving a greater cumulative supply of opioid medications through the sixth month after surgery.
After surgery for musculoskeletal injury, patients discharged by residents who prescribe greater supplies of opioid pain medications received higher supplies of opioids 7 to 8 months after surgery than patients discharged by residents who tend to prescribe less. Thus, limiting postoperative supplies of opioid pain medication may help reduce chronic opioid use.
Our patient looked bad, and his labs looked worse. We’d never seen such a high lactate level. What was going on? The diagnosis would soon emerge, along with a lesson: the different perspectives and ...types of expertise within our team were crucial to solving the case.
We study the mental health of graduate students at eight top-ranked economics PhD programs in the United States using clinically validated surveys. We find that 24.8 percent experience moderate or ...severe symptoms of depression or anxiety—more than two times the population average. Though our response rate was 45.1 percent and sample selection concerns exist, conservative lower bounds nonetheless suggest higher prevalence rates of such symptoms than in the general population. Mental health issues are especially prevalent at the end of the PhD program: 36.7 percent of students in years 6+ of their program experience moderate or severe symptoms of depression or anxiety, versus 21.2 percent of first-year students. Of economics students with these symptoms, 25.2 percent are in treatment, compared to 41.4 percent of graduate students in other programs. A similar percentage of economics students (40–50 percent) say they cannot honestly discuss mental health with advisers as say they cannot easily discuss nonacademic career options with them. Only 26 percent find their work to be useful always or most of the time, compared to 70 percent of economics faculty and 63 percent of the working age population. We provide recommendations for students, faculty, and administrators on ways to improve graduate student mental health. (JEL A23, I12, I18, I23)
Reimagining Global Health Paul Farmer, Arthur Kleinman, Jim Kim, Matthew Basilico / Paul Farmer, Arthur Kleinman, Jim Kim, Matthew Basilico
2013
eBook
Bringing together the experience, perspective and expertise of Paul Farmer, Jim Yong Kim, and Arthur Kleinman, Reimagining Global Health provides an original, compelling introduction to the field of ...global health. Drawn from a Harvard course developed by their student Matthew Basilico, this work provides an accessible and engaging framework for the study of global health. Insisting on an approach that is historically deep and geographically broad, the authors underline the importance of a transdisciplinary approach, and offer a highly readable distillation of several historical and ethnographic perspectives of contemporary global health problems. The case studies presented throughout Reimagining Global Health bring together ethnographic, theoretical, and historical perspectives into a wholly new and exciting investigation of global health. The interdisciplinary approach outlined in this text should prove useful not only in schools of public health, nursing, and medicine, but also in undergraduate and graduate classes in anthropology, sociology, political economy, and history, among others.
INTRODUCTION:A common belief is that some narcotic medications have a higher association with prolonged use. We assessed whether the initial opiate type prescribed to postoperative, opiate-naive ...orthopaedic trauma patients was associated with prolonged opioid use.
METHODS:We studied 17,961 adult, opiate-naive patients treated for a surgical musculoskeletal injury. Discharge prescription in morphine milligram equivalents (MMEs, a standardized dosing unit that allows for comparison across opioid types) was calculated. Opioid prescribing beyond 90 days after injury was defined as prolonged use.
RESULTS:Initial analysis demonstrated a higher likelihood of prolonged use for patients discharged on hydromorphone or morphine versus hydrocodone. However, when we adjusted for discharge MME, only opioid quantity was predictive of prolonged use (P < 0.001). In addition, discharge MME was associated with opioid type (P < 0.01).
DISCUSSION:Persistent opiate use was associated with discharge opioid quantity, not the opioid type. These results highlight the importance of calculating equivalence doses when selecting opioid types and considering amount of narcotics prescribed.
LEVEL OF EVIDENCE:Level III
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