ABSTRACT
Objective. To determine the relationship between some clinical and psychosocial factors and the quality of life of a group of diabetic patients. Method. A cross sectional study was done with diabetic patients attending a primary care unit. Quality of life was evaluated with a verbal global scale. The clinical and psychosocial factors studied were: type of diabetes, duration of the disease, type of treatment, associated diseases, complications, metabolic control (glycosylated hemoglobin), treatment compliance, coping styles, negative attitude to disease, social support, and socioeconómica! level. Results. We interviewed 173 patients, most women (73%), most type 2 (95%). We found that being a woman was a factor negatively related to quality of life. Of clinical variables, only duration of disease was slightly correlated with quality of life (-0.14). Psychological and social variables were significantly correlated with quality of life. We performed a stepwise multiple regression analysis and we found that seven psychosocial variables explained 30% of variance of quality of life. Conclusions. Our results indicate that clinical factors did not correlate with quality of life. It is the way the patient lives with diabetes and not the diabetes by itself what affects the quality of life of diabetic patients. Some psychological and social variables were significantly related to quality of life of these patients.
Objetivo. Determinar la relación de algunos factores clínicos y psicosociales con la percepción global de la calidad de vida de pacientes con diabetes. Material y métodos. Se realizó un escrutinio transversal, de pacientes con diabetes en una clínica de medicina familiar del Seguro Social. La calidad de vida se evaluó con una escala global verbal. Se evaluaron las siguientes variables clínicas: tipo de diabetes, tiempo de evolución, tipo de tratamiento, enfermedades asociadas, complicaciones y el control metabólico. Las variables psicosociales estudiadas fueron: el conocimiento de la enfermedad, el apego al tratamiento, las formas de contender con la enfermedad, el impacto emocional producido por la misma y el apoyo social. Los pacientes fueron entrevistados con instrumentos previamente validados. Se determinó la hemoglobina glucosilada. Resultados. Fueron entrevistados 173 pacientes (73% mujeres), con un promedio de edad de 50.5 años para las mujeres y 51.5 para los hombres. La mayoría (95%) tenía diabetes tipo 2. Se determinó la relación entre las variables estudiadas y la calidad de vida. En el análisis bivariado se encontró que las mujeres tenían significativamente una menor calidad de vida (62.8 vs. 69.5). De los factores sociales, el nivel socioeconómico, el apoyo social y tener una pareja, correlacionaron positivamente con la calidad de vida. De los factores psicológicos, las formas de contención (evitación y resignación), el rechazo a la enfermedad y el impacto emocional correlacionaron negativamente con la calidad de vida. De las variables clínicas, sólo el tiempo de evolución tuvo una correlación discreta (r = - 0.14). En el análisis multivariado, siete variables psicosociales explicaron 30% de la varianza en la calidad de vida. Conclusiones. Nuestros resultados indican que aparentemente los factores clínicos influyen poco sobre la calidad de vida. Consideramos que la calidad de vida, medida de forma global, subjetiva, depende en un gran porcentaje de la forma en la que los pacientes viven la enfermedad más que de las características de la misma.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Diabetes Mellitus/psychology , Quality of Life , Cross-Sectional StudiesABSTRACT
Introducción. Objetivo: evaluar la eficacia y seguridad de clorhidrato de metilfenidato de liberación controlada en sistema OROS (MPH OROS, Concerta®), en niños con trastorno por déficit de atención con hiperactividad (TDAH) previamente tratados con metilfenidato de liberación inmediata (MLI). Material y métodos. Se incluyeron 97 niños entre 6 y 16 años, con diagnóstico de TDAH de cualquier subtipo, según los criterios del DSM-IV, con tratamiento previo por lo menos 4 semanas antes con MLI en dosis de 10 a 60 mg por día, y que presentaban buena respuesta clínica. Se excluyeron niños con otras enfermedades psiquiátricas o metabólicas. La dosis de MPH OROS se administró una vez al día entre 18 a 54 mg. Se utilizaron escalas de impresión global clínica (CGI), Escala Iowa Conners para padres y maestros, Escala de Interacción de Pares, efectos sobre sueño y apetito, escala Yale de tics, somatometría y registro de eventos adversos en cada visita. Resultados. De los 97 niños, abandonaron 26 [4 (4%) por respuesta insuficiente y 2 (2%) por hiporexia y calambres]. Se analizaron 71 pacientes, 64 (90%) masculinos, 7 (10%) femeninos, con edad promedio 9 ± 2 años, con peso inicial promedio 33.8 + 9.7 kg y peso final 34.7 + 9.9 kg. La dosis de MPH OROS fue de 18 mg en 64% de los pacientes. Ningún paciente desarrolló tics de novo. La mejoría clínica de los pacientes acorde a las escalas de Iowa Conners y de pares fue significativa (P =0.001, t de Student). Los eventos adversos más comunes fueron cefalea (7%) e hiporexia (6%) leves y transitorios. Conclusiones. Estos resultados preliminares permiten indicar que MPH OROS es una buena alternativa para el manejo de los niños con TDAH y el cambio por MLI en algunos pacientes mostró una mejoría superior sin impacto negativo en sueño y apetito.
Introduction. Objective: to assess the efficacy of controlled release OROS MPH (Concerta®) in children with attention deficit/hyperactivity disorder (ADHD) previously treated with immediate release methylphenidate (MPH IR). Material and methods. Children with ADHD, all subtypes, ages 6 to 12 years, with good response to MPH, were switched from IR MPH to OROS MPH once a day (qd in the morning) at 18 to 54 mg/day in a 1 year follow-up trial.The primary end-points for analysis were the last available patient visit using last observation carried forward.The scales used were CGI,Yale's for tics, somatometry, appetite and sleep evaluation from parents, and adverse events record. Results.We included 97 patients, 26 drop-outs [4 (4%) for treatment failure and 2 (2%) hyporexia and cramps]. Of the 71 patients, 64 (90%) male and 7 (10%) female, mean age 9 + 2 years, initial mean weigth 33.8 + 9.7 kg and final 34.7 + 9.9 kg (normal growth). Children with OROS MPH showed significantly greater reductions in core ADHD symptoms. On the basis of mean teacher and parents Iowa Conners and Peers interactions ratings were a significant improvement (P =0.001, Student t). CGI ratings were improvement as well.The most common adverse events were headache (7%) and hyporexia (6%) mild and transient. Conclusion. For the treatment of core ADHD symptoms, OROS MPH dosed qd were well tolerated and efficacy treatment and there were no negative impact on sleep and appetite.
ABSTRACT
resumen está disponible en el texto completo
Abstract: Women are especially vulnerable to anxiety and depressive disorders, as shown in the international literature and, in our country, in the National Survey of Psychiatric Epidemiology. However, it is important not only to identify the disorders as such, but also to identify the symptoms, that though not becoming a disorder generate illnesses in women and can respond to psychopharmacological or psychotherapeutic interventions. The Symptom Check List (SCL 90) is a widely used instrument. In this study, three groups of women were assessed: one group of the community (as reference group), a second one, of women diagnosed as depressed in a third level psychiatric institution, and another group of women with a temporomandibular disorder (TMD). The main objective of this study was to identify the psychometric characteristics of the SCL-90. The alpha of Cronbach was determined (internal consistency) by each one of the 9 subscales. The validity was determined through the following criteria: Validity of the SCL-90 as a method to detect depressed women. A ROC curve was made, comparing the depressed women and the women of the community. Validity of the SCL-90 as a measurement of depression. We hypothesized a high correlation with Beck's depression scale and Hamilton's depression scale. Sensitivity to change: effect size. We hypothesized that the greater effect would be in the depression subscale. For construct validity we compare the psychopathological profiles of the three groups of women. We hypothesized the existence of a gradient: the highest ratings in depressed women, the lowest in women of the community, and intermediate ratings in women with TMD. A factorial analysis was also carried out. Women older than 18 years of age were included, who were literate and accepted to participate in this study. They had no cognitive deficit (mental retardation, dementia, psychosis, states of confusion) or any other problem that would impede that they answer the surveys. The three groups were made up as follows: Women with TMD: Women with clinical diagnosis of Temporomandibular Disorder who went to an ambulatory service of Maxilofacial Surgery of the ISSSTEP (Social Security Hospi tal for State Government Employees), who had not had treatment for TMD during the past six months and who did not have degenerative arthritic illness. No previous psychiatric diagnosis. Depressed women: Women attending to the National Psychiatric Institute who were diagnosed with Major Depressive Disorder and were prescribed anti-depressive treatment. Women of the community: Mothers of the students at the secondary school Pablo Cassals, a field of work of the Community Psychiatric Service of the Psychiatric Hospital Fray Bernardino Alvarez Results: The interview was carried out with 289 women, 131 were depressed women, 96, women of the community, and 62, women with TMD. The mean (standard deviation) age was simi lar in the three groups: 36 (10), 37.7 (5.5), 37.6 (11.9) respectively Of the women with depression, 64% had a stable partner, 100% of the women in the community, and 61% of the women with TMD. 69% of the women with depression were dedicated to keeping house, 34% of the women with TMD, and 74% of the women of the community. Internal consistency was determined through Cronbach's alfa. The results of this analysis show us a high consistency of the instrument's nine subscales. Except for the subscale of paranoid symptoms in the women of the community, the alpha coefficients of all subscales in the 3 groups were higher than 0.7. Another form of establishing the validity of the instrument is through the determination of the cut-off point for patient identification. Through the ROC curve, 1.5 points in the subscale of depression was taken, as the best score to minimize the number of false positive and false negative results. As a measurement of depression, it was observed that the correlations of the subscales with Hamilton's depression scale and Beck's depression inventory had the highest correlations with the subscale of depression. The correlations with Beck's Inventory are higher than with Hamilton's scale of depression. This information supports the convergent validity of the subscale of depression with conventional instruments for its assessment. Another way of determining the validity of an instrument is to establish sensitivity to change. The size of the effect was calculated dividing the average of the difference (before-after) over the basal standard deviation of depressed women who participated in the longitudinal study. The size of the effect was higher in Hamilton's scale of depression and second in the subscale of depression, which indicates that there is a specific answer to a specific anti-depressive intervention. According to what has been hypothesized (construct validity), the highest ratings corresponded to the depressed women; the lowest to the women of the community, and the intermediate to the women with TMD. The differences between groups were statistically significant in each of the nine subscales and in the total indexes. The group of the community was significantly different from those of the depressed women and the women with TMD. The difference between these last two groups was also significant. In an exploratory factorial analysis of the 90 reactives, 87 had factorial loads higher than .40 in a first factor that explained 46.77% of the total variance of the SCL 90. Although 13 more factors with Eigen values higher than 1 were identified, the variance explained by each of them was lower than 5%; according to this technique, only one general factor is the best explanation for the checklist. The two reactives with small factorial loads were: "Do you believe that others should be blamed for your problems?", "Do you hear voices that others don't hear?" and "Excesive eating". Although the checklist was developed for the assessment of a psychopathological profile, some authors have proposed that it should be used as a measurement of general psychopathology. In this study, the checklist was evaluated as a method of assessing a psychopathological profile as originally proposed by Derogatis, as a method of assessing general psychopathology (with the three total indicators), and as a specific method of assessing depression. The information that most solidly supports the validity of the List's subscales is the differences in the profile that were observed among the three groups. The points in all the subscales were higher for women with TMD than those for the women of the community, but lower than in depressed patients; this shows that the psychological state of women with TMD tends to be similar to that of women with psychiatric diagnosis of depression. In this regard, the advantage of using the List to measure a profile is evident, and not only to assess general psychopathology The Symptom Checklist proved to have the psychometric characteristics appropriate to be used as an instrument to assess a psychopathological profile, to identify patients with depression, and to measure the intensity of depression. As an instrument to measure change, it is sensitive to psychopharmacological interventions. Although the size of the effect observed in the depression subscale is lower than that observed with the Hamilton scale, it is notably higher than the one observed with Beck's Depression Inventory. With these psychometric characteristics, it is possible to use the List in any type of research, including those that assess anti-depressive interventions.