Evaluation of the prescription amount of narcotic analgesics based on cancer pain relief management

Abstract Background A basic plan for promoting pain relief management for cancer patients was formulated in Japan, and proper use of narcotic analgesics is being promoted to relieve cancer pain. We aimed to explore the relationship between age and opioid narcotic dose in cancer patients and examine the effects of healthcare systems and social policies to prevent opioid abuse and addiction in a national cohort in Japan. Methods Data were collected from April 2014 to March 2019 from the nationwide health insurance claims open database in Japan. Prescription data were collected for opium alkaloids and synthetic narcotics. A multivariate logistic regression analysis was performed based on the age groups and in- or out-of-hospital prescription quantities (mg), taking into account equivalences in quantities of opioids prescribed yearly on the hypothesized relationships between variables. Results The average annual quantities of opium alkaloid prescribed gradually decreased by 2.8% (mg = 10,249,115) over six years, especially in in-hospital prescriptions. On the other hand, in-hospital annual prescriptions of synthetic narcotics increased by 24.1% (mg = 2,135,568), out-of-hospital opium alkaloid by 1.3% (mg = 37,565,229), and synthetic narcotics by 25.9% (mg = 1,404,641). Among the demographic variables, cancer patients aged 65 years or older were significantly associated with the types of opioid variables (p < .001) and annual reductions in prescribed amounts (p < .001). Conclusions Treatment with opium alkaloids and synthetic narcotics increased among outpatients in the years examined; however, the trend varied across age groups. Our findings suggest that improvements in early detection and treatment have resulted in a rise in the number of cancer patient survivors, thereby leading to an increase in narcotic analgesic dose. The palliative care for cancer patients will contribute as an epidemiological indicator to review the evidence-based health-related impact on public health. Key messages • Treatments other than medical intervention should also be considered, taking into account the increase in the number of outpatient opioid prescription recipients due to increased cancer survival. • Social interventions to prevent opioid abuse during cancer pain relief will contribute to preventing substance abuse by promoting collaboration between clinicians and local communities.


Background:
In the last decades, non-standard employment has grown globally. Especially for own account workers (OAW), this implies the self-management of economic, health and other work-related risks. In the context of COVID19, this management was stressed by lockdowns and the novel health risks imposed by an unknown and highly contagious virus, demanding the incorporation of new knowledge and preventive actions. As part of a six-country multiple case qualitative study on non-standard workers (NSW), we explore their experiences and strategies deployed to protect their health while continuing to work.

Methods:
We performed 40 in-depth interviews to NSWs between October 2020 and February 2021, identified through the PWR online-survey and selected through an intentional sampling strategy according to levels of precarity (high-low), gender (male/female) and age (18-39/40-55). Interviews were analysed through abductive thematic analysis.

Results:
We observed a significant transfer to platform, Uber-like jobs in the delivery of goods during lockdown (n = 7). In the absence of institutional prevention programs and provision of protective equipment, OAWs (n = 13) refer the self-provision of COVID19 prevention to protect themselves and their families while continuing to work, deploying a series of strategies amidst limited understanding of both mode of transmission of the virus and actual effective preventive measures. This had serious consequences for them and their families, expressed in anguish, sense of lack of control, fear, and fragility in the face of a major health risk given their constant potential exposure to the virus, leading to both physical and mental health problems, as well as COVID19 infection.

Conclusions:
The substantial growth worldwide of gig delivery work during lockdowns magnified a pressing public health problem, critically requiring social security for gig and OAWs and the development of more equitable and accessible occupational health for all. Key messages: Substantial growth worldwide of gig delivery work during lockdowns magnified a pressing public health problem. Social security for gig and OAWs are critically required as well as the development of more equitable and accessible occupational health for all.

Background:
A basic plan for promoting pain relief management for cancer patients was formulated in Japan, and proper use of narcotic analgesics is being promoted to relieve cancer pain. We aimed to explore the relationship between age and opioid narcotic dose in cancer patients and examine the effects of healthcare systems and social policies to prevent opioid abuse and addiction in a national cohort in Japan.

Methods:
Data were collected from April 2014 to March 2019 from the nationwide health insurance claims open database in Japan.
Prescription data were collected for opium alkaloids and synthetic narcotics. A multivariate logistic regression analysis was performed based on the age groups and in-or out-ofhospital prescription quantities (mg), taking into account equivalences in quantities of opioids prescribed yearly on the hypothesized relationships between variables.

Results:
The average annual quantities of opium alkaloid prescribed gradually decreased by 2.8% (mg = 10,249,115) over six years, especially in in-hospital prescriptions. On the other hand, inhospital annual prescriptions of synthetic narcotics increased by 24.1% (mg = 2,135,568), out-of-hospital opium alkaloid by 1.3% (mg = 37,565,229), and synthetic narcotics by 25.9% (mg = 1,404,641). Among the demographic variables, cancer patients aged 65 years or older were significantly associated with the types of opioid variables (p < .001) and annual reductions in prescribed amounts (p < .001).

Conclusions:
Treatment with opium alkaloids and synthetic narcotics increased among outpatients in the years examined; however, the trend 15th European Public Health Conference 2022 iii525 varied across age groups. Our findings suggest that improvements in early detection and treatment have resulted in a rise in the number of cancer patient survivors, thereby leading to an increase in narcotic analgesic dose. The palliative care for cancer patients will contribute as an epidemiological indicator to review the evidence-based health-related impact on public health. Key messages: Treatments other than medical intervention should also be considered, taking into account the increase in the number of outpatient opioid prescription recipients due to increased cancer survival. Social interventions to prevent opioid abuse during cancer pain relief will contribute to preventing substance abuse by promoting collaboration between clinicians and local communities. reported that staff always helped them to keep in touch with family. There were small, statistically significant differences between 2019 and 2021 ratings, with questions on opportunity for family to talk to a doctor (d = -.328), provision of information to family (d = -.136), and being able to find staff to talk to about worries and fears (d = -.167) recording the biggest decreases. Scores for cleanliness of wards (d = 0.063) and bathrooms (d = .075), and privacy during examination or treatment in the ED (d = 0.085) improved significantly. Patients commented on their appreciation of staff, but missed having visitors, with restrictions posing challenges for those with sensory or physical impairments.

Conclusions:
Given the unique challenges experienced by acute healthcare services during the COVID-19 pandemic, comparisons with pre-pandemic patient experiences should be interpreted with caution. Continuing to gather patient feedback during a pandemic presents a unique opportunity to understand the resilience of healthcare systems as they continue to operate under unprecedented pressure, with the potential to inform

Background:
During the COVID-19 pandemic surges, healthcare stakeholders were concerned with the sufficiency of available health workforce capacity. In this study we examined the changes in the supply and demand of physicians, nurses and care workers in Serbia over the period 2011-2021.

Methods:
The National Employment Service (NES) data on total number of unemployed physicians, nurses and care workers, and vacancy data in health sector were described using the annualized % change for the period 2011-2021. The longterm duration of unemployed female physicians and nurses was further analyzed.

Results:
In 2021, NES has registered total of 13,332 unemployed physicians, nurses and care workers, out of which the majority were females (79%), and nurses and care workers (88%). 2021 data on vacancies showed that only 16% of unemployed workers were needed. The peak of health workers unemployment was in 2016, highlighting the period of unemployment rise (2011)(2012)(2013)(2014)(2015)(2016) at an annualized rate of 3.7% for medical doctors' specialists, 6.4% for medical doctors without specialization, and 3.2% for nurses and care workers, and the period of unemployment decline (2017-2021) at an annualized rate of -7.9% for medical doctors' specialists, -10.9% for medical doctors without specialization, and -5.9% for nurses and care workers. The annualized rate of decline was the lowest for female nurses and care workers. On average 53% of all long term unemployed medical doctors, nurses and care workers were women. In comparison to 2019, during the COVID-19 epidemic in 2020 and 2021 the number of vacancies for specialists and nurses and care workers has increased by one-third.

Conclusions:
The study indicated a continuous mismatch between the supply and demand of physicians and nurses in Serbia (a surplus of some categories of nurse-specialists versus a shortage of some doctor specialists). The Serbian stakeholders need to urgently intervene regarding the long-term unemployment of female health workers. Key messages: NES data imply a low capacity of the Serbian health sector to absorb the huge numbers of (long-term) unemployed health workers.
It is necessary to thoroughly examine and counteract the causes of the dramatic number of unemployed health workers on the NES records in Serbia.