Prevalencia y factores asociados a disfunción familiar en pacientes atendidos en el primer nivel de atención

Introducción: La funcionalidad familiar influye en el proceso salud-enfermedad, es por ello que se destaca su importancia en el primer nivel de atención. No existe evidencia concluyente sobre los factores que influyen en la disfunción familiar en pacientes atendidos en el primer nivel de atención. Objetivo: Determinar la prevalencia y factores asociados a disfunción familiar en pacientes atendidos en el primer nivel de atención. Métodos: Estudio transversal de análisis secundario de datos en pacientes atendidos en 7 establecimientos del primer nivel de atención de Lima, Perú, en 2019. Se utilizó el cuestionario Apgar Familiar y se indagó su asociación con factores demográficos-socioeconómicos. Se estimaron razones de prevalencia (RP) a través de modelos de regresión simple y múltiple. Resultados: De 150 pacientes, la mayoría fueron mujeres (81,3 %) y la mediana de edad fue de 32 años. El 14 % presentó disfunción familiar. Los pacientes con acceso a servicio de agua tenían menor prevalencia de disfunción familiar (RP: 0,04; IC95 %: 0,001 - 0,47). Residir entre 1 a 10 años en Lima representó menor prevalencia de disfunción familiar; en comparación con pacientes recién llegados a la capital (menos de 1 año) (RP: 0,15; IC95 %: 0,04 - 0,62). Conclusiones: La prevalencia de disfunción familiar en pacientes atendidos en primer nivel de atención es baja. Tener acceso a servicio de agua y residir entre 1 a 10 años en la capital influyó en una menor prevalencia de disfunción familiar.

Introduction: Family functionality influences the health-disease process, which is why its importance in the first level of care is highlighted. There is no conclusive evidence on the factors that influence family dysfunction in patients treated at the First Level of Care. Objective: To determine the prevalence and factors associated with family dysfunction in patients treated at the First Level of Care. Methods: Cross-sectional study of secondary data analysis in patients treated in 7 primary care establishments in Lima, Peru in 2019. The Family Apgar questionnaire was used, and its association with demographic-socioeconomic factors was investigated. Prevalence ratios (PR) were estimated through simple and multiple regression models. Results: Of 150 patients, the majority were women (81.3%) and the median age was 32 years. 14% presented family dysfunction. Patients with access to water service had a lower prevalence of family dysfunction (PR: 0.04; 95% CI: 0.001-0.47). Living between 1 and 10 years in Lima represented a lower prevalence of family dysfunction; compared with patients recently arrived in the capital (less than 1 year) (PR: 0.15; 95% CI: 0.04- 0.62). Conclusions: The prevalence of family dysfunction in patients treated at the primary care level was low. Having access to water service and residing between 1 and 10 years in the capital influenced a lower prevalence of family dysfunction.

Disfunción familiar en gestantes adolescentes de un área de salud / Family dysfunction in pregnant adolescents from a health area

Se realizó un estudio descriptivo, observacional, de corte transversal, de las 58 gestantes menores de 20 años, pertenecientes al área de salud del Policlínico Universitario "Josué País García" de Santiago de Cuba, de enero a diciembre del 2013, con vistas a determinar la relación entre la disfunción familiar y la presentación del embarazo en ellas, para lo cual se aplicó el instrumento de evaluación Faces III. Al efectuar el análisis estadístico se evidenció un predominio del grupo etario de 15-18 años, de la vinculación a los diferentes niveles de enseñanza en correspondencia con la edad, así como de la disfuncionalidad familiar y el tipo de familia extensa; estos 2 últimos resultados constituyeron factores predisponentes en el desarrollo de conductas de riesgo, como el embarazo precoz.

A descriptive, observational, cross-sectional study of the 58 pregnant adolescents under 20 years, belonging to the health area of "Josué País García" University Polyclinic in Santiago de Cuba, was carried out from January to December, 2013, aimed at determining the relation between family dysfunctions and their pregnancies, for which the evaluation instrument Faces III was applied. During the statistical analysis a prevalence of the age group 15-18 years, a link to the different teaching levels in correspondence to age were evidenced, as well as of the family dysfunctionality and the numerous members family; these 2 last results constituted predisposing factors in the development of risky behaviors, as early pregnancy.

Tipificación del tipo de disfunción familiar de un barrio vulnerable de la ciudad de Ibagué-Tolima / Typification of the type of family dysfunction in a vulnerable neighborhood in the city of Ibagué-Tolima

Esta investigación tipifica posibles niveles de disfunción en familias vulnerables de un barrio en la ciudad del Ibagué, Tolima, Colombia, a través del APGAR familiar que evalúa la satisfacción a través de la adaptación, participación, ganancia o crecimiento, afecto y recursos. Se encontró una buena función familiar (44,4%), disfunción moderada (22,2%), disfunción familiar severa (18,5%) y disfunción familiar leve (14,8%).

This research typifies possible levels of dysfunction in vulnerable families in a neighborhood in the city of Ibagué, Tolima, Colombia, through the family APGAR that assesses satisfaction through adaptation, participation, gain or growth, affection and resources. Good family function (44.4%), moderate dysfunction (22.2%), severe family dysfunction (18.5%) and mild family dysfunction (14.8%) were found.

Niveles de disfunción familiar, en veinte mujeres victimas de violencia intrafamiliar en el municipio de Armenia / Family dysfuntion levels in twenty women, victims of intrafamily violence, in the municipality of Armenia

Esta investigación pretende encontrar posibles niveles de disfunción familiar en las familias de 20 mujeres víctimas de violencia intrafamiliar en la ciudad de Armenia - Quindío, para lo cual se aplicó el APGAR familiar, el cual evalúa la satisfacción respecto a 5 variables: adaptación, participación, ganancia o crecimiento, afecto y recursos. El estudio encontró que las familias presentan disfunción leve (35%), moderada (30%) y severa (20%), mientras un porcentaje muy bajo tiene buena función familiar (15%); lo anterior indica una correlación importante entre violencia intrafamiliar y disfunción familiar, condición que disminuye la calidad de vida del núcleo familiar, alterando los roles, los modos de expresión afectiva y la interiorización de lo normativo.

This research aims to find possible levels of family dysfunction in families of 20 women victims of domestic violence in the city of Armenia - Quindío, which applied the family Apgar. It evaluates satisfaction with respect to 5 variables: adaptation, participation, gain or growth, affection and resources. The study found that the 35% families have mild dysfunction, 30% moderate dysfunction, and 20% severe dysfunction, while a very low percentage has good family function, which represents 15%. This indicates a significant correlation between intrafamily violence and family dysfunction, a condition that reduces the family unit's quality of life, altering roles, modes of emotional expression, and the internalization of norms.

Contexto familiar e condições de saúde bucal em crianças de 2 a 5 anos no município de Salvador, Bahia: uma análise descritiva / Family context and oral health conditions among 2 to 5 year-old children in Salvador, Bahia: a descriptive analysis / Contexto familiar y condiciones de salud bucal en niños de 2 a 5 años em el municipio de Salvador, Bahia: un análisis descriptivo

Fatores socioeconômicos, como renda familiar e acesso a tratamento odontológico, aspectos relacionados à morfologia dentária e hábitos dietéticos, e o núcleo familiar no qual os indivíduos estão inseridos são relevantes para a compreensão das enfermidades bucais. São objetivos deste estudo realizar uma análise descritiva das condições de saúde-bucal em pré-escolares pertencentes a famílias cobertas pelo PSF de Salvador, Bahia, e destacar características do ambiente familiar no qual elas estão inseridas. Trata-se de estudo de corte transversal, mediante exame clínico dos pré-escolares em ambiente domiciliar, de acordo com critérios da Organização Mundial de Saúde e de entrevista individual com indivíduos maiores de 15 anos presentes no domicílio. Buscou-se detectar a presença de distúrbios psiquiátricos e alcoolismo na família com base no SRQ-20 e na Escala CAGE, respectivamente. Os resultados apontam que 94,93por cento dos domicílios consistem em casas de tijolo/adobe, 98,17por cento têm o lixo coletado, 66,3por cento filtram a água,94,4por cento têm sistema de abastecimento de água/esgoto e 65,3por cento possuem de 4 a 6 cômodos. Das crianças examinadas, 1,3por cento possui alteração gengival e 37,4por cento oclusopatias. O ceo-d correspondeu a 1,23 (DP igual 2,37), sendo 90,2por cento dos dentes atingidos correspondentes a dentes cariados. Considerando os indivíduos maiores de 15 anos, 46,83por cento das famílias apresentam algum membro com sintomas psiquiátricos e 35,92por cento demonstram uso abusivo de álcool. Conclui-se que é alta a prevalência da doença cárie nos pré-escolares e a prevalência de famílias com membros apresentando sintomas psiquiátricos e uso abusivo de álcool na população estudada.

Socioeconomic factors, such as family income and access to dental care,issues related to dental morphology and dietary habits, and the nuclear family which individuals are part of are relevant to the understanding of oral diseases. The objectives of this study were to make a descriptive analysis of oral health conditions among preschoolers from families covered by the Family Health Program in Salvador, Bahia, and to demonstrate the family environment in which they live. This was conducted as a cross sectional study and preschoolers were clinically examined in their households, according to World Health Organization criteria. Questionnaires were completed by people over 15 years old who were in the households.The presence of mental disorder symptoms and alcoholism in the family was evaluated based on the SRQ-20 and CAGE scale, respectively. The results show that 94.93percent of the households were built with brick, 98.17percent had the trash collected, 66.3percent filtered their water, 94.4percent had water/sewage supply and 65.3percent had four to six rooms. Of the children who were clinically examined, 1.3percent had gum alteration and 37.4percent had malocclusion. The dmf-t (decayed, missing, and filled teeth) was 1.23 (2.37), in which 90.2percent of the teeth had cavities.When considering subjects over 15 years-old, 46.83percent of the families had someone with symptoms of mental disorder and 35.92percent demonstrated alcohol abuse. It was concluded that there is a high prevalence of oral cavity disease in preschoolers and the prevalence of families with members presenting psychiatric symptoms and alcohol abuse in this population.

Factores socioeconómicos, tales como el ingreso familiar y el acceso a la atención dental, problemas relacionados con la morfología dental y los hábitos alimenticios, así como el núcleo familiar en que los individuos están insertos son relevantes para la comprensión de las enfermedades bucales. Los objetivos de este estudio son hacer un análisis descriptivo de lascondiciones de salud bucodental en niños preescolares de familias incluidas en el Programa de Salud Familiar de Salvador, Bahía, y destacar las características del medio familiar en que se insertan. Se trata de un estudio transversal mediante un examen clínico de los niños en edad preescolar en el hogar, de acuerdo con los criterios de la Organización Mundial de la Salud y entrevistas individuales con personas mayores de 15 años presentes en el hogar. Se trato de detectar la presencia de trastornos psiquiátricos y el alcoholismo en la familia basados, respectivamente, en el SRQ-20 y en la escala de CAGE. Los resultados muestran que 94,93por ciento de los hogares se componen de casas de ladrillo / adobe, 98,17por ciento cuentan con recolección de basura, 66,3por ciento filtran el agua, 94,4por ciento tienen un sistema de agua / alcantarillado y 65,3por ciento tienen entre cuatro y seis habitaciones. De los niños examinados, 1.3por ciento presentaron cambios gingivales y 37,4por ciento maloclusión. El ceo-d correspondió a 1,23 (DP igual 2,37), con 90,2por ciento de los dientes afectados cabiendo a los dientes cariados. Teniendo en cuenta los individuos mayores de 15 años, 46,83por ciento de las familias tienen un miembro con síntomas psiquiátricos y 35,92por ciento mostrabanel abuso del alcohol. Se concluye que en la población estudiada existe una alta prevalencia de caries entre los niños en edad preescolar, así como, la de familias con miembros que presentan síntomas psiquiátricos y el abuso del alcohol.

Consideraciones bioético-sociales en pacientes geriátricos y ancianos frágiles / Bioethic and social considerations on geriatric patients and fragile elderlies

Se procedió a la revisión de fuentes bibliográficas relacionadas, no solo con el estado actual del envejecimiento en otras latitudes, sino también en Cuba, así como consideraciones bioético-sociales en pacientes de la tercera edad en estado terminal. Se enfatizó en el concepto de estado vegetativo persistente y muerte encefálica aplicado en nuestro país, al igual que los dilemas que existen desde el punto de vista ético entre unos y otros cuidados actualmente. Los cuidados paliativos al geronto-geriátrico, los dilemas y su aplicación a ancianos frágiles constituyen la motivación de este trabajo.

The bibliographical sources related not only with the present state of aging in other latitudes, but also in Cuba, as well some bioethical and social considerations on elderly patients at the terminal stage of life were reiewed. Emphasis was made on the concept of persistent vegetative state and encephalic death applied in our country, and on the dilemas existing from the ethical point of view between one care and the other at present. The palliative care of the elderly, the dilemas and their application to fragile elderlies are the motivation of this work.

Disfunción famiiiar en el personal de salud del hospital la paz en el año 2007 / FAMILY DYSFUNCTION IN THE HEALTH STAFF OF LA PAZ HOSPITAL IN 2007

La familia como sistema juega un papel importante en el proceso generador y de rehabilitación de la enfermedad. El APGAR familiar evalúa el funcionamiento sistémico familiar, y es útil en la identificación de familias en riesgo. Se realizó un estudio descriptivo, transversal de la disfunción familiar en el personal de Salud del Hospital La Paz, que cuenta con un total de 203 recursos humanos entre médicos, licenciadas y auxiliares de enfermería, personal administrativo y otros, mediante una encuesta basada en el test de APGAR. La encuesta compendió tres aspectos: 1) Sexo. 2) Ocupación. 3) Instrumentos de evaluación familiar: APGAR Familiar. De un total de 125 funcionarios, 94% tienen buena función familiar y disfunción moderada un 6%. De los 30 médicos encuestados, solo 2 tuvieron disfunción familiar moderada. El 100% de licenciadas en enfermería tienen buena funcionalidad familiar. De un total de 40 auxiliares de enfermería, 6 son de sexo masculino de los cuales 4 tienen disfunción familiar moderada. El 100% de administrativos tuvieron buena funcionalidad familiar. De cada diez funcionarios del Hospital La Paz 1 tiene disfunción familiar moderada. Este fenómeno pudiera relacionarse con las exigencias permanentes de los pacientes y la misma familia, además de la capacidad de articular un mecanismo para enfrentar las situaciones de estrés. El personal que presenta mayor porcentaje de disfunción familiar moderada son las auxiliares en enfermería, se puede asumir a que existe poca comunicación en sus familias.

Aptitud clínica de los médicos familiares en la identificación de la disfunción familiar en unidades de medicina familiar de Guadalajara, México

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Abstract: Introduction Families function as dynamic systems, where the different members stimulate each other to achieve common objectives. Family development is thus conceived as a chain of changes, in form and function, which follow evolution stages. The balance of positive and negative forces inside the family is translated into an evolution, and so the ability to respond to internal or external changes is vital to avoid discrepancies or clashes between the tasks and roles of the different family members. In this sense, family physicians must be able to identify any potential dysfunction or difficulty inside the family, and to facilitate the compatibility of tasks in order to reestablish the continuity and good functioning of the family. The family physicians' clinical aptitude is made up of a series of abilities intended to identify any signs and symptoms of dys-function. They must also be skilled in using auxiliary resources for the diagnosis and treatment of all these. Such an aptitude is measured by a structured and validated instrument. Material and methods This is an observational, prospective and comparative research of a 450 family physicians sample from 23 first level family health care medical clinics from the National Social Security Institute (Instituto Mexicano del Seguro Social: IMSS). All family physicians working at the clinics were included, excepting those who were at the time on vacation, worked the night shift, attended the ER, were absent or refused to participate. Clinical aptitude for family dysfunction was measured in three areas: 1. Identification of risk factors for family dysfunction; 2. Diagnosis with an integral point of view and 3. Proposal, identification and guidance, which describes a physician's ability to judge decisions taken on case reports and to propose alternative actions. Other variables taken into account were sex, age, specialty, years of experience, shift, clinic and type of contract. Instruments. The instrument was designed to integrate theory and practice. It was conformed by real case reports, which were condensed, divided in sections, and followed by a series of ques-tions with three possible answers: «true¼, «false¼ or «I don't know¼. In total, there were 187 questions, 94 of which were true and 93, false. Correct answers accounted for one point, while incorrect ones rested one point; «I don't know¼ answers had no effect on the results. There were 42 lines to explore risk factors; 24 to explore the use of diagnostic resources; 19 to explore the use of therapeutic resources; 36 to evaluate a physician's knowledge of family sociology; 42 to assess family psychology, and 24 designed to evaluate proposal abilities. It was all validated and standardized with a group of post-graduate medical residents in Family Medicine from Mexico City. The Richardson K index was 0.90. Clinical aptitude was measured using an ordinal scale, where a random level «1¼ was defined by <60 points; a low «2¼ level by 60-99 points; an intermediate «3¼ level by 100-139 points, and a high «4¼ level by >140 points. A descriptive and inferential statistical analysis was used with median, percentage, Mann-Whitney's and Kruskal-Wallis' tests. All this was then processed with the EPI INFO-6 and SPSS Plus software packages. Ethical considerations. This is a risk-free research, as established in the Health Research section of the Mexican Health Law. Ne-vertheless, a signed acceptance form was required from all participants. Results Table 1 shows the general characteristics of the study sample. In turn, table 2 presents clinical aptitude to identify family dysfunction, sorted by clinic. Clinics B and D had, respectively, a median of 105 and 102, with similar ranges. There were no statistically significant differences among the subindexes of each clinic. The diagnosis median was higher than that for guidance. Table 3 reveals a high level of clinical aptitude in 3% of the physicians, an intermediate level in 25%, a low level in 58%, and a random-defined level in 14%. There were no significant differences when clinical aptitude was correlated with sex, shift, type of contract, specialty and years of experience. Discussion. The main objective of a family dysfunction diagnosis is to reestablish the normal flow of a family's vital cycle with the support of a specialized physician. It has been reported that clinical aptitude measurement is useful to discriminate and establish the aptitude level of experiment and non-experiment physi-cians with the aim of creating educational opportunities. A slight advantage, with no significant difference, was appreciated in physicians who attended patients in their offices, which suggests they are in a better position to gain a higher level of trust from their patients. This is due to the fact that they attend a regular set group of patients assigned to their offices. Since the education of family physicians is aimed at offering an integral care to families, family dysfunction recognition is essential. Results also suggest a non-significant advantage from family physicians with curricular education (not all family physicians working at the IMSS have a degree in Family Medicine). Experienced physicians (10 to 19 years on the job) showed another non-significant advantage, which pointed to the value of clinical practice. This is a powerful reason to promote continuous educational programs for family physicians. Family physicians who worked the morning shift showed a non-statistical advantage over their afternoon shift counterparts. This could be explained by the fact that educational and other institutional activities are more likely to take place in the morning. The educational model of family physicians should promote the physicians' involvement in understanding how to become active elements in gathering their own knowledge. Such a model should promote physicians' initiatives for the development of an experience based on constructive critic. The current health care model is mainly focused on a biological interpretation of the health-disease process. However, this is only a partial approach which prevents the implementation of an integral clinical practice. From our research, we expect changes in institutional health care orientation and a reframing of the curricula of general and family physicians'. Although the acquisition of clinical aptitude requires the physicians' experience and involvement in developing their own knowledge, our results do not reflect this ideal condition. This is due to the low percentage of clinical aptitude, which correlates with an evident inability for research and interpretation. Half of the physicians were capable of elaborating diagnostic hypothesis and two thirds of them showed a adequate use of diagnostic resources, such as clinical tests, functional family diagnostic instruments and a guide to conform an integral family workup. All these should be useful educational tools to establish the social functions diagnosis of a family's members, together with their formal and informal roles and their importance in the healthdisease process. Guidance requires the ability to judge decisions taken by other professionals and make suggestions for alternative actions in case reports. This latter skill includes the use of therapeutic resources for only less than half of the physicians know how to properly use these resources. The use of instruments to measure aptitude, competency and work performance is a growing practice in continuous education and human resources formation. Even though these instruments are capable of discriminating high clinical aptitude, they cannot be used to account for this non-significant advantage, because educational activities are conceived as the consumption of infor mation and not as the acquisition of it from each one's experience. Overall, 58% of the family physicians showed a low level of clinical aptitude. Such a result reflects a poor ability to integrate daily experience.

Niveles de la presión arterial y de estrés psicosocial en estudiantes de la Facultad de Salud, Universidad del Valle: Cali, Colombia, 2003-2004 / Blood pressure levels and psychosocial stress in students of health sciences: University of Valle, Cali, Colombia, 2003-2004

Objetivo: Evaluar los niveles de estrés psicosocial y de presión arterial en personas jóvenes sanas y su posible correlación. Materiales y métodos: Se realizó un estudio descriptivo en estudiantes de la Facultad de Salud de la Universidad del Valle en Cali, Colombia. Los niveles de presión arterial y de estrés psicosocial se evaluaron al determinar la percepción de la funcionalidad familiar (APGAR Familiar) y los hechos imprevistos de cambio de vida mediante la escala de reajuste social. Resultados: Se estudiaron 185 estudiantes con una edad de 21.2±2.6 años, 178 (96%) solteros, 100 (54%) mujeres, 173 (93.5%) mestizos, 154 (83.2%) de nivel socioeconómico medio (estrato 3-4). La disfunción familiar se observó en 131 (70.8%) estudiantes, 66 (35.6%) presentaban casos de cambio en sus vidas. El promedio de la presión arterial en los estudiantes fue normal (106.4/69.7) con mayores niveles en los hombres (p<0.001) lo que se asoció con un mayor índice de masa corporal y con la raza negra ( p<0.001, p<0.02). La disfunción familiar no se asoció con cambios en los niveles de la presión arterial (p=0.80). El estrés generado por los sucesos de cambio en sus vidas tampoco se correlacionó con los niveles de presión arterial (p=0.98). Conclusión: En personas jóvenes sanas el estrés psicosocial fue alto para disfunción familiar y para acontecimientos inesperados de cambio en sus vidas sin correlación con los niveles de presión arterial, quizá por una adecuada funcionalidad del endotelio vascular.

Objective: To evaluate the levels of family stress, social stress and the blood pressure levels in young people and the possible correlation. Materials and methods: A descriptive study was performed recruiting healthy students of health sciences in the University of Valle in Cali, Colombia during 2002-2003. The psychosocial stress inventory included evaluation of the family stress and the evaluation of social stress. The blood pressure was evaluated by physicians using standardized technique with calibrated manual sphygmomanometers. Results: 185 students were recruited with an average age of 21.2±2.6 years old, 178 (96%) were singles, 100 (54%) were women, 173 (93.5%) were of mixed ethnic background, 154 (83.2%) were from middle socioeconomic level (level 3-4). The family dysfunction was observed in 131 (70.8%) students, 66 (35.6%) had high cumulative social changes. The average blood pressure level in all students was normal (106.4/69.7) with high blood pressure levels in males than in females (p<0.001) associated with the body mass index (p<0.001) and the black race ( p<0.02). Family dysfunction was not associated with changes in blood pressure (p=0.80). Social stress was not associated with blood pressure levels (p=0.98). Conclusion: In young people psychosocial stress was high but did not affect blood pressure levels probably due to compensatory physiologic action of vascular endothelium.

Síndrome del cuidador de adultos mayores discapacitados y sus implicaciones psicosociales / Syndrome of the caregiver in disability old patients and the psychosocial implications: Valle del Cauca, Colombia 2003-2004

Objetivo: Describir la prevalencia del síndrome del cuidador y las características psicosociales de los cuidadores de adultos mayores discapacitados. Materiales y métodos: Se realizó un estudio piloto de casos y controles en el Valle del Cauca durante el 2003-2004 para evaluar la funcionalidad familiar (APGAR familiar), la ansiedad y depresión (escala de Goldberg), la presencia de enfermedades (cuidadores y no cuidadores), y la prevalencia del síndrome del cuidador (escala de Zarit). Resultados: Se estudiaron 102 familias en su mayoría de nivel socioeconómico bajo (75.3%) con una discapacidad media de 4 años (rango 1-60 años). Se observó una mayor proporción de depresión (81.3% vs. 53.9%, p<0.01), una mayor proporción de ansiedad (85.2% vs. 45%, p<0.001), y una mayor proporción de disfunción familiar severa (26.5% vs. 10.8%) (p=0.004) en los cuidadores en relación con los no cuidadores. De los cuidadores principales 47% presentaron el síndrome del cuidador que se asociaba con ansiedad (96%, p=0.01) y con depresión (100%, p<0.0001); 85.3% de los cuidadores habían presentado enfermedades previas en comparación con 63.7% de los no cuidadores (p=0.0004). Conclusión: Los cuidadores de adultos mayores discapacitados presentan altos niveles de ansiedad, depresión, disfunción familiar y síndrome del cuidador con mayor predisposición a la morbilidad. Los resultados de este estudio identifican a los cuidadores de adultos mayores discapacitados como un grupo vulnerable con necesidades preventivas y terapéuticas.

Objective: To determine the profile of caregivers for disability old patients in home care and to investigate the psychosocial characteristics of caregivers. Materials and methods: A pilot case-control study was performed in the state of Valle del Cauca, Colombia during 2003-2004. Family function (family APGAR), anxiety and depression (Goldberg Scale), morbidity, and the prevalence of the syndrome of family caregivers (Zarit Scale) were assessed.Results: 102 families from low and middle socioeconomic status were studied. Median disability average was 4 years (range 1-60 years). A high proportion of depression (81.3% vs. 53.9%, p<0.01), anxiety (85.2% vs. 45%, p<0.001), and family dysfunction (26.5% vs. 10.8%) (p=0.004) was observed in caregivers; 48 (47%) caregivers had the syndrome and had high levels of anxiety (96%, p=0.01) as well as high levels of depression (100%, p<0.0001); 87 (85.3%) caregivers have had different pathologies in the precedent year in comparison with 65 (63.7%) not caregivers (p=0.0004). Conclussion: A caregivers syndrome was observed in 48 (47%) family members. The caregivers had high levels of anxiety, depression and family dysfunction associated to the syndrome and its morbidity. This study identified the caregivers of old disability people as a vulnerable group with high preventive and therapeutic necessities.

Impacto psicosocial del autismo en la familia / Psychosocial impact of autism on the family

En Bolivia no se tiene ningún dato sobre cuántos autistas existen; y menos aún respecto a cuántas familias son afectadas por esta situación, ni el impacto que ocasiona en ellas. El presente trabajo pretende identificar el impacto psico-social que tiene la presencia de un niño autista en la familia. El estudio fue realizado con 6 familias de Cochabamba, las cuales en su mayoría tienen una estructura familiar nuclear, y son disfuncionales en diferentes grados, pero con una unión estrecha entre sus miembros a causa de los lazos que provoca el autista en sus miembros. La mayoría tienen una adaptabilidad caótica, con niveles de estrés elevados que llevan a la familia a una crisis. De los miembros de la familia, los más afectados son los hermanos del autista, que llegan a presentar cambios de conducta significativos. Los ingresos familiares generalmente son insuficientes para satisfacer las necesidades especiales que tiene el niño autista. Las familias del niño autista presentan una disfunción crónica, ya que no solo el autista tiene el problema de la sociabilización, sino también su familia. También existe dificultad en realizar el diagnóstico de autismo y gran dificultad con el tratamiento y manejo, por la desorientación de la familia y de los profesionales sobre sus prioridades.

In Bolivia does not exist data about the number of autistic children, and we do not know how many families are affected. The present research has the aim to identify the psicosocial impact autistic children have on the family. The present work was done on 6 families with an autistic child. We find that all families are nuclear y have familial dysfunction at different grade, but they present a closer relationship between their members because the union that cause the autistic child. Most families have a chaotic adaptability with high stress levels, which family to crisis. From all family members, autistic brothers and sisters are most affected which take significative behaviour changes. The familial incomes are in general insufficient because the special needs of autistic. As a conclusion we can say that all autistic child families have chronic dysfunction, because not only the autistic child has socialization problem, but all the family. Also, there is a difficult to reach the diagnosis of autism and great difficulty with their treatment and management with disorientation of the family and the professionals about their priories.

Maltrato en los ancianos: un reto a la atención primaria de salud geriátrica / Elderly abuse: a challenge to primary geriatric health care

Se realizó un estudio descriptivo de corte transversal en la población de adultos mayores de un consultorio del Médico de Familia del Policínico "Ana Betancourt" del municipio Playa, clasificándose la muestra (93 pacientes) por grupos de edades, sexo, nivel escolar, ocupacional, estado civil etc., y se les aplicó una encuesta formulario, en la que, además de sus datos generales, se investigó la estructura y funcionamiento de la familia, sus ingresos económicos y la ayuda recibida, su procedencia, así como también el trato recibido de familiares, amigos, allegados, etc. En la investigación se encontró que 41 (44 %) eran objeto de abuso o maltrato en algunas de sus modalidades, siendo el perfil más frecuente el económico financiero con 19 casos (35 %), seguido del maltrato psicológico con 18 (33 %), la desatención en 15 (27 %) y el maltrato físico en 3 (5 %). Se relacionó además el funcionamiento familiar de los hogares de donde proceden los ancianos maltratados.

A descriptive cross-sectional study was undertaken in the population of older adults from a family physician's office of "Ana Betancourt" Polyclinic, in Playa municipality. The sample (93 patients) was classified by groups according to age, sex, educational level, occupation, marital status, etc. In addition to their general data, the family structure and functioning, its incomes, the assistance received, its origin, the treatment given by close relatives and friends, etc., were also investigated by applying a questionnaire-survey. It was found that 41 (44 %) were abused or mistreated in some way . The economic financial profile was the most frequent with 19 cases (35 %), followed by psychiological abuse with 18 (33 %), lack of attention in 15 (27 %) and physical abuse in 3 (5 %). The family functioning of the houses where the elderly abused lived was also exposed.