The Experience of Parental Absence in Royal Navy and Royal Marines Families
Abstract: Being a parent and raising children is exciting and rewarding, but it can be tough at times for any family. The amount, patterns and types of parental absence faced by Naval Service families present additional challenges that are not routinely experienced by most civilian families. The purpose of this resource is to draw together some useful information about parental absence and separation, and provide some strategies to help families thrive. It is a starting place to think about some of the issues. It’s written by a parent, for parents, based on feedback from parents.
Abstract: Context: In response to the opioid crisis, federal guidelines were implemented, including the Veterans Health Administration's (VA) Opioid Safety Initiative in 2013. The impact of policies on patients near the end of life is unknown. Objective: Examine temporal trends in opioid prescribing, pain, and opioid overdoses among Veterans near the end of life. Methods: Retrospective, time series analysis of VA decedents between October 2009 and September 2018 whose next-of-kin participated in VA's Bereaved Family Survey (BFS). Using multivariate regression to adjust for sociodemographic and clinical covariates, we examined temporal trends in outpatient opioid prescribing, uncontrolled pain based on BFS report, and opioid overdose-related hospitalizations, in the last month of life, overall and by clinical diagnosis (cancer versus non-cancer). Results: Among 79,409 decedents, mean daily outpatient opioid dose in morphine milligram equivalents in the last month of life decreased from 4.6 mg in 2010 to 2.1 mg in 2018 (adjusted change -0.20 mg/year; P