ABSTRACT
Colombia is the second largest country in South America. In this article, we provide an overview of medical education in Colombia, including a description of existing public and private medical schools and available undergraduate and postgraduate programs. Medical education in Colombia has evolved through time, following international trends. In addition to 61 undergraduate medical programs, there are 529 postgraduate clinical, 30 PhD, and 131 Master programs in health sciences in Colombia. We identify current challenges and highlight future perspectives for medical education in Colombia.
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Education, Graduate/statistics & numerical data , Education, Medical/statistics & numerical data , Schools, Medical/statistics & numerical data , Colombia , Humans , UniversitiesABSTRACT
BACKGROUND: Long-term use of opioids to treat chronic pain incurs serious risks for the individual-including misuse, abuse, addiction, overdose and death-as well as creating economic, social, and cultural impacts on society as a whole. Chronic pain and substance use disorders are often co-morbid with other medical problems and at the present time, primary care clinicians serve most of this population. Primary care clinicians would benefit from having alternatives to opioids to employ in treating such patients. METHOD: We electronically searched different medical databases for studies evaluating the effect of nonpharmacological treatments for chronic pain. We describe alternative approaches for the treatment of chronic pain and cite studies that provide substantial evidence in favor of the use of these treatments. RESULTS: Cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness-based programs have well-documented effectiveness for the treatment of chronic nonmalignant pain. Integration of such behavioral health therapies into primary care settings may optimize health resources and improve treatment outcomes. CONCLUSION: Evidence-based psychotherapy for chronic pain has established efficacy and safety and improves quality of life and physical and emotional functioning. Such interventions may be used as an alternative or adjunct to pharmacological management. Chronic opioid use should be reserved for individuals undergoing active cancer treatment, palliative care, or end-of-life care.
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Acceptance and Commitment Therapy/methods , Chronic Pain/therapy , Cognitive Behavioral Therapy/methods , Mindfulness/methods , Outcome Assessment, Health Care , HumansABSTRACT
PURPOSE OF REVIEW: Osteoarthritis (OA) is the most common form of arthritis that is characterized by loss of articular cartilage and new formation of bone. Pain and functional disability are common features that lead to disability and poor quality of life. This review discusses the current state of knowledge concerning the treatment of pain in OA, with a focus on pharmacological treatments. This includes the use of non-steroidal anti-inflammatory drugs, acetaminophen, and other disease-modifying agents. RECENT FINDINGS: An updated review of the role of anti-nerve growth factor monoclonal antibodies and other novel agents in the treatment of OA is also presented. In addition, a discussion of current research on biological agents such as small molecules targeting ion channels and G protein-coupled receptors is included. These new pharmacological interventions expand the frontier for treatment of patients with OA. The purpose of the review is to provide clinicians with information about the effectiveness of different pharmacological modalities in order to enable them to make the best choices for the treatment of their patients.
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Acetaminophen/therapeutic use , Analgesics, Non-Narcotic/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Osteoarthritis/drug therapy , Pain/drug therapy , Humans , Osteoarthritis/complications , Pain/etiology , Quality of LifeABSTRACT
Chronic pain in youth is a common experience that is often under-reported, under-diagnosed, and frequently untreated. Biological processes, psychological factors, and socioeconomic determinants play important roles in the perception of pain in youth. Comorbid anxiety and depression are common and may exacerbate clinical presentation. A mental health-centered multidisciplinary approach is necessary for these patients with emphasis on psychosocial interventions to alleviate suffering and foster autonomy by treating pain and comorbid psychiatric illnesses. [Journal of Psychosocial Nursing and Mental Health Services, 56(11), 13-16.].
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Anxiety Disorders/psychology , Chronic Pain/therapy , Depressive Disorder/psychology , Mental Health Services , Adolescent , Comorbidity , Humans , Pain Management/methods , Socioeconomic FactorsSubject(s)
Emigrants and Immigrants , Physicians , Psychiatry , Adult , Australia , Humans , United StatesSubject(s)
Forecasting , Foreign Medical Graduates , Internship and Residency , Psychiatry/education , Emigration and Immigration/legislation & jurisprudence , Foreign Medical Graduates/legislation & jurisprudence , Foreign Medical Graduates/statistics & numerical data , Humans , Prejudice , United States , WorkforceABSTRACT
OBJECTIVE: Antenatal stress is highly prevalent globally and is associated with adverse physical and psychiatric morbidities and adverse neonatal outcomes. However, the burden of antenatal stress and its psychosocial predicators have not been explored in context of the Pakistani sociocultural environment. The present study explores the prevalence of antenatal stress and its association with gender of offspring, socioeconomic background, cultural beliefs, and access to healthcare in the province of Punjab, Pakistan. RESULTS: There was a total of 516 pregnant women. Antenatal stress was measured by the Perceived Stress Scale (PSS). The mean score of the respondents on the Perceived Stress Scale was 7.55 (3.43). A total of 218 (42.2%) respondents reported higher stress levels. Logistic regression analysis (backward method) yielded a significant model predicting high stress levels. According to it, low family income, unplanned pregnancy, increasing number of children, less autonomy in decision making, marital problems, harassment, desire to have a male offspring, and the history of birth complications, attended by midwives were associated with high stress levels.
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Delivery, Obstetric/statistics & numerical data , Developing Countries/statistics & numerical data , Home Childbirth/statistics & numerical data , Personal Autonomy , Pregnancy Complications/epidemiology , Stress, Psychological/epidemiology , Adolescent , Adult , Cross-Sectional Studies , Family Relations/ethnology , Female , Humans , Pakistan/epidemiology , Pregnancy , Pregnancy Complications/ethnology , Prevalence , Stress, Psychological/ethnology , Young AdultABSTRACT
OBJECTIVES: We examined the association of bullying experiences with depressive symptoms and psychosocial functioning among children and adolescents in rural Pakistan. A total of 452 school-going children in Nawabshah, Pakistan were conveniently interviewed to assess rates of bullying experiences and severity of depressive symptoms. Depressive symptoms were assessed using the Patient Health Questionnaire for Adolescents. RESULTS: Experience of victimization was reported by 130 (28.8%) and perpetration by (146, 32.3%). A total of 162 (35.80%) reported mild depressive symptoms, 88 (19.50%) moderate, 33 (7.30%) moderately severe and 19 (4.20%) severe depressive symptoms. Age was not associated with patterns of bullying other than pure bully perpetration (.12, P = .024). Both victims and perpetrators of bullying experienced adverse emotional and social consequences. Bully-perpetrators exhibited the greater severity of depressive symptoms due to distress in psychosocial functioning.
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Bullying/statistics & numerical data , Crime Victims/statistics & numerical data , Depression/epidemiology , Depressive Disorder/epidemiology , Stress, Psychological/epidemiology , Adolescent , Child , Cross-Sectional Studies , Female , Humans , Male , Pakistan/epidemiology , Schools/statistics & numerical data , Severity of Illness IndexABSTRACT
PURPOSE:: Pain is highly prevalent in advanced cancer and requires aggressive management. However, pain management in cancer is minimally investigated in Pakistan. This cross-sectional study explores the adequacy of pain management in patients with advanced stage cancer in Pakistan. METHOD:: From January 2017 to May 2017, a cross-sectional study was conducted at Mayo Hospital, Lahore, Pakistan. A total of 218 patients with cancers were interviewed, and 136 patients with pain ≥5 on a Numerical Rating Scale for pain were included in the study. Demographic of patients and clinical characteristics of tumors were also evaluated. RESULTS:: Only about one-third of the patients with advanced cancer reported adequate pain management. Chi-square test, χ2 (1, n = 136) = 33.038, P < .05, indicated that pain scores were inversely associated with pain control; inadequate pain control was observed in patients with higher pain score and vice versa. Of the 55.88% of patients who were prescribed morphine, only 6 patients were compliant with treatment recommendations. Most patients were prescribed nonopioid medications and tramadol and codeine, which are weak opioid medications. CONCLUSION:: The rate of undertreatment of cancer pain in Pakistan is alarming. Inadequate clinicians' training, patients' and caregivers' beliefs, lack of availability of opioid medications, and socioeconomic factors are some of the barriers to effective pain control. A multidisciplinary team approach is necessary to follow the World Health Organization pain ladder guidelines for the treatment of cancer pain.
Subject(s)
Analgesics, Opioid/therapeutic use , Cancer Pain/drug therapy , Pain Management/methods , Pain Management/statistics & numerical data , Palliative Care/methods , Terminal Care/methods , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Pakistan , Young AdultABSTRACT
Background: The incidence rates of heart failure (HF) and chronic pain increase with age. In the geriatric population, both disorders often coexist and pose a challenge to clinicians in treating them simultaneously. Methods: We conducted an online literature search for reports of the heart failure effects of pharmacological treatments for chronic pain. Results: Topical pain medications are favored agents because of their efficacy, tolerability, and favorable side-effect profile. Acetaminophen is a preferred oral medication for the treatment of pain in patients with HF. Due to deleterious effects including HF, the long-term use of oral nonsteroidal anti-inflammatory drugs and gabapentinoids are discouraged. Conclusion: Prescribers should thoroughly consider the risk-benefit ratio and individual patient-risk profile before instituting pharmacological treatment for chronic pain in patients with HF.
ABSTRACT
Anxiety disorders are the most prevalent psychiatric disorders among youth, with prevalence rates ranging from 25 to 32 percent. These disorders are under-recognized and often undertreated in this population. Anxiety disorders in youth exhibit a chronic and persistent course of symptoms with a higher risk of comorbidities, functional impairment, and worsening of severity. The early recognition and treatment of anxiety disorders in children and adolescents are vital for better long-term outcomes. This article summarizes the evidence-based pharmacologic treatments for mixed anxiety disorders including generalized anxiety disorder, social anxiety disorder, and separation anxiety disorder in children and adolescents based on case reports, case series, open-label trials, and randomized, controlled trials.
ABSTRACT
In December 2017, my mother was diagnosed with an end-stage pancreatic cancer. In the following weeks, she had to be taken to the emergency room frequently due to worsening infections, electrolyte imbalance, and vertigo, which often led to delirium. The doctors treating her were well qualified but lacked education and training about palliative and end-of-life care issues, which was reflected in their clinical practice. They kept treating her medical conditions as if she could be cured; no one recommended comfort measures only. After much deliberation and with some degree of hesitation, I raised the idea of palliative care with the rest of my family. Asking for palliative care-that is, accepting that the medical treatments were not working-sounded like the antithesis of my clinical work as a doctor and my duty as a son. To my surprise, my family agreed; we refused yet another hospital admission and brought her home. She has been spending the last few months in the comfort of her home being cared for by her loving family.
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Hospices , Hospitalization , Palliative Care/methods , Terminal Care/methods , Female , Hospice Care , Humans , Narration , Palliative Care/ethics , Palliative Care/standards , Pancreatic Neoplasms/therapy , Terminal Care/ethics , Terminal Care/standardsABSTRACT
Chronic pain is estimated to occur in from 5.5% to 33% of the world's adult population (Gureje et al., 1998). Chronic pain is frequently treated with opiates, which has produced an opiate addiction crisis (Dowell et al., 2016). Several non-pharmacological treatment alternatives can help manage chronic pain. There is moderate evidence that mindfulness-based interventions (MBIs) such as meditation, yoga, and stress reduction lower the perception of pain, increase mobility, improve functioning and well-being. By integrating MBIs and other therapeutic interventions in a multi-disciplinary pain management plan, clinicians can improve treatment outcomes and potentially decrease pain-related medication utilization.
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Chronic Pain/therapy , Mindfulness/methods , Pain Management/methods , HumansABSTRACT
Pain insensitivity disorders are rare; however, when individuals are insensitive to pain, they are significantly more vulnerable to physical injuries, with higher morbidity and mortality rates, compared with the general population. The authors present the case of an 11-month-old male infant with SCN 9A gene mutation that resulted in congenital insensitivity to pain, while his mother, with a different mutation of the same gene, had hypersensitivity to pain. This is a rare familial presentation of the extreme ends of pain sensitivity, and might be the first such example in medical literature. There is little available information regarding the treatment of pain insensitivity disorders. The authors provide a brief discussion regarding diagnosis (including differentials), known etiology, and treatment of congenital insensitivity to pain, of which a multidisciplinary treatment approach is recommended.