[Problems and adverse reactions related to opioid analgesics in Colombia]. / Problemas y reacciones adversas relacionadas con analgésicos opioides en Colombia.

INTRODUCTION: The prevalence of pathologies that generate chronic pain is high (10-40%), as is the use of opioids. In Colombia, these drugs rank among the first in terms of prescriptions and the number of deaths related to their consumption is rising (0.71/1,000,000 inhabitants). This study seeks to characterise opioid-related problems (ORP) and the variables associated with their resolution. MATERIALS AND METHODS: It is a study based on secondary information. Incidences were calculated using Ministry of Health data and characteristics related to non-recoverable adverse reactions (ADRs) were determined. RESULTS: Altogether 4,437 problems were identified in 3,063 patients (39.51%, male), adults (45 years old; IQR: 29-62). The most common opioids were tramadol (46.49%, 5 mg; IQR: 5-5) and morphine (19.65%, 3 mg; IQR: 2.6-5). The majority of ORP were ADRs (93.15%) and of these, 32.28% were severe. Women had proportionally more gastrointestinal and neurological disorders, while men had a higher frequency of vascular, psychiatric, urinary and haematological problems (p < 0.05). These reactions did not resolve in 8.39%, and prognosis was associated with oral administration - odds ratio (OR): 9.24; 95% confidence interval (CI 95%): 6.36-13.42; severity (OR: 3.96; CI 95%: 2.71-5.76); age (OR: 1.01; CI 95%: 1.001-1.01); weak opioids (OR: 0.57; CI 95%: 0.4-0.84); and neurological-cardiovascular reactions (OR: 0.36; CI 95%: 0.21-0.61). CONCLUSIONS: Interventions to optimise the prescription of opioids should be encouraged to prevent ADRs with poor prognosis. Studies should be conducted to further investigate the impact of gender and route of administration on the occurrence of ADRs, as well as the severity of skin and gastrointestinal problems, which may be underestimated.

TITLE: Problemas y reacciones adversas relacionadas con analgésicos opioides en Colombia.Introducción. Las patologías que generan dolor crónico tienen alta prevalencia (10-40%), así como el consumo de opioides. En Colombia, estos medicamentos ocupan los primeros lugares de prescripción y existe un incremento en las muertes relacionadas con su consumo (0,71/1.000.000 habitantes). Este estudio busca caracterizar los problemas relacionados con opioides (PRM) y las variables asociadas con su resolución. Materiales y métodos. Es un estudio basado en información secundaria. Se calcularon las incidencias con datos del Ministerio de Salud y se determinaron las características relacionadas con reacciones adversas (RAM) no recuperables. Resultados. Se identificaron 4.437 problemas en 3.063 pacientes (39,51%, hombres), adultos (45 años; RIC: 29-62). Los opioides más comunes fueron tramadol (46,49%, 5 mg; RIC: 5-5) y morfina (19,65%, 3 mg; RIC: 2,6-5). La mayoría de los PRM fueron RAM (93,15%), y de éstas, el 32,28% fueron graves. Las mujeres presentaron proporcionalmente más alteraciones gastrointestinales y neurológicas, mientras que los hombres tuvieron una mayor frecuencia de problemas vasculares, psiquiátricos, urinarios y hematológicos (p menor de 0,05). Estas reacciones no se resolvieron en el 8,39% y el pronóstico se asoció con la administración oral ­odds ratio (OR): 9,24; intervalo de confianza al 95% (IC 95%): 6,36-13,42­, gravedad (OR: 3,96; IC 95%: 2,71-5,76), edad (OR: 1,01; IC 95%: 1,001-1,01), opioides débiles (OR: 0,57; IC 95%: 0,4-0,84) y reacciones neurológicas-cardiovasculares (OR: 0,36; IC 95%: 0,21-0,61). Conclusiones. Se sugiere fomentar intervenciones para optimizar la prescripción de opioides y así prevenir RAM con pobre pronóstico. Deben realizarse estudios que profundicen en el impacto del sexo y la vía de administración sobre la ocurrencia de RAM, así como la gravedad de los problemas cutáneos y gastrointestinales, que podría subestimarse.

Levels of heavy metals and metalloids in critically endangered Iberian lynx and other wild carnivores from Southern Spain.

The Iberian lynx (Lynx pardinus) is the most endangered felid in the world with a wild population which probably stands at less than 200 individuals inhabiting two areas in Southern Spain (Doñana and Sierra Morena) that are known to have been contaminated by heavy metals and metalloids due to a long history of mining activities. This contamination may pose a threat to long term conservation efforts and hence, the concentrations of seven elements (As, Se, Cd, Zn, Cu, Pb, Hg) were determined in the liver, muscle and bone of 9 lynx, as well as 17 red foxes (Vulpes vulpes), 11 Egyptian mongooses (Herpestes ichneumon), 4 common genets (Genetta genetta) and 1 Eurasian badger (Meles meles). The mean concentrations found were below the threshold levels indicative of chronic intoxication in all the species studied. In general, genet and red fox were species with the highest concentrations of several elements in Doñana, whilst Iberian lynx had the lowest levels of most of them. Lynx from Sierra Morena had significantly higher concentrations of bone Pb (2.05 microg/g d.w.) than those from Doñana (0.13 microg/g d.w.), probably due to the mineralised underlying geology and/or the abandoned mine workings in Sierra Morena. Egyptian mongoose presented liver concentrations of Hg up to 9.7 microg/g d.w. A strong relationship between Hg and Se levels was found in liver and muscle samples of all the studied species, especially in mongoose. In conclusion, levels of the studied elements do not appear to represent a significant threat for the lynx or for the other carnivores studied. However, given the critical status of the Iberian lynx, a continuous monitoring scheme remains necessary.

[Chronic patients confined to home and their impact on the family: a qualitative study]. / Los enfermos crónicos recluidos en el domicilio y su repercusión en la familia: una investigación cualitativa.

OBJECTIVE: To describe and assess the social and psychic overload which falls on those who care for chronically ill patients confined to their homes. DESIGN: Qualitative study, with semi-structured interviews. SITE: Primary care in the public sector, in an urban context. PATIENTS OR OTHERS PARTICIPANTS: Those caring for the chronically ill, confined to their homes, and who are included in the home care programme of a General Medicine office. INTERVENTION: Semi-structured interview and analysis of the clinical history. Data were obtained concerning: 1. The general characteristics of the patient; 2. General characteristics of the carer; and 3. Social activities, family relationships and both physical and psychological health of the carers. MAIN RESULTS: 12 patients were studied. Two of these had no carer. In the remaining ten cases, the carer was a member of the immediate family. Only one carer was male. In 60% of cases the carer showed dysfunction in relation to the family. There were social repercussions in 70% of the cases and psychiatric morbidity in 50%. CONCLUSION: Care of the chronically ill patient confined to the home carries with it a serious social and psychological burden, which falls essentially on the wife or daughter.

[Effect of the physician's and the patient's sex on the clinical interview]. / Influencia del sexo del médico y del paciente en la entrevista clínica.

OBJECTIVE: To analyse differences attributable to the sex of the doctor and of the patient in the activities and content of the clinic appointment in Primary Attention. DESIGN: Analysis of interaction, in terms of activities and content, in 157 clinic appointments. SITE. General medical consultations in four Primary Attention Public Health Centres. PATIENTS: Those who used the health services on the day of the study. INTERVENTION: Tape recording of the appointments. MAIN MEASUREMENTS AND RESULTS: The interviews were recorded. There were shown to be differences according to the sex of the doctor and of the patient in terms of the development and content of the interviews. The style of the woman doctor involved longer interviews with greater social content; in general sameness of sex (doctor and patient) led to greater mutual complementation in the interviews. CONCLUSIONS: It has been shown that there are differences in the activities and content of the clinic appointments in Primary Attention which depend on the sex of the patient and doctor.

Prevalencia de presión arterial elevada y otros factores de riesgo de enfermedad cardiovascular en trabajadores de cafetines de la Universidad Central de Venezuela (ciudad universitaria) / Prevalence high blood pressure and others risk factors of cardiovascular disease in workers of cafe the cafeterias the Universidad Central de Venezuela (university city)

Se realizó un estudio transversal en una muestra de 100 sujetos, trabajadores de cafetines de la Universidad Central de Venezuela, en la cual predonimó el sexo masculino con el 62 por ciento y frente a 38 por ciento del femenino, con media 35+6 años de antiguedad en el oficio; el 72 por ciento tenían oficio de cocinero, "lonchero" y personal de limpieza y el 28 por ciento de cajero y personal administrativo o gerencial. En su mayoría el nivel de enseñanza fue de 7° año o menos. La prevalencia de la presión arterial elevada fue de 33 por ciento y presión de pulso elevada 46.7 por ciento. La media de la presión sistólica, ajustada a la edad, en personas con más de 5 años en el oficio (135 Hg./mm) estaba significativamente aumentada