“Objective: To estimate the prevalence of and risk factors for opioid abuse/dependence in long-term users of opioids for chronic pain, including risk factors for opioid abuse/dependence that can potentially be modified to decrease the likelihood of opioid abuse/dependence, and non-modifiable risk factors for opioid abuse/dependence that may be useful for risk stratification when considering prescribing opioids.
Methods: We used claims
data from two disparate populations, one national, commercially insured population (HealthCore) and one state-based, publicly insured (Arkansas Medicaid). Among users of chronic opioid LY3023414 purchase therapy, we regressed claims-based diagnoses of opioid abuse/dependence on patient characteristics, including physical health, mental health and substance abuse diagnoses, sociodemographic factors, and pharmacological risk factors.
Results: Among users of chronic opioid therapy, 3% of both the HealthCore and Arkansas Medicaid samples had a claims-based opioid abuse/dependence diagnosis. There was a strong inverse relationship between age and a diagnosis of opioid abuse/dependence. Mental health and substance use disorders were associated with an increased risk of opioid abuse/dependence. Effects of substance use disorders were especially strong, although mental health disorders were more common. Concerning opioid exposure; lower days supply, lower average doses, and use of Schedule
III-IV opioids only, were all associated with lower likelihood of a diagnosis of opioid abuse/dependence.
Conclusion: see more Opioid abuse and dependence are diagnosed in a small minority of patients receiving chronic opioid therapy, but this may under-estimate actual misuse. Characteristics of the patients and of the opioid therapy itself are associated with the risk of abuse and dependence. (C) 2010 GSK3326595 ic50 Elsevier Ireland Ltd. All rights reserved.”
“Nontraumatic coma in childhood is an important pediatric emergency with a wide range of primary etiologies. This prospective descriptive study of 100 consecutive pediatric nontraumatic coma cases was done to identify etiology, clinical
profile, and predictive outcome in a pediatric emergency department at a tertiary care university hospital. Most frequent etiologies were metabolic (33%), central nervous system infections (28%), and intracranial hemorrhage (13%). In the emergency department, 50% of those patients died. Hypothermia, hypotension, flaccidity, and poor Glasgow coma scale at admission correlated significantly with mortality. After 48 hours of admission, poor pulse volume, poor Glasgow coma scale, abnormal respiratory pattern/apnea, and seizures correlated significantly with mortality. On logistic regression, poor Glasgow coma scale at admission, abnormal respiratory pattern, and seizures after 48 hours of admission were independent significant predictors of mortality.