Clinical and Demographical Characteristics of Patients with Medication Overuse Headache in Argentina and Chile: Analysis of the Latin American Section of COMOESTAS Project.

BACKGROUND: Data on the characteristics of Medication Overuse Headache (MOH) in Latin American (LA) are scarce. Here we report the demographic and clinical features of the MOH patients from Argentina and Chile enrolled in the multinational COMOESTAS project in the period 2008-2010. METHODS: The LA population was formed by 240 MOH subjects, 110 from Chile and 130 from Argentina, consecutively attending the local headache centres. In each centre, specifically trained neurologist interviewed and confirmed the diagnosis according to the ICHD-II criteria. A detailed history was collected on an electronic patient record form. RESULTS: The mean patient age was 38.6 years, with a female/male ratio of 8:2. The mean time since onset of the primary headache was 21 years, whereas duration of MOH was 3.9 years. The primary headache was migraine without aura in 77.5 % and migraine with aura in 18.8 %. Forty two % of the patients self-reported emotional stress associated with the chronification of headache; 43.8 % reported insomnia. The most overused medications were acute drug combinations containing ergotamine (70 %), NSAIDs (33.8 %) and triptans (5.4 %). CONCLUSION: Though little described, MOH is present also in LA, where it affects mostly women, in the most active decades of life. Some differences emerge as regards the demographic and clinical characteristics of MOH in this population as compared to Europe or Northern America. What seems more worrying about MOH in Argentina and Chile is that most patients overuse ergotamine, a drug that may cause serious adverse events when used chronically. These findings once more underscore the importance of properly diagnose and treat MOH.

Medication overuse headache in Europe and Latin America: general demographic and clinical characteristics, referral pathways and national distribution of painkillers in a descriptive, multinational, multicenter study.

BACKGROUND: Medication overuse headache (MOH) is a very disabling and costly disorder due to indirect costs, medication and healthcare utilization. The aim of the study was to describe general demographic and clinical characteristics of MOH, along with the national referral pathways and national painkillers distribution in several European and Latin American (LA) Countries. METHODS: This descriptive cross-sectional observational study included 669 patients with MOH referred to headache-centers in Europe and LA as a part of the COMOESTAS project. Information about acute medication and healthcare utilization were collected by extensive questionnaires, supplemented with structured patient interviews. RESULTS: Triptans were overused by 31 % European patients and by 6 % in LA (p < 0.001), whereas ergotamines were overused by 4 % in Europe and 72 % in LA (p < 0.001). Simple analgesics were overused by 54 % in Europe and by 33 % in LA (p < 0.001), while combination-analgesics were more equally overused (24 % in Europe and 29 % in LA). More European patients (57 %) compared with LA patients (27 %) visited general practitioners (p < 0.001), and 83 % of European patients compared to 38 % in LA consulted headache specialists (p < 0.001). A total of 20 % in Europe and 30 % in LA visited emergency rooms (p = 0.007). CONCLUSION: There are marked variations between LA and Europe in healthcare pathways and in acute medication overuse regarding patients with MOH. This should be considered when planning prevention campaigns against MOH.

[Survey on moral judgment criteria among medical students]. / Criterios de juicio moral de estudiantes de Medicina, según el Modelo Intuitivo Social.

BACKGROUND: The evaluation of moral judgment criteria in medical students is important to develop effective educational programs in bioethics. AIM: To compare priority judgment criteria and moral judgment tendency in medical students of first and fifth grade. MATERIAL AND METHODS: The Moral Foundations Questionnaire (MFQ30), to identify moral criteria was applied to 259 students, 63.7% from first year and 50.2% women. RESULTS: The dominant moral tendency both in first and fifth year students was liberal. Justice and compassion were the most important criteria in men and in women, respectively. Respect towards authority and sanctity were the least important criteria in women and men, respectively. CONCLUSIONS: The implications for moral psychology and medical education of these results are discussed.

Criterios de juicio moral de estudiantes de Medicina, según el Modelo Intuitivo Social / Survey on moral judgment criteria among medical students

Background: The evaluation of moral judgment criteria in medical students is important to develop effective educational programs in bioethics. Aim: To compare priority judgment criteria and moral judgment tendeney in medical students of first and fifth grade. Material and Methods: The Moral Foundations Questionnaire (MFQ30), to identify moral criteria was applied to 259 students, 63.7% from first year and 50.2% women. Results: The dominant moral tendeney both in first and fifth year students was liberal. Justice and compassion were the most important criteria in men and in women, respectively. Respect towards authority and sanctity were the least important criteria in women and men, respectively. Conclusions: The implications for moral psychology and medical education of these results are discussed.

[Contribution of epigenetics to understand human development]. / Aportes de la epigenética en la comprensión del desarrollo del ser humano.

Epigenetics refers to the study of how genes produce their effect on the phenotype of the organism. This article is a review on the scope and importance of recently discovered epigenetic mechanisms on human development and their relationship to perinatal epidemiological issues. It shows a general view and present concepts about epigenetics and its contribution to the comprehension of several physiologic and pathological conditions of human beings. Secondly, it analyzes the evidence coming from epidemiological and animal studies, about the influence of events that occur in the perinatal and early postnatal periods on adult life and the possible epigenetic mechanisms involved. Lastly, it underscores the implications of these results of future research and the design of public policies that take into account the importance of events in early life in the future development of individuals.

Aportes de la epigenética en la comprensión del desarrollo del ser humano: [revisión] / Contribution of epigenetics to understand human development: [review]

Epigenetics refers to the study of how genes produce their effect on the phenotype of the organism. This article is a review on the scope and importance of recently discovered epigenetic mechanisms on human development and their relationship to perinatal epidemiological issues. It shows a general view and present concepts about epigenetics and its contribution to the comprehension of several physiologic and pathological conditions of human beings. Secondly, it analyzes the evidence coming from epidemiological and animal studies, about the influence of events that occur in the perinatal and early postnatal periods on adult life and the possible epigenetic mechanisms involved. Lastly, it underscores the implications ofthese results of future research and the design of public policies that take into account the importance of events in early life in thefuture development of individuals.

[Ethical problems in medical services from the patients' point of view]. / Prevalencia de problemas éticos en Servicios de Medicina, desde la perspectiva del paciente.

BACKGROUND: There is a paucity of information on the perception of patients about ethical issues in medical practice. AIM: To determine the type and frequency of ethical problems perceived by patients hospitalized in public and private hospitals. MATERIAL AND METHODS: Eighty eight subjects aged 65 years (48% women), admitted to a public hospital and 44 subjects aged 59 years (52% women) admitted to a private clinic answered a survey about ethical problems. The main issues covered were medical information management, participation in decision making and intimacy of patients. RESULTS: Fifty three percent of patients perceived at least one ethical problem. Patients admitted to the public hospital perceived more communication and intimacy problems than their peers admitted to a private clinic. CONCLUSIONS: Approximately half of the interviewed patients acknowledged the presence of ethical problems, especially in the communication and intimacy areas).