Abstract not available

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Lifetime prevalence estimates of psychotropic medicine use as well as prevalence of DSM-IV prescription drug use disorders from the baseline investigation of the Early Developmental Stages of Psychopathology (EDSP) Study are presented. Use of prescription medication at some time in their life was reported by 27.4% of the respondents. Illicit use of prescription drugs, which means an intake without medical legitimation, was reported by 4.5% of the sample. The findings suggest that abuse of and dependence on prescription drugs, with most cases reporting polysubstance use, is quite rare in the 14- to 24-year-olds. DSM-IV abuse was more prevalent than dependence (0.5 vs. 0.3%). In general, women reported higher prevalence rates of prescription drug use, whereas men reported higher prevalence rates of prescription drug disorders. This result suggests that men have a higher risk to develop a substance-use-related disorder.

Thesis (M.S.)--University of South Florida, 2009. / Title from PDF of title page. Document formatted into pages; contains 35 pages. Includes bibliographical references.

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Old people in general, and those affected by dementia disorders in particular, are more sensitive to drug side effects than younger people. Despite this, the use of nervous system drugs and analgesics among old people is common, and has increased in recent years. Institutional geriatric care accommodates people who need round-the-clock supervision and care, due to somatic, psychiatric, cognitive or behavioral symptomatology. A majority of those living in institutional geriatric care suffers from dementia disorders. This thesis is based on three different data collections. Two large cross-sectional studies, the AC1982 and AC2000 data collections, including all those living in institutional geriatric care in the county of Västerbotten in May 1982 and 2000 respectively (n=3195 and n=3669) and one study, the GERDA/Umeå 85+ data collection, including a sample of very old people, living at home and in institutions (n=546), in the municipalities of Umeå, Sweden and Vaasa and Mustasaari, Finland, in 2005-2006. The use of psychotropic drugs and analgesics was common among old people living in geriatric care and among very old people in general. A higher proportion of people with dementia received certain nervous system drugs, such as antipsychotic drugs. The use of antipsychotic drugs among people with cognitive impairment living in geriatric care was found to be correlated to several behaviors and symptoms that are not proper indications for antipsychotic drug use, and also factors related more to the staff and the caring situation. Over the course of eighteen years, from 1982 to 2000, there has been a manifold increase in the use of antidepressants, anxiolytics and hypnotics in geriatric care, but the use of antipsychotics had decreased slightly. During the same time, the prevalence of several depressive symptoms decreased significantly, correcting for demographical changes. One analysis of calculated numbers needed to treat, however, indicated poor remission rates, suggesting that even better results might be achievable. The prevalence of depressive symptoms among people with moderate cognitive impairment remained unchanged between 1982 and 2000, despite the fact that about 50% were receiving treatment with antidepressants in 2000. One possible explanation might be that depressive symptoms have different etiologies in different stages of a dementia disorder. Approximately a quarter of the people experiencing pain in geriatric care were not receiving any regular analgesic treatment. One possible reason might be misconceptions among the caring staff regarding whether or not the residents were receiving analgesic treatment. Such misconceptions were found to be common. In conclusion, psychotropic and analgesic drug use among old people in geriatric care, and very old people in general, was found to be common and in many cases possibly inappropriate. The use of antipsychotics among people with dementia deserves particular concern, because of the high risk of severe adverse events and the limited evidence for positive effects. The use of antidepressants, on the other hand, might have contributed to a lower prevalence of depressive symptoms among old people.

El dolor es un síntoma muy común y la práctica asistencial diaria nos muestra que, a pesar de todas las herramientas que tenemos para combatirlo, aún somos incapaces de controlarlo adecuadamente en muchos pacientes. La evaluación del dolor es de vital importancia para el diagnóstico y el tratamiento de las enfermedades que cursan con éste síntoma y, aún más, cuando el síntoma se convierte en la enfermedad. En el presente trabajo se describen varios estudios en los cuales se valoraron la prevalencia y características del dolor, y en el que se ha desarrollado un instrumento para la valoración del dolor hospitalario y la satisfacción de los pacientes. Posteriormente lo hemos utilizado para evaluar si el dolor en los pacientes hospitalarios está bien controlado y, de no ser así, intentar establecer las razones por las cuales no lo está. Los objetivos del presente trabajo fueron la construcción de un instrumento para evaluar la satisfacción de los pacientes con el tratamiento analgésico. Posteriormente se determinó la prevalencia y las características del dolor en una muestra de pacientes hospitalizados, así como los métodos de valoración del mismo. Inicialmente se realizó una prueba piloto con el nuevo instrumento en 255 pacientes, la cual mostró que las puntuaciones de dolor en los pacientes hospitalizados eran elevadas. Además, la intensidad del dolor era incongruente con la satisfacción de los pacientes con el tratamiento recibido, ya que ésta estaba más relacionada con el trato recibido por los profesionales sanitarios que con el alivio del dolor. Posteriormente se utilizó el mismo instrumento en 1675 pacientes de 15 hospitales catalanes, para confirmar y ampliar los resultados de la primera investigación. Al principio se confirmó que la prevalencia del dolor era elevada y que inclusive era mayor durante el ingreso y al alta que a la llegada al hospital. Para analizar las causas de este hallazgo se valoró la utilización de analgésicos en los hospitales. El estudio demostró que, a pesar del alto número de prescripciones analgésicas, de que el tipo de analgésico era el adecuado y de x que las dosis utilizadas eran las correctas, la mayoría de los pacientes presentaba valoraciones de intensidad de dolor más altas de lo deseable ya que solamente el 1% de los pacientes tenían prescritas dosis de rescate analgésicas y que las pautas analgésicas no se cumplían rigurosamente. Posteriormente se valoró el registro de la intensidad del dolor, y se observó que más de la mitad de los pacientes carecían de un registro de la intensidad del dolor y que esta práctica, valorada como indicador de calidad asistencial, no se cumplía de manera rutinaria. En conclusión, hemos observado que los pacientes hospitalizados presentan unas puntuaciones de dolor elevadas, que las recomendaciones para el tratamiento analgésico hospitalario no se cumplen rigurosamente y que no se registra la intensidad del dolor en las historias clínicas de forma sistemática. Sorprendentemente, a pesar de esos hallazgos, los pacientes refieren estar satisfechos con el alivio del dolor. Por esta razón continuamos con la investigación con el propósito de estimar si es la valoración del dolor, la falta de rigor en el seguimiento de las pautas analgésicas hospitalarias o bien las creencias y experiencias previas de los pacientes las que nos llevan a tener esta alta prevalencia de dolor en los pacientes hospitalizados. / Pain is a common symptom and many evidences show us that, in spite of all the tools we have to manage it, we are unable to do so. Pain evaluation is of great importance for the diagnosis and treatment of patients, and even more when the pain symptom becomes the disease. Within the present work, several studies have been conducted in order to evaluate the prevalence and characteristics of pain in the hospital setting. We also have developed a tool for the evaluation of pain and patient satisfaction. Subsequently we have used this tool to appraise if pain is adequately handled and if otherwise, try to establish the main reasons for this finding. The main objective of this work was the construction of an instrument to evaluate patients’ satisfaction with the management of pain, and to assess the prevalence and characteristics of pain in a sample of patients in a hospital setting, as well as the methodology used to assess them. Initially a pilot test of the tool was performed in 255 patients, which showed that the pain scores in inpatients were too high. Moreover, pain intensity was incongruent with patients’ satisfaction with pain relief. Yet, it had a higher correlation with satisfaction with health workers than with satisfaction with the received treatment. Next, the same tool was used with three additional questionnaires in 1675 admitted patients into 15 hospitals in Catalonia, in order to look deeper into the results of the first study. For starters, it was confirmed that pain prevalence was too high and higher during hospitalization and at discharge than before admittance. To analyze the cause of these findings the analgesic use in the hospital was examined. The results showed that, in spite of the high number of analgesic prescriptions and the use of the correct type of analgesic, most of the patients had high pain intensity scores; only 1% of the patients had rescue analgesia prescribed and the analgesic regimes were not properly administered. Subsequently, pain intensity registration in the medical record was xii evaluated, showing that that more than half of patients did not have their pain intensity registered on the medical chart. This practice is valued as an indicator of medical assistance quality, and even though it was not followed as a routine in the hospitals. In conclusion, we have observed that hospital inpatients show high pain intensity scores, the recommendations for analgesic use in a hospital setting are not rigorously followed, and pain intensity scores are not systematically registered in the medical charts. Surprisingly, in spite of theses findings, patients seem to be satisfied with the analgesic treatment. In consequence, we are continuing with the research with the aim of figuring out if the high prevalence of pain in Catalonian hospitals is due to pain evaluation, the absence of rigor in following the analgesic prescriptions or maybe the patients’ previous experiences and beliefs.

Thesis (M.S.)--University of South Florida, 2007. / Title from PDF of title page. Document formatted into pages; contains 52 pages. Includes bibliographical references.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 4 uppsatser.

Orientador: Eduardo Hochuli Vieira / Banca: Élio Hitoshi Shinohara / Banca: Idelmo Rangel Garcia Júnior / Banca: Eduardo Hochuli Vieira / Resumo: A dor pode fazer parte ou não do processo inflamatório e significar a presença de dano ao organismo. É por meio dela que a maioria das afecções se manifesta. O cirurgião-dentista é responsável pela orientação ao paciente a respeito da dor esperada e sobre a estratégia de suavizá-la. Esse trabalho tem por objetivo elaborar um manual para que se possa fornecer aos clínicos e aos alunos de graduação informações e embasamento necessário para realizar uma prescrição medicamentosa adequada para a dor aguda, sendo sugeridos alguns protocolos de atendimento. / Abstract: Pain represents a mechanism which can participate or not of the inflammatory process causing injury to the organism. Most of the affections are manifested through the pain. The dental surgeon is responsible for the patient's orientation regarding the expected pain and also about the strategy to soothe this expectation. This study aims to elaborate a practical manual in order to offer to the dental professionals and also to the undergraduate students information and enough background to accomplish an adequate prescription for the acute pain suggesting suitable clinical protocols. / Mestre