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.

Homicidio y disfuncionalidad familiar / Homicide and family dysfunction

Introducción: La familia es la instancia de intermediación entre el individuo y la sociedad. Es en ella donde la persona adquiere sus primeras experiencias, valores y concepción del mundo. Constituye el espacio por excelencia para el desarrollo de la identidad y es el primer grupo de socialización del individuo. Una familia con un funcionamiento apropiado, o familia funcional, origina el desarrollo integral de sus miembros y logra la subsistencia de estados de salud favorables en estas. Por otra parte, una familia disfuncional o con un funcionamiento inadecuado, debe ser considerada como factor de riesgo, al favorecer la aparición de enfermedades en sus miembros y la ocurrencia de hechos violentos, como el homicidio. Objetivo: Explorar la relación que existe entre la disfuncionalidad familiar y el delito de homicidio. Métodos: Se realizó una investigación retrospectiva e indirecta de todos los homicidios acaecidos en el contexto familiar en La Habana durante el año 2013, utilizando para la misma el método de autopsia psicológica. Conclusiones: En el homicidio, como máxima expresión de la violencia, existe un estrecho vínculo entre los protagonistas del homicidio y la disfuncionalidad familiar, dado por el hacinamiento, la promiscuidad y la actividad ilícita como medio de sustentación familiar, unido a esto el consumo de alcohol y otras drogas(AU)

Introduction: Family is the instance of intermediation between the individual and society. In the family, the person acquires his/her first experiences, values ​​and conception of the world. It constitutes the space par excellence for the development of identity and is the first group of socialization of the individual. A family with an appropriate functioning, or a functional family, originates the integral development of its members and achieves the subsistence of favorable health states in these. On the other hand, a dysfunctional family or one with an inadequate functioning, should be considered as a risk factor, favoring the onset of diseases in its members and the occurrence of violent acts, such as homicide. Objective: To explore the relationship between family dysfunctionality and the crime of homicide. Methods: A retrospective and indirect research was carried out of all homicides occurred in the family context in Havana during 2013, using the method of psychological autopsy. Conclusions: In homicide, as the maximum expression of violence, there is a close link between the homicide protagonists and family dysfunction, given by overcrowding, promiscuity and illegal activity as a means of family support, together with the consumption of alcohol and other drugs(AU)

Análisis integral de un caso de moyamoya reportado en la ciudad de Barranquilla (Colombia) / Comprehensive analysis of Moyamoya case reported in Barranquilla (Colombia)

Resumen Este caso clínico muestra los resultados del análisis e intervención interdisciplinar que se realizó en una paciente femenina de 8 años diagnosticada a la edad de 3 años con enfermedad de moyamoya. Remitida para evaluación, se encontró estenosis progresiva de las arterias cerebrales. La evaluación del desarrollo motor mostró poca agilidad motora gruesa y fina, bajo tono, debilidad muscular, dificultad para establecer movimientos alternos y simultáneos, además dificultad al masticar y deglutir, por lo que requirió ajuste de la minuta alimenticia por parte de nutrición. Falta de control esfinteriano. En los aspectos cognitivos se evidenció déficit, falta de comprensión de órdenes, desconocimiento de categorías semánticas, falta de seguimiento de instrucciones, tratado por fonoaudiología y terapia ocupacional. Estado emocional preservado, capacidad de establecer vínculos afectivos y empatía; en lo familiar se presentó disfuncionalidad familiar por miembro enfermo, que es el eje central en la dinámica familiar, negligencia familiar con otros miembros, desajuste de roles. Se estableció intervención psicoterapéutica, con enfoque cognitivo conductual, apoyado en el modelo de Terapia Racional Emotiva, Psicoeducación, Terapia familiar sistémica. Seguimiento médico con fármacos y evaluación de pruebas diagnósticas. En tres años de seguimiento se evidenció: adaptación progresiva en adquisición de habilidades sociales, reacciones afectivas en su núcleo familiar y entorno, lo cual permitió concluir que las estrategias adoptadas generaron un cambio significativo en el contexto familiar, con adopción de factores protectores, identificación de roles, cambios en la adherencia, lo que en conjunto permitió mejoras en la calidad de vida y clínica de la paciente.

Abstract The clinical case presented in this article reflects the results of the analysis and interdisciplinary intervention that was performed on a 8 year old female patient diagnose at 3 years old with the Moyamoya disease, she was referred for evaluation, finding progressive stenosis of the brain arteries, the motor development evaluation exhibit low gross and fine motor agility, low muscle tone, muscular weakness, difficulty to set alternating and simultaneous movements, also trouble to masticate and swallowing, so it required adjustment of the food diet in the behalf of her nutrition. Absence of sphincter control. In the cognitive aspects it was evident the lack of understanding orders, lack of semantic categories, failure to follow instructions, it was treated by speech therapy and occupational therapy. Emotional state preserved, ability to bond and empathy, in the familiar aspect it exhibit family dysfunctionality because of sick family member that is now the focus on the family dynamic, family neglect with other members, mismatch roles. Was established psychotherapeutic intervention with cognitive behavioral approach, supported the model of Rational Emotive Therapy, psychoeducation, systemic family therapy. Medical monitoring with drugs and evaluation of diagnostic tests. It was evident in three years follow-up: Progressive adaptation acquisition of social skills, affective reactions in the household and environment, which it led to the conclusion that the strategies adopted generated a significant change in the family context, with adoption of protective factors, identifying roles, changes in adhesion, which together allowed improvements in quality of life and clinical patient.

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.

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.

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.