"De todos os lados, eu me sentia culpada": o sofrimento mental de estudantes de medicina / "From all sides I felt guilty": the mental suffering of students at a medical school

Resumo: Introdução: O curso de Medicina é conhecido pela alta prevalência de estudantes diagnosticados com algum tipo de transtorno mental. O ingresso e a formação no curso são marcados por inúmeras modificações no estilo de vida que podem influenciar a saúde mental do indivíduo. Objetivo: Este estudo teve como objetivos compreender como se sentem os alunos de Medicina que relatam fazer acompanhamento psiquiátrico por transtorno mental e também identificar aspectos que influenciam o problema mental deles. Método: Trata-se de uma pesquisa qualitativa desenvolvida por meio de entrevistas semiestruturadas, guiadas por um roteiro de perguntas abertas que abordaram temáticas preestabelecidas de acordo com o objetivo da pesquisa. A seleção dos sujeitos se deu por meio da técnica bola de neve, em que o primeiro participante foi convidado a indicar outro aluno e assim sucessivamente, formando uma cadeia de referência. Os critérios de inclusão foram os seguintes: ser estudante de Medicina, estar em acompanhamento psiquiátrico e concordar em participar espontaneamente da pesquisa. As entrevistas foram audiogravadas, transcritas na íntegra e convertidas em narrativas para posterior categorização e análise do conteúdo. Resultado: Analisaram-se sete entrevistas, nas quais as experiências relatadas apontaram para sofrimentos mentais potencializados ao longo do curso. O recebimento do diagnóstico de transtorno mental e a realização de acompanhamento psiquiátrico e psicológico foram descritos como momentos de alívio e de maior compreensão individual. Contudo, o preconceito dos próprios estudantes quanto aos problemas mentais e a constatação desse estigma em seu entorno foram percebidos como causa para se postergar a busca por ajuda. Conclusão: Percebeu-se, por meio das experiências dos alunos de Medicina diante do sofrimento mental, o quanto o estigma é presente mesmo em um curso em que se esperam maior conhecimento e abertura sobre o tema, sendo esse um desafio a ser superado.

Abstract: Introduction: Medical school is renowned for a high prevalence of mental disorder diagnoses among students. Admission and training are marked by countless lifestyle changes that can influence the mental health of the individual. Objective: To understand how medicine students who report psychiatric care feel, and also to identify aspects that influence their own mental problem. Methods: This study is a qualitative research developed from semi-structured and audio-taped interviews. Participants were selected through the snowball technique, in which the first participant was invited to recommend another student and so on, building a chain of reference. The inclusion criteria were: to be a medical student; to attend psychiatric care and to voluntarily accept participation. The audio-recorded material was fully transcribed and converted into narratives for subsequent categorization and content analysis. Results: Seven interviews were analyzed, and the experiences reported pointed to mental suffering that accentuated throughout the medical course. Receiving the diagnosis of mental disorder and undergoing psychiatric and psychological care were described as moments of relief and greater self-understanding. However, the students' own prejudices about mental problems and the perception of this stigma in their surroundings were recognized as a reason for not seeking help earlier. Conclusion: The experiences of medical students who face mental suffering shed light on the degree of stigma even among students of a course in which greater knowledge and openness regarding the subject are expected. This remains a challenge to be overcome.

Validade e Concordância do registro em prontuário do uso de serviços da Rede de Atenção à Saúde por idosos / Validity and consistency of the entries in the Health Care Network's patient records for the use of services by the elderly

Resumo O objetivo deste artigo é verificar a validade e a concordância entre registros em prontuários e autorrelato do uso dos serviços de saúde por idosos usuários da Rede de Atenção à Saúde. Estudo observacional transversal de base populacional. Foram avaliados registros em prontuário e autorrelato de consultas médicas, odontológicas, visitas domiciliares, encaminhamentos para consultas no setor secundário e hospitalizações nos anos de 2015 e 2016. Foram analisados percentuais de concordância, estatística Kappa, sensibilidade, especificidade e valores preditivos para cada um dos itens. O maior percentual de concordância (81,93%) com Kappa significativo (p = 0,03) foi para o item "hospitalização". As consultas odontológicas apresentaram maior Kappa (k = 0,271), significativo (p = 0,01). As análises demonstraram alta especificidade nos registros de hospitalização (83%), e maior sensibilidade para visitas domiciliares (74%). Os valores preditivos positivos foram baixos para hospitalização (8%), e os negativos baixos para consultas médicas (17%), A baixa concordância entre o uso do serviço de saúde autorrelatado e registros em prontuário apontam para uma das possíveis causas da fragmentação da continuidade do cuidado.

Abstract The scope of this article is to verify the validity and consistency of entries in medical records and self-reporting about the use of the health services by elderly users of the Health Care Network. It involved a cross-sectional, population-based observational study. Entries in medical, dental, home visit, referral to the secondary sector and hospitalization appointment records for the years 2015 and 2016 were evaluated. The concordance percentage, Kappa coefficient, sensitivity, specificity and predictive values for each item were also analyzed. The highest concordance percentage (81.93%) with a significant Kappa coefficient (p = 0.03) was for hospitalization. The dentistry appointments revealed a higher Kappa coefficient (k = 0.271) with significance of p=0.01. The analyses showed high specificity in the hospitalization records (83%), and a greater sensitivity for home visits (74%). Positive predictive values were low for hospitalization (8%), and negative predictive values were low for medical appointments (17%). The low concordance between the use of the self-reported health service and entries in medical records highlight one of the possible causes of the fragmentation in continuity of care.

Reporte voluntario y anónimo de errores de medicación en pacientes hospitalizados en un Departamento de Pediatría / Voluntary and anonymous reporting of medication errors in patients admitted to the Department of Pediatrics

Objetivo. Evaluar reportes de errores de medicación en niños hospitalizados para determinar las frecuencias, causas y eventos adversos (EA). Métodos. Estudio prospectivo de reportes de errores de medicación de Terapia Neonatal (UCIN), Clínica Pediátrica (CP) y Terapia Pediátrica (UCIP). Se excluyeron reportes de pediatría ambulatoria y datos incompletos. Se evaluaron las variables relacionadas. Resultados. De 989 errores reportados en pediatría, los de medicación fueron 401 (41 %). De ellos, 353 (88 %) llegaron a los pacientes y 48 (12 %) fueron cuasierrores. El 42 % ocurrieron a la mañana; 24 %, tarde; 17 %, mañana y tarde, y 17 %, noche; diferencias no significativas (p = 0,18). El error más frecuente fue dosis equivocada, 118 (33,4 %). Los reportes de errores de prescripción fueron 160 (45 %); administración, 149 (42 %), y dispensación, 44 (2,5 %). Los errores de dosis fueron más frecuentes en la prescripción (p < 0,05). La UCIN reportó la mayor cantidad de errores, 179 (50 %); CP, 91 (25,5 %), y UCIP, 83 (24,5 %). Hubo un total de 91 EA reportados (22,5 %); la mayoría leves, 53 (58 %), y moderados, 31 (34 %). La UCIN reportó 53 EA (58 %); UCIP, 25 (27 %), y CP, 18 (19,7 %). No ocurrieron fallecimientos.Conclusión. La tasa de errores de medicación reportados en niños hospitalizados fue de 41 %. Los errores en las dosis de medicamentos fueron los más frecuentes. Hubo 91 EA; prevalecieron los leves (58 %); la UCIN reportó el mayor número (58 %).

Objective. To assess reports of medication errors in hospitalized children to establish their frequency, causes, and adverse events (AEs). Methods. Prospective study of medication errors reported at the Neonatal Intensive Care Unit (NICU), Pediatric Clinic (PC), and Pediatric intensive Care Unit (PICU). Ambulatory Pediatrics reports and incomplete data were excluded. Related variables were evaluated. Results. Out of 989 errors reported in Department of Pediatrics, 401 (41 %) corresponded to medication errors. Of these, 353 (88 %) reached patients and 48 (12 %) were quasi-errors; 42 % occurred in the morning; 24 %, in the afternoon; 17 %, in the morning and afternoon, and 17 %, in the night; differences were not significant (p = 0.18). Dosing errors were the most common ones, 118 (33.4 %). In total, 160 reports (45 %) corresponded to prescription errors; 149 (42 %), to administration errors; and 44 (2.5 %), to dispensing errors. Dosing errors were more common in prescriptions (p < 0.05). The highest number of errors was reported at the NICU, 179 (50 %); compared to 91 (25.5 %) at the PC and 83 (24.5 %) at the PICU. A total of 91 AEs were reported (22.5 %); most were mild, 53 (58 %), or moderate, 31 (34 %). The NICU reported 53 AEs (58 %); the PICU, 25 (27 %); and the DCP, 18 (19.7 %). No deaths occurred.Conclusion. The rate of medication errors reported in hospitalized children was 41 %. Dosing errors were the most common ones. A total of 91 AEs were reported; most were mild (58 %); the highest number was reported at the NICU (58 %).

Psychiatric morbidity in pre-mastectomy patients diagnosed with breast cancer at a tertiary private hospital in Makati City

OBJECTIVES:This study aimed at identifying psychiatric problems among patients who were diagnosed with breast cancer and scheduled for mastectomy.METHODOLOGY:All the women who were diagnosed with breast cancer and were awaiting their scheduled mastectomy at the surgical clinic were interviewed using the Self-Reporting Questionnaire (SRQ) and the Zung Self Rating Depression Scale. Their sociodemographic and histopathological reports were also noted.RESULTS:There were 21 women included in this study with mean age of 43.5 years. Majority (61.9%) were married and mostly high school graduates (42.8%) and unemployed i.e. 76.19% housewives. Most complained of breast pain (71.4%) while a third (38.1%) noted nipple discharge. Based on the SRQ,61.9% scored positive for mood/ anxiety and only 4.7% were found to be positive for psychosis. When rated according to the Zung Self Rating Depression Scale, 6 or 28.6% were noted to have marked depression and 5 or 23.8% had severe depression.CONCLUSION:Since most women with breast cancer in this study have been found to be positive for mood/anxiety and depression, it is recommended that screening for psychiatry morbidity should be part of the standard care and a support group manned by mental health professionals should be established as part of the holistic management.

Psychiatric morbidity among disabled clients of the rehabilitation sheltered workshop- Department of Social Welfare and Development (DSWD)

OBJECTIVES: The aim of this study is to assess the psychosocial needs of persons with disability of the Rehabilitation Sheltered Workshop (RSW) of the DSWD as well as screen for psychiatric illness.METHODOLOGY: There were 38 persons with various disabilities enrolled at the RSW. They were interviewed and screened using the Self Reporting Questionnaire (SRQ).RESULTS: About a third (34.21%) were married and 28.94% were single. Fifty percent were physically disabled i.e. amputees or with deformities of the extremities; 34.21% were blind the remaining 15.78% had a variety of disabilities e.g. deafness, facial deformity or speech impairment. The mean age was 45.5 years old. Based on the SRQ 38.64% of the visually disabled clients scored positive for mood/anxiety while 53.84% scored positive for psychosis; while 52.63% of the orthopedic clients scored positive for mood/anxiety and an even higher 73.68% scored positive for psychosis. For the other handicapped clients,33.33% scored positive for mood/anxiety and 50.00% scored positive for psychosis.CONCLUSION: Majority (63.16%) of the 38 clients at the RSW were psychotic and only 44.73% were found to have mood/ anxiety symptoms, thus the need for psychiatric follow up as well as initiation of psychopharmacological and psychotherapeutic interventions for these clients.

Observation on the effect of previous analgesia of acupuncture on the patients with the mixed hemorrhoid surgery pain / 国际中医中药杂志

Objective To study the effects of previous analgesia of acupuncture on patients with the mixed hemorrhoid surgery pain.MethodsA total of 70 patients with mixed hemorrhoid treated with “Milligan-morgan hemorrhoids” were randomly divided into treatment group and control group, 35 patients in each group. The treatment group was treated 30 min prior to the surgery with needling and manipulating Baliao, Chengshan, Hegu every five minutes until the operation, while the control group was not treated before the operation. The patients were assessed by Visual Aualogue Scale and self-reporting Inventory.ResultsAfter the operation, the treatment group was significantly better than the control group in the outcome index of beginning time of pain (14.3 ± 4.9 hvs. 4.2 ± 2.3 h, Z=-5.666,P<0.01) and peak time of pain (17.3 ± 4.5 hvs. 6.0 ± 2.9 h,Z=-5.581,P<0.01). The treatment group was significantly better than the control group in decreasing the pain beginning VAS score (3.3 ± 1.7vs. 4.6 ± 1.7,Z=-2.820, P<0.01) and pain peak VAS score (4.5 ± 2.0vs. 6.5 ± 1.2,Z=-4.025,P<0.05). After surgery, the treatment group was significantly better than the control group in decreasing the score of Self-reporting Inventory scale at the 1stday (1.8 ± 1.3vs. 3.0 ± 1.3),Z=-3.472,P<0.01) and 2ndday (1.2 ± 0.9vs. 1.9 ± 1.2,Z=-2.464,P<0.05). And the treatment group was significantly better than the control group inreducing the quantities of compound aminopyrine phenacetin tablet (0.5 ± 0.9vs.1.5 ± 1.7,t=3.167,P=0.002).ConclusionAcupuncture analgesia 30 minutes prior to the mixed hemorrhoid surgery can significantly reduce the postoperative pain.

Validación de la Escala Rapid Assessment of Physical Activity (RAPA) en población chilena adulta consultante en Atención Primaria / Validation of the Rapid Assessment of Physical Activity Scale (RAPA) in an Adult Chilean Population Seeking Primary Care / Validação da escala Rapid Assessment of Physical Activity (Rapa) em população chilena idosa consultante em Atenção Primária

Introducción: la práctica de actividad física es esencial para el cuidado de la salud. Se requiere contar con instrumentos que permitan medirla y monitorear los cambios en las personas que la practican. Objetivos: adaptar culturalmente el cuestionario Rapid Assessment of Physical Activity (RAPA), y estimar sus propiedades psicométricas, su validez y confiabilidad, para medir el nivel de actividad física en personas adultas consultantes en centros de atención primaria en Santiago (Chile). Materiales y métodos: el RAPA adaptado fue aplicado a 180 adultos asistentes a 5 centros de salud. Se determinó su índice de masa corporal (IMC) y circunferencia de cintura (CC). Resultados: las puntuaciones en la escala RAPA se relacionaron en forma inversa y significativa con el perímetro de cintura y el IMC. Las personas categorizadas con bajo nivel de actividad física (Poco Activo y Poco Activo Regular Ligero) presentan un IMC promedio más elevado y son más frecuentemente categorizados con CC alterada. La confiabilidad del instrumento fue moderada (r = 0,61; K = 0,34). Conclusiones: el RAPA en su versión en español adaptada para Chile, es un instrumento de fácil aplicación, que pese a su moderada confiabilidad, logra ser sensible al desarrollo de actividad física, que presenta una relación coherente con los parámetros antropométricos de IMC y CC sensibles a dicha actividad.

Introduction: Physical activity is vital to health care and having instruments to measure and monitor changes in people who are physically active is essential. Objectives: Culturally adapt the Rapid Assessment of Physical Activity (RAPA) questionnaire and estimate its psychometric properties, validity and reliability as an instrument to measure the level of physical activity among adults seeking primary care at health centers in Santiago (Chile). Materials and Methods: The adapted RAPA was applied to 180 adults who were being treated at five health centers. Their body mass index (BMI) and waist circumference (WC) was determined. Results: The scores on the RAPA scale were inversely and significantly linked to waist circumference and BMI. Persons categorized as having low levels of physical activity (i.e., little activity and little regular light activity) have a higher BMI, on average, and are more often categorized with altered WC. The reliability of the instrument was moderate (r = 61; K = 0.34). Conclusions: The Spanish language version of the Rapid Assessment of Physical Activity (RAPA) questionnaire adapted for Chile is a user-friendly application. Despite being only moderately reliable, it is sensitive to the development of physical activity, which shows a coherent connection to the anthropometric parameters of BMI and WC that are sensitive to this kind of activity.

Introdução: a prática de atividade física é essencial para o cuidado da saúde. Requer-se contar com instrumentos que permitam medi-la e monitorar as mudanças nas pessoas que a praticam. Objetivos: adaptar culturalmente o questionário Rapid Assessment of Physical Activity (Rapa) e estimar suas propriedades psicométricas, sua validade e confiabilidade para medir o nível de atividade física em pessoas idosas consultantes em centros de atenção primária em Santiago (Chile). Materiais e método: o Rapa adaptado foi aplicado a 180 idosos frequentadores de cinco unidades de saúde. Determinou-se seu índice de massa corporal (IMC) e circunferência de cintura (CC). Resultados: as pontuações na escala Rapa se relacionaram em forma inversa e significativa com o perímetro de cintura e o IMC. As pessoas categorizadas com baixo nível de atividade física (pouco ativo e pouco ativo regular leve) apresentaram um IMC médio mais elevado e são mais frequentemente categorizadas com CC alterada. A confiabilidade do instrumento foi moderada (r = ,61; K = 0,34). Conclusões: o Rapa em sua versão em espanhol adaptada para o Chile é um instrumento de fácil aplicação, que, mesmo com sua moderada confiabilidade, consegue ser sensível ao desenvolvimento da atividade física, que apresenta uma relação coerente com os parâmetros antropométricos de IMC e CC sensíveis a essa atividade.

A prospective study on adverse drug reactions in outpatients and inpatients of medicine department in a tertiary care hospital.

Background: No pharmacotherapeutic agent is completely free from noxious and unintended effects and thus adverse drug reactions (ADRs) are inevitable consequences of drug therapy. Incidence of ADRs in Indian population ranges between 1.8% and 25.1%. However, ADR reporting in India is inadequate. Developing awareness inpatients and healthcare professionals (HCPs) will help in reducing the ADRs, its suffering and socioeconomic impact. Hence, the present study of ADR monitoring in the outpatients and inpatients of the medicine department in a tertiary care hospital is undertaken. The main objective of this study was to assess the ADR reporting patterns in outpatient and inpatient of medicine department. The study was also aimed to assess the causality, severity, and preventability of these ADRs and comparison between spontaneous reporting by HCP and patient selfreporting of suspected ADRs. Methods: This study was a prospective observational study conducted in 111 consecutive patients who experienced ADRs in the department of medicine. The study plan included analysis and assessment of the clinical pattern, spectrum of ADRs reported based on causality, severity, preventability factors. The impact of ADRs on emotional, occupational, and social life of patients was evaluated. The assessments were compared between patient reporting and HCP reporting of ADRs. Results: The clinical spectrum of ADRs ranged from the more common mild reactions such as skin rashes, itching, nausea, and vomiting to moderately severe reactions prolonging the hospital stay. The predominant causative drugs were antimicrobials, antiretrovirals, non-steroidal anti-inflammatory drugs and antihypertensives. The majority of ADRs were probable in causality assessment, moderate in severity and probably preventable. Comparison of ADR reporting between patient and HCP revealed that ADRs reported by patient’s been less in incidence, similar in qualitative analysis to HCP with very elaborative narration and highlighted emotional and occupational impact due to ADRs than HCP reports. Conclusion: A wide range of ADRs are possible in medicine department. Adequate awareness of ADR reporting and precautions, while prescribing drugs are essential. Including patients as additional reporters of suspected ADR may add to the benefit of pharmacovigilance.

Effect change of obesity on diabetes depending on measurement: self-reported body mas index from 2012 Community Health Survey vs. directly measured from the Korea National Health and Nutrition Examination Survey / 한국역학회지

OBJECTIVES: Obesity is a well-recognized risk factor for type 2 diabetes mellitus (DM) among young and middle-aged adults in South Korea. To elaborate on the association between obesity and Diabetes mellitus (DM), subjective data from self-reporting survey or objective data from health examination is generally used. This study was conducted to validate the change of association from using these different measurements. METHODS: Community Health Survey data and Korea National Health and Nutrition Examination Survey data, as subjective and objective data respectively, were used. Population, resident in Seoul and over 45 aged, were selected for the study and the association between obesity and DM were defined by using multivariate logistic regression model. RESULTS: In subjective data, DM prevalence was 12.4% (male, 14.7; female, 10.6) and obesity prevalence was 26.0% (male, 29.2; female, 23.4). Whereas, in objective data, DM prevalence was 15.0% (male, 17.8; female, 12.9), and obese population was 32.4% (male, 34.4; female, 30.8). Based on the effect of obesity on DM prevalence from each data, using objective data increased the impact of obesity. Difference of relative risk of obesity between from subjective data and from objective was bigger in female than male and statistically significant. CONCLUSIONS: The differences of association pattern between subjective and objective data were found, due to higher obesity prevalence in objective data, and discrepancies of socio-economic status. These discrepancies could be inevitable Therefore we have to face them proactively, and understand the different aspect of various variables from different measurement.

Survey of Depression in the Elderly Patients with Diabetes Mellitus / 신경정신의학

OBJECTIVES: Depression is commonly comorbid in elderly patients with physical illness. This study examined the prevalence of depression in the elderly with Diabetes Mellitus (DM). METHODS: Eighty-nine patients, over 60 years old, with DM were enrolled. The medical and psychiatric history, Hamilton Rating Scale for Depression (HDRS), Patient Health Questionnaire-9 (PHQ-9), Geriatric Depression Scale-Short form Korean (GDS-SF-K), and Mini-Mental Status Examination Korean version were examined. RESULTS: The prevalence of depression was estimated as 21.3% (male 4.5% ; female 16.9%) in HDRS, 32.6% (male 9.0% ; female 23.6%) in PHQ-9, and 24.7% (male 5.6% ; female 19.1%) in GDS-SF-K. CONCLUSION: The self-reporting scale, such as GDS-SF-K, PHQ-9 is an effective screening test for depression. The prevalence of elderly depression with DM ranged from 20% to 30%, the prevalence of depression is almost three times more common in women.

Morbilidad cardiovascular por autoreporte y suasociaci¾n con factores biopsicosociales, Tolima,Colombia / Self reported cardiovascular disease and association with biopsychosocial factors, Tolima, Colombia

Objetivo: establecer la prevalencia de morbilidadcardiovascular por autoreporte en adultos de 18 a 69 a±os, enel Tolima, y explorar su asociaci¾n con factores biol¾gicos,psicol¾gicos y sociales, a partir de la Encuesta Nacionalde Salud 2007. MetodologÝa: estudio epidemiol¾gicoobservacional, con un componente descriptivo-transversaly otro analÝtico-transversal de asociaci¾n, que emple¾ 1219registros de personas entre 18 y 69 a±os del departamento delTolima, provenientes de la Encuesta Nacional de Salud 2007.Se describieron las caracterÝsticas demogrßficas y se determin¾la prevalencia de factores de riesgo biopsicosociales paraenfermedad cardiovascular por auto-reporte. Se exploraronasociaciones entre esos factores y enfermedad cardiovasculargrave. Resultados: los factores de riesgo mßs prevalentes enlas personas que desarrollaron un evento cardiovascular fueronhipertensi¾n: 16,8%; dependencia al alcohol: 14,1%; niveleducativo nulo: 14%; la prevalencia de eventos cardiovascularesgraves es del 5,5%. Al ajustar por variables de sexo y edadse encontr¾ que los factores de riesgo para enfermedadcardiovascular grave son el autoreporte de problemasde salud mental, hipertensi¾n, dependencia al alcohol,hipercolesterolemia e hipertrigliceridemia. Conclusiones:ademßs de los factores biol¾gicos reconocidos, se encontr¾que el autoreporte de problemßticas mentales tambiÚn es unfactor de riesgo para la enfermedad cardiovascular grave autoreportada...

Objective: to determine the prevalence of self-reportedcardiovascular disease in adults aged 18 to 69 in Tolima andto explore their association with biological, psychologicaland social factors from the 2007 National Health Survey.Methodology: an observational epidemiological study witha descriptive component and an analytic cross section ofassociation, employing 1219 records of people between theages of 18 and 69 in the Tolima department, taken from the2007 National Health Survey. Demographic characteristicswere described and the prevalence of biopsychosocial riskfactors for cardiovascular disease by self-reporting wasdetermined. The relationships between these factors andsevere cardiovascular disease were explored. Results:the most prevalent risk factors in people who developeda cardiovascular event were high blood pressure: 16.8%;alcohol dependence: 14.1%; lack of education: 14%. Theprevalence of major cardiovascular events was 5.5%. Afteradjusting for age and sex variables it was found that riskfactors for major cardiovascular disease are: self-reporting ofmental health problems, hypertension, alcohol dependence,hypercholesterolemia and hypertriglyceridemia. Conclusions:in addition to the biological factors that were identified, it wasfound that self-reporting mental health issues is also a riskfactor for self-reported serious cardiovascular disease...

Autorreporte de Ansiedad en Niños y Adolescentes Chilenos no Consultantes: Análisis de sus Dimensiones / Anxiety self-report on non-consulting chilean children and adolescents: dimensional analysis

Los trastornos ansiosos en la población chilena infantojuvenil son de alta prevalencia y frecuentemente subdiagnosticados. Han existido variados intentos para crear instrumentos que ayuden a su tamizaje, dentro de estos el SCARED es uno de los más utilizados. Para la población hispanoamericana se adaptó este autoreporte de niños y adolescente (AANA) con características psicométricas adecuadas. El objetivo del presente trabajo es analizar la capacidad para discriminar entre Trastorno ansioso y sus distintas dimensiones (pánico/somático, ansiedad de separación, ansiedad generalizada, fobia social y fobia escolar) del AANA en población infantojuvenil chilena no consultante. Los resultados obtenidos mostraron que el instrumento estudiado es capaz de determinar un único constructo (ansiedad) y que los distintos ítems logran determinar las 5 dimensiones encontradas en el estudio original. De acuerdo a los resultados es posible concluir que el AANA es un instrumento adecuado para pesquisar trastornos ansiosos en la población infantojuvenil chilena estudiada. Palabras Claves: Trastornos ansiosos, ansiedad, infantojuvenil, AANA, Análisis factorial exploratorio.

Anxiety disorders in chilean children and adolescents are highly prevalent and often underdiagnosed. Various attempts have been made to design tools which contribute in the screening of these conditions, among these the SCARED is one of the most popular ones. An adaptation of this instrument has been developed for hispanic population, the AANA (anxiety self-report for children and adolescents), which has proven adequate psychometric characteristics. The aim of this article is to analyzethe AANA's discriminant capacity for anxiety disorders and its various dimensions (panic / somatic, separation anxiety, generalized anxiety, social phobia and school phobia) in Chilean non consulting children and adolescents. Our results showed that this instrument was able to determine a single construct (anxiety) and its items succeeded in identifying the 5 dimensions found in the original study. According to these results, we can conclude that the AANA is a suitable instrument for anxiety disorders screening in the chilean child and adolescent population studied. Key words: Anxiety disorders, self-reporting, SCARED, exploratory factor analisys,children and adolescents.

Survey of Depression in the Elderly Patients with Chronic Obstructive Pulmonary Disease / 신경정신의학

OBJECTIVES: Depression is commonly comorbid in the elderly patients with physical illness. This study examined the prevalence of depression in the elderly with chronic obstructive pulmonary disease (COPD). METHODS: The eighty-seven patients with COPD were enrolled. The subjects are over 60 years old. The medical and psychiatric history, Hamilton Rating Scale for Depression (HDRS), Patient Health Questionnaire-9 (PHQ-9), Patient Health Questionnaire-2 (PHQ-2), Geriatric Depression Scale-Short form Korean (GDS-SF-K), Mini-Mental Status Exam Korean version (MMSE-KC) were investigated. Global Initiative for Chronic Obstructive Lung Disease (GOLD), which predict the severity of COPD, also investigated. RESULTS: The prevalence of depression was estimated to be 24.7% (male 19.3% ; female 35.7%) in HDRS, 31.0% (male 24.6% ; female 43.3%) in PHQ-9, 8.0% (male 10.5% ; female 3.3%) in PHQ-2, 23.0% (male 17.5% ; female 33.3%) in GDS-SF-K. The severity of COPD (GOLD) was associated with the prevalence of depression (HDRS, p=0.027 ; PHQ-9, p=0.045 ; PHQ-2, p=0.112 ; GDS-SFK, p=0.089). CONCLUSION: The prevalence of elderly depression with COPD ranged from about 20% to 30%, the prevalence of depression is nearly two times more common in women. The severity of COPD (GOLD) was associated with the prevalence of depression. The self-reporting scale, such as GDS-SF-K, PHQ-9 and PHQ-2 is the effective screening test of depression.

Are self reported morbidities deceptive in measuring socio-economic inequalities.

Background & objectives: The ambiguity and variability in existing literature on the magnitude of socio-economic inequality in self-reported morbidities makes it difficult to set priorities in health policy. This study examined three critical research questions: first, how far self-reporting affects measuring socio-economic inequalities in case of obstetric morbidities. Second, does using simple bivariate variations mislead in estimating socio-economic differentials in prevalence of obstetric morbidities? Finally, whether use of sophisticated regression based decomposition results can overcome such problems. Methods: The data from National Family Health Survey (NFHS-3; 2005-06) were used, and analyzed by statistical tools such as bivariate estimates and regression based decomposition analysis. Results: Bivariate results revealed that self-reported obstetric morbidity data were misleading in measurement of socio-economic differentials, as these failed to show existing socio-economic variations in obstetric morbidities by socio-economic standing of women. However, decomposition analysis showed that the prevalence of obstetric complications was greater among socioeconomically disadvantaged groups. Interpretation & conclusions: Based on our findings on measurement of socio-economic inequality in self-reported obstetric morbidity, we conclude that the use of regression based inequality decomposition estimates not only overcomes the problems of measuring socio-economic inequality based on self-reported morbidities, but also increases the validity of such measures.

Evaluation of Subjective Well-being: Analysis of the Satisfaction With Life Scale in Chilean Population / Evaluación del Bienestar subjetivo: Análisis de la Escala de Satisfacción con la Vida en población chilena

The aim of this investigation is to evaluate the psychometric properties of the Satisfaction with Life Scale (SWLS), in the adult population from ages 18 to 65. In order to do this two studies were conducted. In the first one, we evaluated the internal consistency and construct validation of data from 330 people between 18 and 52 years of age; in the second study, we evaluated the confirmatory factor and validation of data indicators from 1157 people between 18 and 65 years of age. The results show suitable indicators of internal consistency (Cronbach's alpha = 0.82), the exploratory and confirmatory factor analysis finds a one factor's solution. The correlation between the SWLS, the WHOQOL-BREF Quality of Life Questionnaire, and the Difficulties in Emotion Regulation Scale (DERS), display significant, consistent correlations in the expected direction. We conclude that the SWLS is a reliable and valid instrument to use for evaluating the cognitive sphere of subjective well-being in Chile's adult population.

El objetivo de esta investigación fue evaluar las propiedades psicométricas del cuestionario de satisfacción con la vida (SWLS) en población adulta de 18 a 65 años. Para esto, se realizaron dos estudios. En el primero se evaluó la consistencia interna y la validez de constructo con datos de 330 personas entre 18 y 52 años. En el segundo estudio se evaluó la estructura factorial confirmatoria e indicadores de validez con datos de 1157 personas entre 18 y 65 años. Los resultados mostraron adecuados indicadores de consistencia interna (alfa de Cronbach = 0.82), en el análisis de estructura factorial exploratoria y confirmatoria se encontró una solución unifactorial. La correlación entre SWLS, Cuestionario de Calidad de Vida WHOQOL-BREF y Cuestionario de Dificultades en la Regulación Emocional, arrojó correlaciones significativas, congruentes y en la dirección esperada. Concluimos que el cuestionario SWLS es un instrumento confiable y válido para su utilización en la evaluación de la esfera cognitiva del bienestar subjetivo en población adulta en Chile.

Optimizing adherence to antiretroviral therapy.

HIV has now become a manageable chronic disease. However, the treatment outcomes may get hampered by suboptimal adherence to ART. Adherence optimization is a concrete reality in the wake of ‘universal access’ and it is imperative to learn lessons from various studies and programmes. This review examines current literature on ART scale up, treatment outcomes of the large scale programmes and the role of adherence therein. Social, behavioural, biological and programme related factors arise in the context of ART adherence optimization. While emphasis is laid on adherence, retention of patients under the care umbrella emerges as a major challenge. An in-depth understanding of patients’ health seeking behaviour and health care delivery system may be useful in improving adherence and retention of patients in care continuum and programme. A theoretical framework to address the barriers and facilitators has been articulated to identify problematic areas in order to intervene with specific strategies. Empirically tested objective adherence measurement tools and approaches to assess adherence in clinical/ programme settings are required. Strengthening of ART programmes would include appropriate policies for manpower and task sharing, integrating traditional health sector, innovations in counselling and community support. Implications for the use of theoretical model to guide research, clinical practice, community involvement and policy as part of a human rights approach to HIV disease is suggested.

Stress level and coping strategy of surgical staff who saved the patients after Wenchuan earthquake / 中国心理卫生杂志

Objective: To investigate the stress and coping strategy of rescue surgical staff early after earth-quake. Methods: The self reporting questionnaire (SRQ-20) and coping styles questionnaire (CSQ) were distribu-ted to 37 surgical staff and 44 psychiatric staff (the control group) in Chengdu City 2 weeks after Wenchuan earth-quake. The results were analyzed by t test, correlation analysis and logistic regression analysis. Results: The grades of rescue surgical staff in SRQ-20 and negative coping styles factor was higher than that of the psychiatric staff [(9.3±4.7)vs.(3.2±3.9), (29.8±6.2) vs.(26.1±7.1); Ps<0.05] . The SRQ-20 score in rescue surgical staffs was positively correlated with negative coping styles factor (r=0.50, P=0.002) and age (R~2=0.168, P=0.012) . Conclusion: Surgical staff, especially the elder, have more intensive acute stress reaction. It is essential to publicize psychologic knowledge and improve mental health of surgical staff.

Development of a Format to Record Clinical Experiences of Trainees during the Initial Two-year Period of Postgraduate Clinical Training. A Study of the Validity and Reliability of Technical Items in the Self-reporting Questionnaire / 医学教育

A self-reporting questionnaire was designed and sent to our Jichi Medical School graduates each year since 1980, in order to investigate clinical competences attained in certain technical items. The responses from graduates of classes 1984 through 1987 were analysed, and the questionnaire was found to be highly reliable and moderately valid. The coefficient variable was 0.942, and the relevant variable was 0.934 using the half-split method. The content was clear, because items in the questionnaire were selected from published official reports. In the construction validity, 4 meaningful groups of items were found by factor-analysis. Yearly analysis using such a questionnaire may clarify some of the problems experienced by trainees and training hospitals, and would encourage the trainees to undergo a process of selfevaluation.

Development of a Format to Record Clinical Experiences of Trainees during the Initial Two-year Period of Postgraduate Clinical Training; A Study of Self-evaluation by Jichi Medical School Graduates / 医学教育

A self-reporting questionnaire was designed and sent to our Jichi Medical School graduates each year since 1980, in order to investigate clinical competence. The format was designed based on several major reports concerning postgraduate clinical training in primary medical care. We found that more than 70% of Jichi Medical School graduates trained in the multi-specialty rotation style in general hospitals that were certified by the Ministry of Health and Welfare. Our results also suggested that these graduates obtained a relatively high level of clinical competence in performing physical examinations, basic laboratory testing, clinical procedures, and various treatments.