Opioid use disorders national registries and opioids sales registries: A 10-year prevalence study from a middle-income country

2021 ◽  
Vol 17 (5) ◽  
pp. 383-388
Author(s):  
Daniela Yucumá, MD ◽  
Ana Beatriz Pizarro, RN ◽  
Diego Alberto Moreno, MD ◽  
Juan David Mosos, MD ◽  
Marian Rincón-Montaña, MD ◽  
...  
Keyword(s):  
Behavioral Disorders ◽  
Progressive Increase ◽  
National Registry ◽  
Middle Income Country ◽  
Opioid Use ◽  
Middle Income ◽  
Middle Income Countries ◽  
Icd 10 ◽  
Opioid Use Disorders ◽  
Mental And Behavioral Disorders

Objectives: (1) To estimate the prevalence, geographic distribution, and demographic characteristics of patients diagnosed with mental and behavioral disorders due to the use of opioids in Colombia, between 2009 and 2018. (2) To describe the opioid sales trends in Colombia over the last few years.Methods: We conducted an observational study analyzing information from Individual National Registry of Health Services and the Colombian official database for pharmaceuticals prices and quantities sold. The included ICD-10 codes were mental and behavioral disorders due to the use of opioids (F11) codes subdivisions.Results: 12,557 cases of mental and behavioral disorders due to opioid use were reported, with a rate of 3.0 per 100,000 inhabitants for the studied period. Men represented 74.2 percent, with a male:female ratio of 2.9:1. The highest prevalence was found between 20 and 24 years, in the northwest Colombian area. A progressive increase in the total number of opioid units sold during the study period was found, and the most frequently sold opioids were tramadol (55 percent) and codeine (20 percent).Conclusions: Recognition of opioid use disorders has increased in the last 10 years; it affects more males than females, mostly young adults, and is higher in certain affluent regions of Colombia. We found a progressive annual increase in the sales of opioids in the country, which could be related to the increase in the rate of registries. Studies that have analyzed opioid abuse in Latin America are limited, and further studies are needed to evaluate this situation in middle-income countries from the region.

scholarly journals Do we really need opioids in anesthesia?

2020 ◽  
Vol 24 (2) ◽  
pp. 239-248
Author(s):  
Xavier Falières
Keyword(s):  
Hospital Readmission ◽  
Postoperative Delirium ◽  
Cancer Recurrence ◽  
Postoperative Phase ◽  
Opioid Use ◽  
Middle Income ◽  
Middle Income Countries ◽  
Opioid Induced Hyperalgesia ◽  
Tertiary Hospitals ◽  
The Usa

Since the 1990s, high-income countries have seen an exponential increase in opioid use, misuse, and overdose. This “opioid crisis”, or “opioid epidemic”, began in the USA, spread to Europe, and is now extending to Asia. Today, opioids are still rarely available in many low and middle-income countries. In Pakistan, for instance, the only available opioids are morphine, fentanyl, nalbuphine, and tramadol, and these too are available only in tertiary hospitals. Is there a relationship between opioid exposure during anesthesia and opioid-induced hyperalgesia, hospital readmission, opioid addiction, cancer recurrence, immune system impairment, higher risk of postoperative delirium, and cognitive dysfunction? Signs in the recent literature confirm some of these hypotheses, and reducing opioid use in anesthesia is becoming a necessity. The concept of “opioid-free anesthesia” has emerged over the years in the literature. Is opioid-free anesthesia the solution?  Is it a real paradigm shift? Nevertheless, it is important to keep in mind that stress-induced postoperative pain negatively influences outcome. The use of opioids in the postoperative phase could be necessary, but they have to be titrated and reduced to the minimum needed. Opioid-free postoperative analgesia is a new debate in the literature.

scholarly journals Crowdsourcing to identify social innovation initiatives in health in low- and middle-income countries

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Lindi van Niekerk ◽  
Arturo Ongkeko ◽  
Rachel Alice Hounsell ◽  
Barwani Khaura Msiska ◽  
Don Pascal Mathanga ◽  
...  
Keyword(s):  
Social Innovation ◽  
Collective Intelligence ◽  
Middle Income Country ◽  
Income Country ◽  
Middle Income ◽  
Middle Income Countries ◽  
Distributed Problem Solving ◽  
Challenges And Opportunities ◽  
Crowdsourcing Contest ◽  
Low And Middle Income

Abstract Background Crowdsourcing is a distributed problem-solving and production mechanism that leverages the collective intelligence of non-expert individuals and networked communities for specific goals. Social innovation (SI) initiatives aim to address health challenges in a sustainable manner, with a potential to strengthen health systems. They are developed by actors from different backgrounds and disciplines. This paper describes the application of crowdsourcing as a research method to explore SI initiatives in health. Methods The study explored crowdsourcing as a method to identify SI initiatives implemented in Africa, Asia and Latin America. While crowdsourcing has been used in high-income country settings, there is limited knowledge on its use, benefits and challenges in low- and middle-income country (LMIC) settings. From 2014 to 2018, six crowdsourcing contests were conducted at global, regional and national levels. Results A total of 305 eligible projects were identified; of these 38 SI initiatives in health were identified. We describe the process used to perform a crowdsourcing contest for SI, the outcome of the contests, and the challenges and opportunities when using this mechanism in LMICs. Conclusions We demonstrate that crowdsourcing is a participatory method, that is able to identify bottom-up or grassroots SI initiatives developed by non-traditional actors.

scholarly journals A qualitative exploration of stigma experience and inclusion among adults with mild to moderate intellectual disability in an Indonesian context

2021 ◽  
pp. 174462952110023
Author(s):  
Restu Handoyo ◽  
Afia Ali ◽  
Katrina Scior ◽  
Angela Hassiotis
Keyword(s):  
Intellectual Disability ◽  
Thematic Analysis ◽  
Service Providers ◽  
Structured Interview ◽  
Middle Income Country ◽  
Interview Schedule ◽  
Middle Income ◽  
Moderate Intellectual Disability ◽  
Middle Income Countries ◽  
Qualitative Exploration

Background: People with intellectual disability are among the most stigmatised groups in society. There is a paucity of studies reporting on how stigma is experienced in low- and middle-income countries. This study aims to explore the experience of stigma among adults with mild/moderate intellectual disability and the extent of their inclusion in Indonesian society. Method: Fifteen adults with mild/moderate intellectual disability were purposively recruited from three service providers and were interviewed using a semi-structured interview schedule. The data were analysed using thematic analysis. Results: The findings suggest that adults with intellectual disability experience stigma in multiple settings (family, school, community), have limited access to social activities, and internalised the experienced stigma. Conclusion: This study adds to the international understanding of stigma experienced by adults with mild/moderate intellectual disability in daily life and their inclusion in society in a middle-income country.

Impact of transport on arrival status and outcomes in newborns with heart disease: a low–middle-income country perspective

2020 ◽  
Vol 30 (7) ◽  
pp. 1001-1008
Author(s):  
Balaganesh Karmegaraj ◽  
Mahesh Kappanayil ◽  
Abish Sudhakar ◽  
Raman Krishna Kumar
Keyword(s):  
Clinical Outcomes ◽  
Clinical Status ◽  
Middle Income Country ◽  
Organ Injury ◽  
Catheter Intervention ◽  
Middle Income ◽  
Middle Income Countries ◽  
Prolonged Ventilation ◽  
Prolonged Icu Stay ◽  
Low And Middle Income

AbstractObjectives:We sought to systematically study determinants of “clinical status at arrival after transport” of neonates with CHD and its impact on clinical outcomes in a low- and middle-income country environment.Methods and results:Consecutive neonates with CHD (n = 138) transported (median distance 138 km; 5–425 km) to a paediatric cardiac programme in Southern India were studied prospectively. Among 138 neonatal transports, 134 were in ambulances. Four neonates were transported by family in private vehicles; 60% with duct-dependent circulation (n = 57) were transported without prostaglandin E1. Clinical status at arrival after transport was assessed using California modification of TRIPS Score (Ca-TRIPS), evidence of end-organ injury and metabolic insult.Upon arrival, 42% had end-organ injury, 24% had metabolic insult and 36% had Ca-TRIPS Score >25. Prior to surgery or catheter intervention, prolonged ICU stay (>48 hours), prolonged ventilation (>48 hours), blood stream sepsis, and death occurred in 48, 15, 19, and 3.6%, respectively. Ca-TRIPS Score >25 was significantly associated with mortality (p = 0.005), sepsis (p = 0.035), and prolonged ventilation (p < 0.001); end-organ injury with prolonged ICU stay (p = 0.031) and ventilation (p = 0.045); metabolic insult with mortality (p = 0.012) and sepsis (p = 0.015).Fifteen babies needed only medical management, 10 received comfort care (due to severe end-organ injury in 3), 107 underwent cardiac surgery (n = 83) or catheter intervention (n = 24), with a mortality of 6.5%. Clinical status at arrival after transport did not impact post-procedure outcomes.Conclusion:Neonates with CHD often arrive in suboptimal status after transport in low- and middle-income countries resulting in adverse clinical outcomes. Robust transport systems need to be integrated in plans to develop newborn heart surgery in low- and middle-income countries.

scholarly journals Challenges in Controlling SARS-CoV-2 in a Lower-middle Income Country and the Potential Unintended Effects due to Aggressive Restrictions

2020 ◽  
Author(s):  
Lincoln Lau ◽  
Peng Wu ◽  
Daryn Go ◽  
Warren Dodd ◽  
Charles Yu
Keyword(s):  
Health Systems ◽  
The Philippines ◽  
Unintended Consequences ◽  
Middle Income Country ◽  
Unintended Effects ◽  
Middle Income ◽  
Middle Income Countries ◽  
Number Of Patients ◽  
Community Transmission ◽  
Official Data

In response to the COVID-19 pandemic, the Philippines placed the majority of the country under enhanced community quarantine, restricting the movement of most of its 100 million plus population. These aggressive measures were initiated on March 15, 2020 and intensified on March 17. According to official data, the number of confirmed COVID-19 cases has exponentially increased during this period, but it is important to note that the number of patients tested also substantially increased during the same period. It is not conclusive that widespread transmission of COVID-19 only started in March and our analysis suggests that community transmission was happening earlier. In discussing extended quarantine measures, it is important to properly understand the trends and recognize the limitations of the data. The unintended consequences on the population, especially in lower-middle income countries with fragile health systems like the Philippines, must be carefully considered.

scholarly journals Evaluation of Urban Design Qualities across Five Urban Typologies in Hanoi

Urban Science ◽  
2021 ◽  
Vol 5 (4) ◽  
pp. 76
Author(s):  
Thanh Phuong Ho ◽  
Mark Stevenson ◽  
Jason Thompson ◽  
Tuan Quoc Nguyen
Keyword(s):  
Urban Design ◽  
Cultural Context ◽  
Vital Role ◽  
Middle Income Country ◽  
Low Density ◽  
Middle Income ◽  
Urban Forms ◽  
Middle Income Countries ◽  
Health And Wellbeing ◽  
Low And Middle Income

Urban design has been shown to play a vital role in promoting the health and wellbeing of urban citizens. However, studies of microscale urban design are underrepresented in comparison with macroscale urban design, especially from low- and middle-income countries in Asia, where urban forms are traditionally compact, complex and with multiple layers and varied urban typologies. The study evaluated microscale urban design qualities of streets (n = 40) across five urban typologies in Hanoi—a typical city in a low- and middle-income country in Asia. The study found that urban typologies and their characteristics have particular impacts on urban design qualities. Old and high-density urban typologies tend to report higher urban design qualities than modern and low-density typologies. Urban design qualities are also significantly associated with the number of pedestrians on the streets. Compared to Western cities, the urban design qualities in Hanoi are substantially different, especially in terms of imageability and complexity, reflecting the differences in urban design and cultural context between cities from various regions. Overall, the study contributes to our understanding of urban design circumstances in Hanoi, providing policymakers, planners, urban designers and architects with important insights for sustainable urban design policies, strategies and interventions.

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