Prevalência de sofrimento mental em pessoas com diabetes mellitus durante a pandemia de Covid-19 / Prevalence of mental distress in people with diabetes mellitus during the Covid-19 pandemic / Prevalencia de angustia mental en personas con diabetes mellitus durante la pandemia Covid-19

Objetivo: estimar a prevalência de sofrimento mental em pessoas com diabetes mellitus durante a pandemia de Covid-19. Método: estudo transversal, de caráter exploratório, com amostra de 111 pessoas com diabetes. Na coleta de dados, utilizou-se um questionário de sintomas denominado Self Report Questionnaire-20 (SRQ-20). A análise de dados foi realizada por meio da estatística descritiva. Resultados: a prevalência de sofrimento mental entre as pessoas com diabetes foi de 37,8%. No grupo de humor depressivo-ansioso, os sintomas mais prevalentes demonstraram que 64% dos diabéticos se sentiram nervosos, tensos ou preocupados. Quanto ao decréscimo de energia vital,51,4% dos diabéticos se cansaram com facilidade. Para os sintomas somáticos, identificou-se que 30,6% apresentaram sensações desagradáveis no estômago. Quanto aos pensamentos depressivos, verificou-se que 31,5% tiveram dificuldade para tomar decisões. Conclusão: recomenda-se a criação de estratégias e linhas integrais de cuidados que minimizem os impactos psicossociais causados pela pandemia da COVID-19 neste segmento populacional.

Objective: to estimate the prevalence of mental distress in people with diabetes mellitus during the Covid-19 pandemic. Method:cross-sectional, exploratory study with a sample of 111 people with diabetes. For data collection, a symptom questionnaire called the Self Report Questionnaire-20 (SRQ-20) was used. Data analysis was performed using descriptive statistics. Results: the prevalence of mental suffering among people with diabetes was 37.8%. In the depressed-anxious mood group, the most prevalent symptoms showed that 64% of diabetics felt nervous, tense or worried. As for the decrease in vital energy, 51.4% of diabetics got tired easily. For somatic symptoms, it was identified that 30.6% had unpleasant sensations in the stomach. As for depressive thoughts, it was found that 31.5% had difficulty making decisions. Conclusion: it is recommended to create comprehensive strategies and lines of care that minimize the psychosocial impacts caused by the COVID-19 pandemic in this population segment.

Objetivo: estimar la prevalencia de angustia mental en personas con diabetes mellitus durante la pandemia de Covid-19. Método: estudio exploratorio transversal con una muestra de 111 personas con diabetes. Para la recolección de datos, se utilizó un cuestionario de síntomas llamado Self Report Questionnaire-20 (SRQ-20). El análisis de los datos se realizó mediante estadística descriptiva. Resultados: la prevalencia de sufrimiento mental entre las personas con diabetes fue del 37,8%. En el grupo de estado de ánimo depresivo-ansioso, los síntomas más prevalentes mostraron que el 64% de los diabéticos se sentían nerviosos, tensos o preocupados. En cuanto a la disminución de la energía vital, el 51,4% de los diabéticos se cansaban con facilidad. Para los síntomas somáticos, se identificó que el 30,6% presentaba sensaciones desagradables en el estómago. En cuanto a los pensamientos depresivos, se encontró que el 31,5% tenía dificultad para tomar decisiones. Conclusión: se recomienda crear estrategias y líneas de atención integrales que minimicen los impactos psicosociales provocados por la pandemia COVID-19 en este segmento de población.

Determination of anxiety levels of turkish university students and affecting factors in COVID-19 pandemic: sample of a private university

INTRODUCTION: The Coronavirus disease 2019 (COVID-19) pandemic and its consequences have created anxiety in various segments of society. In particular, the transition to online education brought by this process has made the education process of university students difficult. Therefore, in the COVID-19 pandemic, it is important to examine the anxiety levels of university students and their relationship with somatic symptoms. OBJECTIVE: To examine the level of generalised anxiety disorder and to reveal the relationship between somatic symptoms and the generalised anxiety disorder level of Turkish university students. METHODS: Empirical research. Participants in the research constituted a total of 605 students studying at a private university in Istanbul. The Generalised Anxiety Disorder Scale (GAD-7) was used to collect data. Data were analysed using the chi-square test and Pearson correlation analysis. RESULTS: It was found that, among the participants, 193 (31.90%) of the students had mild anxiety, 149 (24.63%) had moderate anxiety and 121 (20.00%) had severe anxiety. The study revealed that there is a significant positive relationship between the number of somatic symptoms and generalised anxiety disorder scores of university students. CONCLUSION: Most of the university students are affected by anxiety during the COVID-19 pandemic and this effect is correlated with the frequency of somatic symptoms. In this context, it would be beneficial for universities to plan for acute and long-term psychological services and to cooperate with the government to provide timely crisis-oriented psychological services.

La angustia que no engaña y la que engaña / The anguish that does not deceive and the one that does

El presente texto tiene como propósito interrogar la afirmación lacaniana de la angustia como afecto que no engaña. Para tal propósito, iniciaremos revisando las últimas elaboraciones freudianas sobre la angustia localizables en el texto "Inhibición, síntoma y angustia", para luego ubicar en el seminario La angustia ciertas coordenadas allí desarrolladas por Lacan, como es la de la angustia como señal de lo real, su relación al objeto a, al falo y al fantasma; así como la propuesta de fin de análisis más allá de la angustia de castración. Posteriormente, propondremos que en Lacan podemos ubicar dos modos de presentarse la angustia: una, que engaña, en su articulación al fantasma y a la angustia de castración; otra, que no engaña, en consonancia con el significante de la falta en el Otro en términos de desamparo. Finalmente, ubicamos algunas consecuencias para la práctica analítica, al denotar la articulación del deseo del analista con la angustia vía el acto, y señalando que no distinguir en el análisis las dos manifestaciones de la angustia previamente denotadas, resulta engañoso para el analista al confundir la detención del análisis con su finalización

The purpose of this text is to interrogate the Lacanian affirmation of anguish as an affect that does not deceive. For this purpose, we will begin by reviewing the latest Freudian elaborations on anguish that can be found in the text "Inhibition, Symptom and Anguish", and then locate in the Seminar The anguish certain coordinates developed there by Lacan, such as that of anguish as a sign of what it is real, its relation to object a, phallus and phantasy; as well as the proposal for the end of the analysis beyond castration's anguish. Later, we will propose that in Lacan we can locate two ways of presenting anguish: first one, which deceives in its articulation the phantasy and the anguish of castration; another one, which does not deceive in relation with the signifier of the lack in the Other in terms of helplessness. Finally, we locate some consequences for analytical practice by denoting the articulation of the analyst´s desire with anguish by the means of the act, and pointing out that not distinguishing in the analysis the two previously denoted manifestations of anguish, is misleading for the analyst by confusing the stop of the analysis with its completion

Caracterización sociodemográfica y clínica psiquiátrica de pacientes con síntomas médicamente inexplicables en una institución prestadora de salud de Medellín (Colombia) / Sociodemographic Characterization and Psychiatric Symptoms of Patients with Medically Unexplained Symptoms in a Healthcare Institution in Medellin (Colombia)

RESUMEN Introducción: Se define como síntoma médicamente inexplicado los síntomas físicos de varias semanas de duración cuya adecuada evaluación médica no revele alguna enferme dad que los explique; cuando estos síntomas se tornan persistentes, llevan a exploraciones clínicas exhaustivas y múltiples intervenciones. Estos pacientes tienen un deterioro mayor, o al menos comparable en cuanto a funcionamiento físico, salud mental y percepción nega tiva de su salud, que los pacientes con múltiples enfermedades médicas crónicas; tienen significativamente más eventos estresantes vitales (abuso psicológico, físico y/o sexual) y más probabilidades de cumplir criterios diagnósticos de ansiedad y depresión. Objetivo: Caracterizar sociodemográfica y psiquiátricamente un grupo de pacientes identi ficados en atención primaria con síntomas médicamente inexplicados. Métodos: Estudio descriptivo transversal de pacientes de 18-70 años, a quienes se aplicó el PHQ-15, el PHQ-9 y el PHQ para ansiedad y una encuesta diseña para la investigación. Resultados: Se analizó a 36 pacientes, el 94,4% mujeres, con una mediana de edad de 45 [20] años; el 33,3% de ellas estaban casadas y el 91,7% tenía hijos. El 55% tenía síntomas somáticos funcionales graves, el 77,8% tenía 1 o más trastornos somáticos funcionales y el 77,7% presentaba síntomas afectivos o ansiosos de relevancia clínica. El 25% de los pacientes reportaron antecedente de maltrato en la infancia; el 41,7%, maltrato de pareja, y el 41,6% había sido víctima del conflicto armado colombiano. Conclusiones: El principal hallazgo de este estudio fue que cerca de 8 de cada 10 pacientes cumplían criterios de un trastorno somático funcional con gran intensidad sintomática, y cerca de 3 de cada 10 pacientes cumplían criterios de 2 trastornos funcionales, la mayoría de estos pacientes sin otras enfermedades médicas de base. Además, en estos pacientes se encontró alta prevalencia de exposición a diferentes tipos de violencia a lo largo de la vida.

ABSTRACT Introduction: Medically unexplained symptoms are defined as physical symptoms that have been present for several weeks and that an adequate medical evaluation has not revealed any disease that explains them; when these symptoms become persistent, they lead to comprehensive clinical investigations and multiple interventions. These patients have a greater or at least comparable commitment to physical functioning, mental health, and negative health perception than patients with multiple chronic medical conditions; have significantly more stressful life events (psychological, physical and/or sexual abuse) and are more likely to meet diagnostic criteria for anxiety and depression. Objective: To characterize sociodemographic and psychiatric characteristics of a group of patients identified in primary care with medically unexplained symptoms. Methodology: A descriptive, cross-sectional study with patients from 18 to 70 years old who were given PHQ-15, PHQ-9 and PHQ for anxiety, and a survey designed for the study. Results: 36 patients were analysed, 94.4% women, median age 45 [RIC, 20] years-old, 33.3% married, 91.7% had children. 55% had severe functional somatic symptoms, 77.8% had one or more functional somatic disorders, and 77.7% had clinically relevant affective or anxiety symptoms. 25% of the patients reported a history of child abuse, 41.7% were mistreated by a partner, and 41.6% were victims of the Colombian armed conflict. Conclusions: The main finding of this study was that 8 out of 10 patients met criteria for a functional somatic disorder with great symptomatic severity and three out of ten patients met criteria for two functional disorders, most of these patients without otherbasic medical diseases. In addition, we found a high prevalence of exposure to different types of violence that these patients have been subjected to throughout their life.

Terapia morfoanalítica nos transtornos de sintomas somáticos / Morphoanalytic therapy in somatic symptom disorders / Terapia morfoanalítica en los trastornos de síntomas somáticos

A Terapia Morfoanalítica (TM) é uma terapia psicocorporal analítica que possibilita a integração das experiências psicoafetivas a partir do corpo. Permite compreender o componente psíquico da manifestação física, bem como a somatização do fenômeno psíquico. Este estudo objetivou avaliar o efeito da TM em pessoas com transtornos de sintomas somáticos, além de observar o impacto desta terapia na vida pessoal destes indivíduos. Trata-se de um Estudo de Caso de dois indivíduos. Foram realizadas 24 sessões de TM, uma vez por semana, com duração de uma hora. As avaliações constituíram-se de coleta de dados pessoais e antropométricos, nível de dor e flexibilidade muscular, bem como avaliação da presença de ansiedade, depressão e alexitimia, por meio de questionários. Também foi realizada avaliação da modulação autonômica. A evolução psicoemocional foi acompanhada no decorrer de todo tratamento morfoanalítico. A eficácia da TM foi observada tanto nos índices emocionais, quanto físicos. Isso demonstra a efetividade desta modalidade terapêutica, que associa os trabalhos corporais com o trabalho verbal analítico, na melhor integração psicossomática.

Morphoanalytic Therapy (MT) is an analytical psycho-corporal therapy that enables the integration of psycho-affective experiences from the body. It allows us to understand the psychic component of physical manifestation as well as the somatization of the psychic phenomenon. This study aimed to evaluate the effect of MT in people with somatic symptom disorder, in addition to observe the impact of this therapy on the personal life of these individuals. This is a case study of two individuals. Twenty-four MT sessions were performed once a week, lasting one hour each. The evaluations consisted of personal and anthropometric data collection, pain level and muscular flexibility, as well as of the presence of anxiety, depression and alexithymia, through questionnaires. Autonomic modulation was also evaluated. The psychoemotional evolution was followed during all morphoanalytic treatment. The efficacy of MT was observed in emotional and physical indexes. This demonstrates the effectiveness of this therapeutic modality, which associates bodily works with analytical verbal work, in the best psychosomatic integration.

La Terapia Morfoanalítica (TM) es una terapia psico-corporal analítica que posibilita la integración de las experiencias psico-afectivas desde el cuerpo. Permite la comprensión del componente psíquico de la manifestación física, así como la somatización del fenómeno psíquico. Este estudio objetivó evaluar el efecto de la TM en personas con trastorno de síntomas somáticos, además de observar el impacto de esta terapia en la vida personal de estos individuos. Se trata de un estudio de caso de dos individuos. Se realizaron 24 sesiones de TM, una vez por semana, con una duración de una hora. Las evaluaciones se constituyeron de recolección de datos personales y antropométricos, nivel de dolor y flexibilidad muscular, así como evaluación de la presencia de ansiedad, depresión y alexitimia, por medio de cuestionarios. También se realizó una evaluación de la modulación autonómica. La evolución psicoemocional fue acompañada en el transcurso de todo tratamiento morfoanalítico. La eficacia de la TM fue observada tanto en los índices emocionales, como físicos. Esto demuestra la efectividad de esta modalidad terapéutica, que asocia los trabajos corporales con el trabajo verbal analítico, en la mejor integración psicosomática.

Helicobacter pylori associated to unexplained or refractory iron deficiency anemia: an Egyptian single-center experience

ABSTRACT Background: Refractory or unexplained iron deficiency anemia accounts for about 15% of all cases. The endoscopic gastrointestinal workup sometimes fails to establish the cause of iron deficiency anemia and a considerable proportion of patients regardless of risk category fail to respond to oral iron supplementation. The aim of the present study was to assess the etiological role of Helicobacter pylori infection in adult Egyptian patients with unexplained or refractory iron deficiency anemia. Methods: A case controlled study was composed of 104 iron deficiency anemia cases and 70 age- and gender-matched healthy controls. Patients were diagnosed with iron deficiency anemia according to hemoglobin, mean corpuscular volume, serum ferritin, and transferrin saturation. Upper and lower endoscopies were performed and active H. pylori infection was investigated by testing for the H. pylori antigen in stool specimens. Hematological response to H. pylori treatment with triple therapy together with iron therapy (n = 32) or only iron therapy (n = 32) were assessed in patients with H. pylori infection. Results: H. pylori infection was more prevalent in patients with unexplained or refractory iron deficiency anemia (61.5%). Of the different hematological parameters investigated, there was a significant correlation only between H. pylori infection and mean corpuscular volume (p-value 0.046). Moreover, there was a significant correlation between receiving triple therapy together with iron supplementation and improvements in the hematological parameters [hemoglobin (p-value < 0.001), mean corpuscular volume (p-value < 0.001), iron (p-value < 0.001) and serum ferritin (p-value < 0.001)] compared to receiving iron supplementation alone. Conclusions: Failing to test for H. pylori infection could lead to a failure to identify a treatable cause of anemia and could lead to additional and potentially unnecessary investigations. Furthermore, treatment of H. pylori infection together with iron supplementation gives a more rapid and satisfactory response.

Cambios biopsicosociales durante el climaterio: síntomas somáticos, insomnio y manifestaciones depresivas / Biopsychosocial changes during the climacteric: somatic symptoms, insomnia and depressive manifestations / Alterações biopsicossociais durante o climatério: sintomas somáticos, insônia e manifestações depressivas

El climaterio es un proceso dinámico y complejo, mediado por el contexto en donde viven las mujeres. El objetivo de este estudio exploratorio, observacional y descriptivo, fue evaluar los síntomas somáticos, su relación con las manifestaciones depresivas, mediante la Menopuase Rating Scale (MRS) y la escala de Zung. Los principales síntomas son: sofocos, insomnio y dolores articulares. Se constató que tales síntomas se intensifican en presencia de manifestaciones depresivas, afectando la salud y la calidad de vida.

Climacteric is a dynamic and complex process, mediated by the context in which women live. The aim of the study descriptive, exploratory and observational was to assess somatic symptoms and their relationship with depressive manifestations through Menopause Rating Scale (MRS) and the Zung scale. The Study shows that symptoms: hot flashes, insomnia and joint pains are intensified in the presence of depressive manifestations affecting the health and quality of life.

O climatério é um processo dinâmico e complexo, mediado pelo contexto em que as mulheres vivem. O objetivo deste estudo exploratório, observacional e descritivo foi avaliar os sintomas somáticos, sua relação com as manifestações depressivas, através da Menopuase Rating Scale (MRS) e da escala de Zung. Os principais sintomas são: afrontamentos, insônia e dores articulares. Constatou-se que esses sintomas se intensificam na presença de manifestações depressivas, afetando a saúde e a qualidade de vida.

Niños españoles con sintomatología depresiva: un estudio de sus quejas somáticas / Spanish children with depressive symptoms: a study of their somatic complaints

La presencia de síntomas somáticos en población clínica infantil ha sido analizada en estudios internacionales, pero son escasos los trabajos dirigidos a estudiar las características de los síntomas somáticos en niños españoles con sintomatología depresiva. El presente estudio examina la relación entre las quejas somáticas y los síntomas depresivos en una muestra de niños españoles, teniendo en cuenta su sexo y edad. Participaron 666 niños con edades entre 8 y 12 años que completaron el Inventario de Depresión Infantil y el Inventario de Somatización Infantil que examina 35 síntomas somáticos. Los resultados indican que los síntomas pseudoneurológicos, gastrointestinales y de dolor son más frecuentes en los niños con sintomatología depresiva, siendo el dolor de articulaciones, el dolor de cabeza y el cansancio los síntomas más prevalentes. Se concluye la importancia de atender adecuadamente a los síntomas somáticos puesto que con frecuencia pueden responder a un trastorno emocional más que a una enfermedad física.

The presence of somatic symptoms in children has been widely analyzed in international studies, but there is a lack of studies aimed at studying the characteristics of somatic symptoms in Spanish children with depressive symptoms. This study examines the relationship between somatic complaints and depressive symptoms in a sample of Spanish children, taking into account their age and sex. Participants were 666 children aged between 8 and 12 years who completed the Child Depression Inventory and the Children's Somatization Inventory that examine 35 somatic symptoms. The results indicate that pseudoneurological, pain and gastrointestinal symptoms are more common in children with depressive symptoms, being the joint pain, headache and fatigue the most prevalent symptoms. An adequately detection of somatic symptoms in children could be important due to these symptoms often may respond to an emotional disorder rather than a physical illness.

Relevancia de la menopausia y del apoyo social en las diferencias en salud entre mujeres y hombres / Relevance of the Menopause and Social Support in Gender Differences in Health

RESUMEN Se analizó la relevancia de la menopausia y el apoyo social en las diferencias en salud entre mujeres y hombres mediante un estudio transversal realizado con 710 mujeres y 606 hombres de la población general española con edades entre 20 y 65 años. Se encontró que, aunque en la juventud apenas había diferencias entre hombres y mujeres, a partir de la perimenopausia las mujeres informaban de más insomnio y síntomas vasomotores que los hombres, así como de más dolor durante la postmenopausia. El apoyo social percibido se asociaba con mejor salud, sobre todo en las mujeres en postmenopausia y premenopausia.

ABSTRACT This study examined the relevance of the menopause and social support in gender differences in health. A cross-sectional survey of a general population sample comprising 710 women and 606 men, aged between 20 and 65 was carried out. No health differences were found between younger men and women. However, perimenopausal women reported more insomnia and vasomotor symptoms, as well as they reported more pain than men through the postmenopause. Perceived social support was associated with better health, especially in premenopausal and postmenopausal women.

Miedo al derrumbe y síntoma somático: dos buenas excusas para estudiar el proceso originario / Fear of breackdown and somatic symptom: two good excuses to study the original process

Se propone aquí pensar, desde lo teórico y clínico, y en el marco de la teoría psicoanalítica, al síntoma somático (concepto de Paul Laurent Assoun, 1998 (1)) como un equivalente y un concomitante del "miedo al derrumbe" de Winnicott (2); es decir, esa vivencia que se espera con miedo, que aunque pasada, no ocurrió para este paciente que está tendido ahora en el diván y sigue vigente como amenaza futura. Es una vivencia traumática que no tuvo lugar, pues no pudo ser inscrita, pero que se marca en ese psiquismo. Es esta la característica común que conecta el síntoma somático y el miedo al derrumbe; aquello insimbolizado pero que ha dejado huella en el cuerpo y el psiquismo ¿cuál es esta forma de inscripción previa a la simbolización primaria que articula el miedo al derrumbe y qué relación puede tener con el síntoma somático? Ejemplificando con un caso se intenta contrastar la teoría con la práctica clínica, concluyendo que la vivencia de derrumbe marca al psiquismo como un continente que determinará las vivencias posteriores dejando a perpetuidad la amenaza de derrumbe

Prevalence of psychosocial distress among flood victims in selected urban barangays in Manila

OBJECTIVES: This study was conducted to estimate the prevalence of psychosocial problems among residents of four flood-prone barangays in Manila located along the Maricaban-Malibay creek in Pasay City and were reported to have experienced 10-15 feet-deep flood waters simultaneously caused by Typhoon Maring and the southwest monsoon in August 2013.METHODOLOGY: A stratified two-stage random cluster sampling method, adapted from the Community Assessment for Public Health Emergency Response (CASPER) Toolkit, was employed in the syudy. The first stage of sampling used street clusters, with more or less of the same size, as the primary sampling unites (PSU) and households as secondary sampling units (SSU) to select the households that will be included in the survey. Since the clusters were more or less of the same size, they ahd equal chances of being selected in the study if the probability of selection is proportionate to size (PPS). Seven houses were then randomly chosen from the 30 selected clusters. All of the househol heads from the 210 selected households were given several copies of the self-administered questionnairescalled the Self-Reporting Questionnaire-20 (SRQ-20), a screening tool developed by WHO, to determine the psychosocial condition of the household members 12-65 years.RESULTS: The prevalence of psychosocial distress in this population was estimated at 17% (95%CI=13.7-20.3%). The residents of the study barangays were in their rehabilitation phase i.e., three months post disaster when data was collected for this study. The study also characterized the households in the sample according to socio-economic status, presence of members with special needs, and presence of children 0-5 years ol. In the aftermath of the disaster, 46.84% of the respondents had positive answer on the group of questions about decreased energy, 49.8% on somatic symptoms,25.89% on depressive thoughts and 40.91% on depressive moods.There was a higher prevalence of these 4 factors among females, those separated, with low socioeconomic status and low educational attainment.CONCLUSION: The estimated prevalence of psychosocial distress was 17% (95%CI=13.7%-20.3%), In the aftermath of the disaster, 46.8% of the respondents had positive answer on the group of questions about decreased energy, 49.8% on somatic symptoms, 25.9% on depressive thoughts and 40.9% on depressive moods.

Health care utilization of mexican patients with medically unexplained physical symptoms / Uso de los servicios de salud de pacientes mexicanos con síntomas físicos medicamente inexplicables

Abstract Objective: To determine the prevalence of medically unexplained physical symptoms and the characteristics and use of health services in a group of patients with medically unexplained physical symptoms and a group of patients with other illnesses. Methods: This was a cross-sectional, retrospective and multicenter study. We included 1,043 patients over 18 years of age from 30 primary care units of a government health institution, in 11 states of Mexico, attended by 39 family physicians. The prevalence of medically unexplained physical symptoms was determined and both groups with or without symptoms were compared with regard to drug use, laboratory and other studies, leaves of absence, and referrals in the last six months. The group with medically unexplained physical symptoms was diagnosed using the Patient Health Questionnaire and the diagnostic criteria of Reid et al. Emergency or terminal illnesses were excluded. The chi square test was used with a statistical significance of p < 0.05. Results: Medically unexplained physical symptoms was diagnosed in 73 patients (7.0%). The majority were women (91.8%); their predominant symptom was from the gastrointestinal system in 56 (76.7%). This group had a greater use of clinical studies and referrals to other services (mean 1.1 vs. 0.5; p <0.0001 and 0.6 vs. 0.8; p < 0.01, respectively). Conclusions: The prevalence of medically unexplained physical symptoms was low, but with a greater impact on some health services. This could represent an overload in medical costs....au

Resumen Objetivo: Determinar la prevalencia de Síntomas Físicos Medicamente No Explicables y las características y uso de los servicios de salud entre el grupo de pacientes con Síntomas Físicos Medicamente No Explicables, y el grupo con otras enfermedades. Métodos: Estudio transversal, retroprospectivo y multicéntrico. Se incluyeron a 1,043 pacientes mayores de 18 años, en 30 unidades de atención primaria de una institución gubernamental en salud, en 11 estados de la República Mexicana, atendidos por 39 médicos familiares. Se estimó la prevalencia de Síntomas Físicos Medicamente No Explicables y se compararon los dos grupos con y sin estos síntomas, en cuanto al uso de medicamentos, estudios de laboratorio, de gabinete, incapacidades y referencias en los últimos seis meses. El grupo de Síntomas Físicos Medicamente No Explicables fue diagnosticado por el Patient Health Questionnaire (son los síntomas físicos más comúnmente referidos por estos pacientes en el primer nivel de atención), además de criterios diagnósticos de Reid et al. Se excluyeron urgencias o con enfermedad terminal. Se utilizó prueba Chi cuadrada con p <0.05 para significancia estadística. Resultados: El 7.0% (73) se diagnosticó como Síntomas Físicos Medicamente No Explicables, la mayoría mujeres (91.8%); el síntoma predominante pertenece al sistema gastrointestinal con 76.7% (56). Este grupo demandó mayor uso de estudios de gabinete y referencias a otros servicios (media 1.1 vs. 0.5; p <0.0001 y 0.8 vs 0.6; p <0.01, respectivamente). Conclusiones: La prevalencia de Síntomas Físicos Medicamente No Explicables fue baja, pero con impacto significativo en el uso de algunos servicios de salud. Esto pudiera representar un mayor costo comparado con otro grupo de pacientes...au

Influencia del nivel de instrucción en la presencia y severidad de los síntomas premenstruales / Influence of educational level on the presence and severity of premestrual symptoms

Objetivos: Valorar la relación entre ciertos factores sociales en la vida de una mujer, más que nada el nivel de instrucción, con la presencia y severidad de los síntomas premenstruales que presenten las mismas. A su vez, se buscó correlacionar estas características con el consumo de anticonceptivos orales (ACO). Materiales y Métodos: se estudiaron 200 mujeres concurrentes al centro de salud Nº 20 de la zona noroeste de la ciudad de Rosario y a la Universidad Abierta Interamericana, localización lagos, sede regional Rosario. La recolección de los datos se realizó entre Diciembre de 2010 y Abril de 2011. Se aplicó el formulario de evaluación «Shortened Premenstrual Assessment Form¼ del American College of Obstetricians and Gynecologist, y se indagó en base a preguntas cerradas, dicotómicas y de opción múltiple. Resultados: de las 200 mujeres encuestadas, el 61% (122) presentaron síntomas premenstruales de intensidad moderada a severa y 39% (78) síntomas leves. No se encontraron diferencias estadísticamente significativas con respecto a la influencia del nivel de instrucción (OR 0.79 IC 95% 0.43- 1.45) ni al efecto del consumo de ACO (OR 4.61 IC 95% 1.83-11.86), sobre la presencia y severidad de los síntomas premenstruales. Conclusión: según datos obtenidos en este trabajo, no parecería existir correlación entre el nivel de instrucción de la paciente y la presencia de síntomas premenstruales.

Objective: To assess the relationship between certain social factors in the life of women, especially educational level, and the presence and severity of their premenstrual symptoms. At the same time, these characteristics were correlated with the use of oral contraception (OC). Materials and methods: 200 women who visited Health Care Center No. 2 located in the Northwest of Rosario city and the Universidad Abierta Interamericana, Lagos site located at Rosario city regional site. Data were collected between December 2010 and April 2011. The «Shortened Premenstrual Assessment Form¼ of the American College of Obstetricians and Gynecologist was used. This survey consisted in close, dichotomous, and multiple choice questions. (See Annex) Results: of the 200 women surveyed, 61% (122) presented moderate to severe premenstrual symptoms and 39% (78) presented mild symptoms. No statistically significant differences were found regarding the influence of educational level (OR 0.79 95% CI 0.43-1.45) or the effect of OC use (OR 4.61 95% CI 1.83-11.86) on the presence and severity of premenstrual symptoms. Conclusion: according to the data obtained in this study, there is no correlation between the educational level of the patient and the presence of premenstrual symptoms.