scholarly journals Shifting interpretations in evidence and guidance in pain and opioids research: A bibliometric analysis of a highly cited case series from 1986

2022 ◽  
Author(s):  
Sina Tafreshi ◽  
Adam Steiner ◽  
Abhimanyu Sud
Keyword(s):  
Bibliometric Analysis ◽  
Qualitative Content Analysis ◽  
Case Series ◽  
Opioid Analgesics ◽  
Long Term Effects ◽  
Clinical Practices ◽  
The North ◽  
Index Study ◽  
Exploration Period ◽  
The Impact

Rationale, aims, and objectives: Portenoy and Foley’s 1986 landmark study “Chronic use of opioid analgesics in non-malignant pain: report of 38 cases” has been reproached for opening the floodgates of opioid prescribing for chronic non-cancer pain and the attendant harms. This influential article has been cited over 500 times in the scientific literature over the last four decades. This study seeks to understand the impact of Portenoy and Foley’s article on subsequent discussions and research about opioids. Methods: We conducted a multi-method bibliometric analysis of all citations of this article from 1986 through 2019 using quantitative relational and qualitative content analysis to determine how uses and interpretations of this case series and associated prescribing guidance have changed over time, in relationship to the evolution of the North American opioid crises. Results: Using time series analysis, we identified three periods with distinct interpretations and uses of the index study. In the first “exploration” period (1986-1996), the index study was well-received by the scientific community and motivated further study of the effects of opioids. In the second “implementation” period (1997-2003, coinciding with the release of OxyContin®), this study was used as evidence to support widespread prescribing of opioid analgesics, even while it was recognized that long-term effects had not yet been evaluated. The third “reassessment” period (2004-2019) focused on how opioid-related harms had been overlooked, and in many cases these harms were directly attributed to this study. Conclusion: These changes in interpretation demonstrate shifting currents of the use and mobilization of evidence regarding pain and opioids, and how these currents both impact and are impacted by clinical practices and major sociohistorical phenomena such as the opioid crisis. Researchers and clinicians must account for these shifting dynamics when developing and interpreting scientific knowledge, including in the form of clinical practice guidelines.

TBE in Italy

2019 ◽  
Author(s):  
Valentina Tagliapietra ◽  
Flavia Riccardo ◽  
Giovanni Rezza
Keyword(s):  
Case Series ◽  
East Part ◽  
Mountainous Regions ◽  
North East ◽  
The North ◽  
Tick Borne Encephalitis ◽  
Low Incidence

Italy is considered a low incidence country for tick-borne encephalitis (TBE) in Europe. Areas at higher risk for TBE in Italy are geographically clustered in the forested and mountainous regions and provinces in the north east part of the country, as suggested by TBE case series published over the last decade.

TBE in Italy

2020 ◽  
Keyword(s):  
Surveillance System ◽  
Ad Hoc ◽  
National Level ◽  
Case Series ◽  
Incidence Rates ◽  
Mountainous Regions ◽  
North East ◽  
The North ◽  
Tick Borne Encephalitis ◽  
Low Incidence

Italy is considered a low-incidence country for tick-borne encephalitis (TBE) in Europe.1 Areas at higher risk for TBE in Italy are geographically clustered in the forested and mountainous regions and provinces in the north east part of the country, as suggested by TBE case series published over the last decade.2-5 A national enhanced surveillance system for TBE has been established since 2017.6 Before this, information on the occurrence of TBE cases at the national level in Italy was lacking. Both incidence rates and the geographical distribution of the disease were mostly inferred from endemic areas where surveillance was already in place, ad hoc studies and international literature.1

ADOLESCENTS' PERCEPTIONS OF STRESSORS CONTRIBUTING TO SUICIDAL BEHAVIOUR

2017 ◽  
Vol 26 (2) ◽  
pp. 192-213
Author(s):  
Henriëtte Van den Berg ◽  
Hester Tancred ◽  
Dap Louw
Keyword(s):  
South African ◽  
Family Environment ◽  
Family Relationships ◽  
Suicidal Behaviour ◽  
Stressful Life Events ◽  
Qualitative Content Analysis ◽  
Peer Group ◽  
Conservation Of Resources ◽  
Western Cape ◽  
The Impact

South African adolescents show increased levels of suicidal behaviour. This article explores the perceptions of adolescents at risk of suicide regarding the psychosocial stressors they believe contribute to suicidal behaviour among South African adolescents. This study was conducted on 214 adolescents from the Western Cape Province with a high suicide risk. The group was selected on the basis of their high scores on the Suicidal Ideation Questionnaire. A qualitative content analysis was performed with their responses on a question about the reasons for adolescent suicide. The analysis highlighted risk factors relating to substance abuse, negative emotional experiences, lack of self-esteem, problem-solving ability and hope for the future; negative family environment and conflict in family relationships; peer group and romantic relationships; stressful life events; and socioeconomic factors. Guided by the Conservation of Resources (COR) theory suggestions were made for adolescent resource development to counter-act the impact of the various stressors they experience.

SUMBER-SUMBER RESILIENSI PADA REMAJA AKHIR YANG MENGALAMI KEKERASAN DARI ORANGTUA PADA MASA KANAK-KANAK

Psibernetika ◽  
2018 ◽  
Vol 11 (1) ◽  
Author(s):  
Devina Calista ◽  
Garvin Garvin
Keyword(s):  
Late Adolescents ◽  
Long Term Effects ◽  
Short Term ◽  
Parental Affection ◽  
Resilience Factors ◽  
Childhood Violence ◽  
Past Experiences ◽  
The Impact ◽  
Depth Interviews

<p><em>Child abuse by parents is common in households. The impact of violence on children will bring short-term effects and long-term effects that can be attributed to their various emotional, behavioral and social problems in the future; especially in late adolescence that will enter adulthood. Resilience factors increase the likelihood that adolescents who are victims of childhood violence recover from their past experiences</em><em>,</em><em> become more powerful individuals and have a better life. The purpose of this study was to determine the source of resilience in late adolescents who experienced violence from parents in their childhood. This research uses qualitative research methods with in-depth interviews as a method of data collection. The result shows that the three research participants have the aspects of "I Have", "I Am", and "I Can"; a participant has "I Can" aspects as a source of resilience, and one other subject has no source of resilience. The study concluded that parental affection and acceptance of the past experience have role to the three sources of resilience (I Have, I Am, and I Can)</em></p><p><em> </em></p><p><strong><em>Keyword : </em></strong><em>Resilience, adolescence, violence, parents</em></p>

Nachhaltigkeit im Wald – vor und hinter der Welle der Globalisierung | Sustainable Forest Management – In Front and Behind the Wave of Globalization

2000 ◽  
Vol 151 (12) ◽  
pp. 502-507
Author(s):  
Christian Küchli
Keyword(s):  
Forest Management ◽  
Cultural Landscape ◽  
Sustainable Forest Management ◽  
Essential Element ◽  
Specific Situation ◽  
The South ◽  
The North ◽  
Time Space ◽  
Starting Point ◽  
The Impact

Are there any common patterns in the transition processes from traditional and more or less sustainable forest management to exploitative use, which can regularly be observed both in central Europe and in the countries of the South (e.g. India or Indonesia)? Attempts were made with a time-space-model to typify those force fields, in which traditional sustainable forest management is undermined and is then transformed into a modern type of sustainable forest management. Although it is unlikely that the history of the North will become the future of the South, the glimpse into the northern past offers a useful starting point for the understanding of the current situation in the South, which in turn could stimulate the debate on development. For instance, the patterns which stand behind the conflicts on forest use in the Himalayas are very similar to the conflicts in the Alps. In the same way, the impact of socio-economic changes on the environment – key word ‹globalisation› – is often much the same. To recognize comparable patterns can be very valuable because it can act as a stimulant for the search of political, legal and technical solutions adapted to a specific situation. For the global community the realization of the way political-economic alliances work at the head of the ‹globalisationwave›can only signify to carry on trying to find a common language and understanding at the negotiation tables. On the lee side of the destructive breaker it is necessary to conserve and care for what survived. As it was the case in Switzerland these forest islands could once become the germination points for the genesis of a cultural landscape, where close-to-nature managed forests will constitute an essential element.

Healthcare System in the Arctic Zone of Russia. Known and Emerging Issues and Solutions to Them

2019 ◽  
pp. 3-20
Author(s):  
V.N. Leksin
Keyword(s):  
Metallurgical Industry ◽  
Healthcare Services ◽  
The Arctic ◽  
Russian Arctic ◽  
Arctic Zone ◽  
Shift Workers ◽  
The North ◽  
Medical Institutions ◽  
Emerging Issues ◽  
The Impact

The impact on healthcare organization on the territory of Russian Arctic of unique natural and climatic, demographic, ethnic, settlement and professional factors of influencing the health of population, constantly or temporarily living on this territory is studied. The necessity is substantiated of various forms and resource provision with healthcare services such real and potential patients of Arctic medical institutions, as representatives of indigenous small peoples of the North, workers of mining and metallurgical industry, military personnel, sailors and shift workers. In this connection a correction of a number of All-Russian normative acts is proposed.

A general practice provider federation in a mixed health economy in England: a case study investigation

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696929
Author(s):  
Jill Mitchell
Keyword(s):  
General Practice ◽  
Shared Vision ◽  
Health Economy ◽  
Structured Interviews ◽  
The North ◽  
Common Strategy ◽  
Common Purpose ◽  
Collaborative Working ◽  
The Impact

BackgroundThere is an emerging debate that general practice in its current format is out-dated and there is a requirement to move to a federated model of provision where groups of Practices come together. The emergence of federations has developed over the past 5 years but the factors that influence how federations develop and the impact of this new model is an under researched area.AimThe study explored the rationale around why a group of independent GP practices opted to pursue an alternative business venture and the benefits that this strategy offered.MethodA single organisational case study of a federation in the North of England was conducted between 2011–2016. Mixed methods data collection included individual and group semi-structured interviews and quantitative surveys.ResultsFederations promote collaborative working, relying on strategic coherence of multiple individual GP practices through a shared vision and common purpose. Findings revealed many complexities in implementing a common strategy across multiple independent businesses. The ability of the federation to gain legitimacy was two dimensional – externally and internally. The venture had mixed successes, but their approach to quality improvement proved innovative and demonstrated outcomes on a population basis. The study identified significant pressures that practices were experiencing and the need to seek alternative ways of working but there was no shared vision or inclination to relinquish individual practice autonomy.ConclusionOrganisational development support is critical to reform General Practice. Whether central funding through the GP Five Year Forward View will achieve the scale of change required is yet to be evidenced.

The Impact of Sanctions on North Korea’s Foreign Trade from the Perspective of the Comparative Advantage Theory

2019 ◽  
pp. 4-15
Author(s):  
I. A. Korgun ◽  
G. D. Toloraya
Keyword(s):  
Foreign Trade ◽  
Competitive Advantage ◽  
National Economy ◽  
North Korea ◽  
Rent Seeking ◽  
Economic Transformation ◽  
Global Trade ◽  
Negative Consequences ◽  
The North ◽  
The Impact

The presented study analyzes the opportunities for North Korea to capitalize on its competitive advantages in foreign trade in the context of sanctions.Aim. The study aims to identify mechanisms that allow North Korea to engage in foreign trade in circumvention of UN sanctions and to analyze their impact on the national economy.Tasks. The authors analyze the structure of North Korea’s national economy, its initial competitive advantage, identify the specific features of North Korea’s foreign trade in the context of sanctions, and determine the consequences of illicit trade in circumvention of sanctions for the national economy.Methods. This study uses an interdisciplinary approach that combines the classical theory of competitive advantage with the concept of rent seeking, with the concept of rent seeking and analysis of trade flows.Results. The study shows that, despite the restrictions imposed by sanctions, North Korea strives to make the most of its advantages, such as resource availability and cheap labor, in global trade. The country builds its own export-import chains in circumvention of sanctions. These chains are rather mobile, flexible, and controlled by the elite. As a result, benefits from trade that could be evenly distributed among the population are concentrated in the hands of a narrow segment of society. ‘Rent seeking’ makes it possible to formulate the negative consequences of these processes for the North Korean economy and the international community.Conclusions. Solving the North Korean issue requires an economic transformation in the country through the replacement of restrictive sanctions with more constructive ones. The exclusion of North Korea from open global trade leads to the country’s marginalization and impairs the transparency of international commodity flows.

Environmental impact of nutrients from nordic fish farming

1995 ◽  
Vol 31 (10) ◽  
pp. 61-71 ◽  
Author(s):  
M. Enell
Keyword(s):  
Major Part ◽  
Fish Farming ◽  
Fish Farms ◽  
Feed Composition ◽  
The North ◽  
Comprehensive Development ◽  
The Baltic ◽  
Inland Water Bodies ◽  
The Impact ◽  
Feed Coefficient

During the last 20 years there has been an interesting development of the Nordic fish farming, with regard to the feeding and farming technology and to the increase in production quantities. During the period 1974-1994 the production increased from 15,800 to about 250,000 tonnes/year. In 1974 the major part of the production was in Denmark, and in 1994 the major part was in Norway. The nutrient impact of fish farming on surrounding sea areas is mainly a function of the feed coefficient, the feed composition and metabolic processes in the fish. The comprehensive development of the feed composition and the feeding technology has resulted in reduced load of unmetabolized nutrients from fish farms, calculated per tonne fish produced. In 1974 the mean Nordic feed coefficient was 2.08 and in 1994 the coefficient was 1.25. Feed coefficients of 1.0-1.1 are now reported for Danish and Norwegian freshwater and marine fish farms. The nitrogen (N) and phosphorus (P) content of the feed has decreased, in addition the quality of the nutrient substances in the feed has changed, especially for N. The N content has decreased from 7.8 to 6.8% during the period 1974-1994 and the content of P has decreased from 1.7 to 0.7% during the same period. This development of the feed coefficient and the feed composition has resulted in a present load from a typical Nordic fish farm of 55 kg N and 4.8 kg P/t fish produced. The figures for 1974 were 132 kg N and 31 kg P/t fish produced. The Nordic fish farming production in 1994 resulted in a load of about 13,750 t N and about 1,200 t P on the actual recipients. The load from the Swedish, Finnish and Danish fish farming operations, with the Baltic Sea and the Skagerrak as the recipients, is negligible in comparison with other pollution sources. The quantities of N and P from the fish farming are equal to 0.5% of the atmospheric deposition on the sea surface and 3% of the atmospheric P load. Norwegian, Icelandic and the Faroe Islands fish farming operations are using the North Sea and the Norwegian Sea as the recipients. However, the nutrient load from single fish farms in certain coastal and inland water bodies can be significant and must be considered in the impact assessment together with other sources.

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