Factors Influencing Parental Decision-Making Regarding Analgesia for Children with Musculoskeletal Injury-Related Pain: A Qualitative Study.

OBJECTIVES: To explore and understand parental decision-making relating to acute pain management for their children presenting to the emergency department. STUDY DESIGN: This study employed one-on-one semistructured interviews. Parents of children with acute musculoskeletal injuries were recruited from 3 Canadian pediatric emergency departments. Interviews were conducted via telephone from June 2019 to March 2021. Verbatim transcription and thematic analyses occurred concurrently with data collection, supporting data saturation and theory development considerations. RESULTS: Twenty-seven interviews were completed. Five major themes regarding pain care emerged: (1) my child's comfort is a priority, (2) every situation is unique, (3) opioids only if necessary, (4) considerations when choosing opioids, and (5) pain research is important. Overall, parents were highly comfortable with their assessment of their child's pain. Participants' willingness to use opioid analgesia for their children was primarily dependent on perceptions of injury and pain severity. Opioid-averse and opioid-accepting families had similar considerations when making analgesic decisions but weighed risks and benefits differently. CONCLUSIONS: Parents assess and manage their children's pain globally and multimodally, with comfort being prioritized. For most parents, the desire to relieve their children's pain outweighed concerns of substance use disorder, misuse, and adverse events when making decisions about opioid analgesia for short-term use. These results can inform evidence-based family-centered approaches to co-decision-making of analgesic plans for children with acute pain.

Adolescent and Caregiver Perspectives on Living With a Limb Fracture: A Qualitative Study.

BACKGROUND: Fractures occur in up to half of children by age 16 years. After initial emergency care for a fracture, function is universally impaired in children, and impacts extend to the immediate family. Knowledge of expected functional limitations is key to providing proper discharge instructions and anticipatory guidance to families. OBJECTIVES: The primary objective of this study was to understand how changes in functional ability impact youth with fractures. METHODS: We conducted individual, semistructured interviews from June 2019 to November 2020 with adolescents and their caregivers 7 to 14 days following their initial visit to a pediatric emergency department. We used qualitative content analysis methodology; recruitment proceeded until thematic saturation was achieved. Coding and analysis were concurrent with recruitment and interviews. The interview script was modified in an iterative process, to reflect emerging themes. RESULTS: Twenty-nine interviews were completed. The most frequently affected functions were ( a ) showering and hygiene (requiring the most caregiver support), ( b ) sleep (due to pain and cast-related discomfort), and ( c ) exclusion from sports/activities. Many adolescents experienced disruptions to social activities and gatherings. Youth valued independence and took more time to complete tasks, regardless of inconvenience. Both adolescents and caregivers reported feelings of frustration from day-to-day impacts of the injury. Generally, caregivers' perspectives were in keeping with the experiences that adolescents described for themselves. Notable family impacts included "sibling burden," or conflicts that arose when a sibling had to take on extra chores/tasks. CONCLUSIONS: Overall, caregivers' perspectives were congruent with the self-described experiences of adolescents. Key messages for optimized discharge instructions include pain and sleep management, allowing extra time to complete tasks independently, considering impact on siblings, preparing for changes in activities and social dynamics, and normalizing frustration. These themes highlight an opportunity to better tailor discharge instructions for adolescents with fractures.

Parental Perspectives on Children's Functional Experiences After Limb Fracture: A Qualitative Study.

BACKGROUND: Fractures are a common childhood injury. Although the pain associated with fractures is well described, the related functional impact is less understood. When a child's function is impaired, his or her ability to participate in day-to-day life is restricted. Eighty percent of children with fractures experience compromise in daily function. An in-depth understanding of function can guide emergency department (ED) providers' discharge instructions. OBJECTIVES: Our aim was to report caregivers' perspectives of the functional impact of limb fractures on their children's day-to-day life activities. METHODS: We performed a qualitative study using interviews of caregivers of children (aged 5 to 11 years) who received care for acute, nonoperative long bone fractures in a pediatric ED. Audio-recorded, semistructured telephone interviews were completed 7 to 14 days after the ED visit. Interviews were primarily open ended, including questions targeting areas of function from existing pediatric fracture literature. Qualitative analysis was completed using content analysis. RESULTS: Twenty-five interviews were included in the final analysis. Most of the children were diagnosed with upper extremity fractures, and most participants were mothers. All parents reported a change in their child's function. The most commonly affected areas were sleep, activities of daily living, and play. Play was either self-limited by the child or restricted by the parent. Pain was worse in the first days after discharge. Many children struggled emotionally with functional limitations. All children required help from their parents to perform daily tasks; this required adaptive strategies such as planning, changes to household routine, and missed work. Key concerns from parents included regression in the child's independence and fracture healing and complications. CONCLUSIONS: Function is universally impaired in young children with fractures, significantly affecting family life after discharge. Discharge conversations with families should include pain management, changes to activities of daily living, family routines and play, and expectations for fracture healing.

Changes in quality of life and its associated factors among illicit drug users in Vietnamese mountainous provinces: a 12-month follow-up study.

BACKGROUND: Sustainability of methadone maintenance treatment (MMT) program involves regularly assessing its impact on health and social outcomes of drug users in different settings, particularly in disadvantaged areas. In this study, we evaluated the change in quality of life (QoL), and identified associated factors amongst drug users over the course of 12-month MMT in Vietnamese mountainous provinces. METHODS: We conducted a longitudinal study among patients from 6 MMT clinics in three mountainous provinces of Vietnam. At baseline, we screened 300 participants and after a 12-month treatment, 244 participants remained to involve in the study. World Health Organization Quality of Life short form instrument (WHOQOL-BREF) was used to measure the QoL of patients. The magnitude of the changes was extrapolated. RESULTS: There were significant changes in all four dimensions of quality of life measured by WHOQoL-BREF between baseline and 12 months with the effect size ranged from 0.21 to 0.24. Increased age, being workers compared to unemployment and having health problems or comorbidities were positively related to reduced scores of QoL. CONCLUSIONS: To conclude, we observed a significant increase in the QoL level regarding physical, psychological, social relationships and environmental aspects among people who used drug after 12 months of MMT. Findings from this study emphasize the role of continuously receiving MMT treatment among people using drugs to enhance their QoL.

Global research mapping of substance use disorder and treatment 1971-2017: implications for priority setting.

BACKGROUND: Globally, substance use disorders are prevalent and remain an intractable public health problem for health care systems. This study aims to provide a global picture of substance use disorders research. METHODS: The Web of Science platform was used to perform a cross-sectional analysis of scientific articles on substance use disorders and treatment. Characteristics of publication volume, impact, growth, authors, institutions, countries, and journals were examined using descriptive analysis and network visualization graphs. RESULTS: Thirteen thousand six hundred eighty-five papers related to illicit drugs (5403), tobacco (4469), and alcohol (2137) use disorders and treatment were published between 1971 and 2017. The number of publications on Mindfulness and Digital medicine topics had the highest increase with more than 300% since 2003-2007 despite later presence than other methods. The number of papers on other non-pharmaceutical therapies (behavioral therapy, cognitive behavioral therapy, skills training or motivational interviewing) grew gradually, however, the growth rate was lower every 5-year period. The United States is the substance use disorder research hub of the world with the highest volume of publications (8232 or 60.2%) and total citations (252,935 or 65.2%), number of prolific authors (25 of top 30 or 83%) and institutions (24 of top 26 or 92%), formed the most international research partnerships (with 96 distinct countries). The international collaboration followed a pattern based on geographic proximity and cultural similarity. CONCLUSIONS: This study offers a comprehensive picture of the global trend of publications of substance use disorder. Findings suggest a need for research policy that supports the examination of interventions that culturally adhere to different local contexts to address substance use disorder in communities.

Socioeconomic Inequalities in Health-Related Quality of Life among Patients with Cardiovascular Diseases in Vietnam.

PURPOSE: This study aims to explore the sociodemographic differences in health-related quality of life (HRQOL) among Vietnamese patients with cardiovascular diseases (CVD). METHODS: A cross-sectional survey of 600 cardiovascular disease patients (300 inpatients and 300 outpatients) being treated at the Hanoi Heart Hospital was completed between July and December 2016. Data about HRQOL were collected by using the EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) and EuroQOL-visual analogue scale (VAS). Sociodemographic characteristics were collected. A multivariate Tobit regression was used to detect the correlations between HRQOL and sociodemographic factors. RESULTS: Our sample had an average EQ-5D index of 0.82 (SD=0.21) and VAS score of 77.8 (SD=13.6). Participants were most likely to report problems in pain/discomfort (38.8%) and anxiety/depression (35.2%) and were least likely to report problems related to self-care (19.8%). Age and sex were strongly associated with the EQ-5D index and the VAS. Having health insurance and the number of hospital visits were negatively associated with HRQOL, while participation in the chronic disease management program had the positive relationship. CONCLUSIONS: HRQOL among patients with CVD was moderately lower compared to the Vietnamese general population. Sociodemographic characteristics were strongly associated with HRQOL suggesting that addressing these inequalities should be prioritized in delivering services. Patients should also be encouraged to participate in the chronic disease management program due to its positive effects on quality of life.

Health-related quality of life in elderly diabetic outpatients in Vietnam.

BACKGROUND: Health-related quality of life (HRQoL) is an important indicator for designing care and treatment services for patients with diabetes. This is especially true given its rapid increase among the elderly population in Vietnam. HRQoL data in elderly diabetic Vietnamese are currently limited. This study aimed to 1) measure the HRQoL of elderly patients with type 2 diabetes (T2DM) in Vietnam and 2) identify related factors and their relationship with HRQoL. PATIENTS AND METHODS: A cross-sectional study was conducted. We recruited 171 patients aged ≥60 years with T2DM at the Outpatient Department, National Geriatric Hospital from June to November 2015. Patients were asked to evaluate their health status using the EuroQol Five Dimensions Three Levels (EQ-5D-3L) and the Visual Analog Scale (VAS). Sociodemographic, diabetic treatment, and management characteristics were collected. Multivariate Tobit regression was used to determine which factors were associated with HRQoL, and the strength of this relationship. RESULTS: Patients reported some problems in all areas of the EQ-5D: pain/discomfort (50.9%), mobility (33.3%), anxiety/depression (24.0%), usual activities (21.1%), and self-care (10.5%). The mean EQ-5D index score was 0.80 (SD=0.20), and the mean EQ-VAS was 57.5 (SD=14.4). Patients who were male, lived in an urban area, could afford treatment, were taking fewer medications, and monitored blood pressure often (1-4 times a week) had a higher EQ-5D index when compared to other groups. Meanwhile, a longer duration of diabetes and older age were negatively associated with the EQ-5D index. Patients with any comorbidity had lower VAS scores than their counterparts. CONCLUSION: The presence of diabetes and comorbidity were responsible for a significant decrease in HRQoL. Screening and identifying health problems, providing prompt treatment, and facilitating self-management among patients have the potential to increase diabetic patients' HRQoL.

A Bibliometric Analysis of the Global Research Trend in Child Maltreatment.

Child maltreatment remains a major health threat globally that requires the understanding of socioeconomic and cultural contexts to craft effective interventions. However, little is known about research agendas globally and the development of knowledge-producing networks in this field of study. This study aims to explore the bibliometric overview on child maltreatment publications to understand their growth from 1916 to 2018. Data from the Web of Science Core Collection were collected in May 2018. Only research articles and reviews written in the English language were included, with no restrictions by publication date. We analyzed publication years, number of papers, journals, authors, keywords and countries, and presented the countries collaboration and co-occurrence keywords analysis. From 1916 to 2018, 47,090 papers (53.0% in 2010⁻2018) were published in 9442 journals. Child Abuse & Neglect (2576 papers; 5.5%); Children and Youth Services Review (1130 papers; 2.4%) and Pediatrics (793 papers, 1.7%) published the most papers. The most common research areas were Psychology (16,049 papers, 34.1%), Family Studies (8225 papers, 17.5%), and Social Work (7367 papers, 15.6%). Among 192 countries with research publications, the most prolific countries were the United States (26,367 papers), England (4676 papers), Canada (3282 papers) and Australia (2664 papers). We identified 17 authors who had more than 60 scientific items. The most cited papers (with at least 600 citations) were published in 29 journals, headed by the Journal of the American Medical Association (JAMA) (7 papers) and the Lancet (5 papers). This overview of global research in child maltreatment indicated an increasing trend in this topic, with the world’s leading centers located in the Western countries led by the United States. We called for interdisciplinary research approaches to evaluating and intervening on child maltreatment, with a focus on low-middle income countries (LMICs) settings and specific contexts.