Chronic noncancer pain: characteristics of patients prescribed opioids by community physicians and referred to a tertiary pain clinic.

OBJECTIVE: To describe the characteristics of patients with chronic noncancer pain (CNCP) prescribed opioids by community physicians and referred to a tertiary pain clinic. DESIGN: Cross-sectional, descriptive study. SETTING: A tertiary care, hospital-based pain clinic in Toronto, Ont. PARTICIPANTS: A total of 455 consecutive patients newly referred to the pain clinic by community physicians. MAIN OUTCOME MEASURES: Data on demographic characteristics, pain ratings, and medication intake were obtained using standardized collection forms and retrospective chart review. Patients were classified by diagnosis: group 1 patients had biomedical disorders only, group 2 patients had biomedical disorders and psychological factors, and group 3 patients had psychological factors only. Patients were also categorized based on opioid use: no opioid use (NOU); low opioid use (LOU), with a daily morphine-equivalent dosage (MED) of 200 mg or less; or high opioid use (HOU), with a daily MED of more than 200 mg. RESULTS: In the general study population, 63% of patients were taking opioids, with 1 in 5 exceeding an MED of 200 mg daily. In group 1, 59% of patients used opioids and 10% had HOU; 66% of patients in groups 2 and 3 were taking opioids, with 21% and 26% classified as having HOU. The mean (SD) daily MED for groups 2 and 3 HOU patients combined was significantly higher than that of group 1 HOU patients: 575.7 (472.9) mg/d versus 284.9 (74.6) mg/d, respectively. Men were twice as likely as women to have HOU; Canadian-born patients were 3 times as likely as foreign-born patients to have HOU. Psychoactive drugs were coprescribed in 61% of LOU patients and 76% of HOU patients. Greater opioid use was associated with group 2 and 3 diagnoses, male sex, Canadian-born origin, and high pain scores. CONCLUSION: Our results indicate that male, Canadian-born CNCP patients presenting with psychological morbidity or comorbidity and reporting higher pain severity ratings were more likely to receive opioids. Additionally, many CNCP patients referred to our tertiary care pain clinic were receiving opioids in excess of a 200-mg/d MED. More studies are needed to determine which factors lead to high-dose opioid prescribing in a subset of this CNCP population.

[Sexually-transmitted disease prevalence and the factors associated with it in sexually-exploited children in Bogota, Colombia]. / Prevalencia y Factores Asociados a Enfermedades de Transmisión Sexual en Menores Explotados Sexualmente en Bogotá, Colombia.

OBJECTIVE: Presenting the characteristics of a group of children who have been sexually exploited in Bogota, determining the prevalence of sexually-transmitted disease (STD) in this group of children and establishing the factors associated with STD in this population. METHODOLOGY: This was a descriptive, cross-sectional study. The medical charts of children aged 10 to 17 years who sought medical attention at Fundación Renacer between January 2002 and June 2004 were reviewed. The analysis included descriptive statistics, correlations and binomial logistic regression. RESULTS: 255 children's charts were included, producing the following characteristics: being female (58.8%), average age was 15.4, 5.9% were affiliated to social security, 89.8% engaged in substance abuse, 41.2% used family planning, 3.9% used a condom during every intercourse and there were 0.86 average pregnancies per female adolescent. Sexually-transmitted disease prevalence was 30.9%. The most common diseases were condilomatosis and Neisseria gonorrhoeae infection. Substance abuse and infrequent condom use were associated with a diagnosis of STD. CONCLUSION: Child sexual exploitation is a reality in Colombia. In spite of the limitations of this study, it can be concluded that STDs are an important problem in the sexually-abused child population in Bogota. Preventing child sexual exploitation and integral attention for these children (including health service provision) must become a priority.

Prevalencia y Factores Asociados a Enfermedades de Transmisión Sexual en Menores Explotados Sexualmente en Bogotá, Colombia / Sexually-transmitted disease prevalence and the factors associated with it in sexually-exploited children in Bogota, Colombia

Objetivos Presentar características de un grupo de niños que han sido explotados sexualmente en Bogotá, determinar la prevalencia de Enfermedades de Transmisión Sexual (ETS) en estos menores y establecer factores asociados a estas enfermedades en este grupo. Metodología Estudio descriptivo de corte transversal. Se revisaron historias clínicas de pacientes entre 10 y 17 años que asistieron a la consulta médica ambulatoria de la Fundación Renacer entre Enero del 2002 y Junio del 2004. El análisis incluyó estadísticas descriptivas, correlaciones y regresión logística binomial. Resultados Se incluyeron 255 historias de menores. Características: 58,8 por ciento mujeres, 15,4 años edad promedio, 5,9 por ciento tenían alguna afiliación a seguridad social, 89,8 por ciento consumían alguna sustancia psicoactiva, 41,2 por ciento utilizaba algún método anticonceptivo, el 3,9 por ciento refirió utilizar condón en todas sus relaciones y 0,86 embarazos en promedio por adolescente femenina. La prevalencia de diagnósticos de enfermedades de transmisión sexual fue de 31,0 por ciento. Las enfermedades mas comunes fueron condilomatosis e infección por Neisseria gonorrhoeae. Las ETS se asociaron con número de sustancias psicoactivas consumidas y con uso poco frecuente de condón. Conclusión La explotación sexual infantil es una realidad en Colombia. Este estudio confirma que las enfermedades de transmisión sexual son un problema importante en los menores explotados sexualmente en Bogotá. La prevención de explotación sexual infantil y la atención integral a estos menores, incluyendo la atención en salud, deben ser una prioridad.

Objective Presenting the characteristics of a group of children who have been sexually exploited in Bogota, determining the prevalence of sexually-transmitted disease (STD) in this group of children and establishing the factors associated with STD in this population. Methodology This was a descriptive, cross-sectional study. The medical charts of children aged 10 to 17 years who sought medical attention at Fundación Renacer between January 2002 and June 2004 were reviewed. The analysis included descriptive statistics, correlations and binomial logistic regression. Results 255 children's charts were included, producing the following characteristics: being female (58.8 percent), average age was 15.4, 5.9 percent were affiliated to social security, 89.8 percent engaged in substance abuse, 41.2 percent used family planning, 3.9 percent used a condom during every intercourse and there were 0.86 average pregnancies per female adolescent. Sexually-transmitted disease prevalence was 30.9 percent. The most common diseases were condilomatosis and Neisseria gonorrhoeae infection. Substance abuse and infrequent condom use were associated with a diagnosis of STD. Conclusion Child sexual exploitation is a reality in Colombia. In spite of the limitations of this study, it can be concluded that STDs are an important problem in the sexually-abused child population in Bogota. Preventing child sexual exploitation and integral attention for these children (including health service provision) must become a priority.

Problemática en torno al embarazo en Adolescentes de 14 a 19 años, en Nocaima (Cundinamarca) / Pregnancy in adolescents as a problem to 14 - 19 year olds in Nocaima (Cundinamarca)

El embarazo en adolescentes es preocupante y generador de graves consecuencias en la salud individual, familiar y colectiva. Quince millones de adolescentes aproximadamente en el mundo, dan a luz cada año. El aborto es la opción preferida y utilizada en los embarazos no deseados. Este fenómeno se hace presente en jóvenes de un municipio de Colombia que ha ingresado en el proceso de convertirse en saludable. La comunidad ha reconocido ésta situación como uno de los problemas a intervenir, en consecuencia, el presente trabajo pretende estudiarlo y analizar medidas de intervención para promover una sexualidad libre y responsable, disminuyendo la ocurrencia del embarazo indeseado en adolescentes. Objetivo: En población escolar, encontrar datos sobre anticoncepción, embarazo y factores relacionados en adolescentes, ya que la información actual es incompleto. Se buscará revelar diferencias entre la población rural y urbana. Metodología: Estudio de tipo observacional descriptivo con aplicación de encuesta a 226 mujeres jóvenes entre Agosto y Octubre de 2005, con edades comprendidas entre 14 y 19 años de edad, cursando entre octavo y undécimo grado estudiando en los 3 centros educativos incluidos en el proyecto. Resultados: El 88.9% de las participantes se encontraba entre 14 y 17 años. El 66.8% de las adolescentes sabe como usar correctamente los métodos anticonceptivos que conocen, y el 28.8% de las mismas ha tenido relaciones sexuales, con una edad promedio de inicio de 15 años. De las adolescentes encuestadas 11.1% han estado embarazadas en algún momento de su vida. De estos embarazos el 57,% terminaron en aborto y el 66,8% de las embarazadas dejaron sus estudios. Conclusiones: Luego de establecer jornadas de estudio, revisando los temas asociados al embarazo y los factores inherentes a la actividad sexual en esta etapa, se observó que el embarazo en adolescentes es un problema de salud pública prevenible. Además, se puede sugerir una relación de este problema con el déficit de redes de apoyo familiar y social, y con las carencias en la toma de decisiones a nivel individual.

Adolescent pregnancy is a current problem which raises concern due to its individual, familiar and collective consequences. Fifteen million adolescents give birth each year in the world. Abortion is the preferred option used in unwanted pregnancies. Adolescent pregnancy is frequent in Nocaima, Cundinamarca and is a community concern in this small town initiating its process of becoming a healthy municipality. As such, the community has highlighted this problem to be studied and submitted to intervention to promote a free and responsible sexuality decreasing unwanted adolescent pregnancies. Objective: To find data on contraception, pregnancy and related factors in selected adolescents therefore, improving current incomplete information. Methods: Descriptive observational study with survey application on 226 female 14 to 19 year old students from three high school facilities in Nocaima including 8th to 11th graders. Results: 88.9% of the participants were between 14 and 17 years of age. 66.8% of the adolescents claim to use correctly contraceptive methods and 28.8% have had sexual intercourse with an average initiation at age 15. 11.1% have been pregnant once in their lives and of these 57.1 % ended in induced abortion and 66.8% were school dropouts. Conclusions: After having implemented an educational campaign on healthy sex and reproductive behaviors we view adolescent pregnancy as a public health problem which is preventable and related to the deficit of social and family support as well as weakness in individual decision making.