Substance Use in Patients With First-Episode Psychosis: Is Gender Relevant?

OBJECTIVE: Only a few studies in patients with first-episode psychosis have included gender in the study hypothesis or considered this a primary study variable. The aim of this study was to explore the influence of gender in the pattern of substance use in patients with first-episode psychosis. METHODS: This is a sub-analysis of a randomized open clinical trial that compared 1-year treatment retention rates of patients with first-episode psychosis randomized to haloperidol, olanzapine, quetiapine, risperidone, or ziprasidone. Our sub-analysis included 85 men and 29 women. RESULTS: Substance use was relatively high among these patients and differed significantly by gender. Men were more likely to use substances overall than women (89.4% for men vs. 55.2% for women), χ(2) = 16.2, df = 1, p <.001, and were also more likely to use alcohol (χ(2) = 13, df = 1, p <.001), cannabis (χ(2) = 9.9; df = 1, p <.002), and cocaine (χ(2) = 10.3; df = 1, p <.001), compared to women. While there were no gender differences in age at first consumption of alcohol or cocaine, men were significantly younger at first consumption of cannabis (M = 16.08 years, SD = 2.1) than women (M = 18.0 years, SD = 3.8), F(1, 59) = 5, p <.02. When analyzed separately by gender, women showed no significant differences in the influence of number of substances used on age at onset of psychosis, F(3, 29) = 1.2, p =.30. However, there was a significant difference among men, with earlier onset of psychosis noted in men consuming multiple substances; F(4, 85) = 5.8, p <.0001. Regarding prediction of age at onset of psychosis, both male gender and the use of a higher number of substances significantly predicted an earlier age at onset of psychosis. CONCLUSIONS: Our study provides some evidence of gender differences in the pattern of substance use in patients with first-episode psychosis, suggesting the possible need for gender-specific approaches in the interventions performed in these patients. This study is registered as #12610000954022 with the Australian New Zealand Clinical Trials Registry (www.anzctr.org.au).

One-year, randomized, open trial comparing olanzapine, quetiapine, risperidone and ziprasidone effectiveness in antipsychotic-naive patients with a first-episode psychosis.

The aim of this study was to compare the 12-month effectiveness of several second-generation antipsychotic drugs, with that of haloperidol in never-treated patients with first-episode psychosis. In total, 114 patients without life time exposure to any psychotropic medication were randomized to haloperidol, olanzapine, risperidone, quetiapine or ziprasidone. Primary outcome was time to all-cause discontinuation. Secondary outcomes included discontinuation rates and symptom change as measured by the Positive and Negative Syndrome Scale (PANSS). The overall discontinuation rate 64%. At 12 months, the proportion of patients discontinuing treatment was 40.0% for olanzapine, 56.5% for quetiapine, 64.0% for risperidone, 80.0% for ziprasidone and 85.7% for haloperidol. Mean time to antipsychotic discontinuation was higher in patients randomized to second-generation antipsychotics than in those taking haloperidol. Significantly lower discontinuation was noted in patients on olanzapine than on haloperidol, or ziprasidone. Our results suggest that olanzapine might lead to longer treatment continuation in treatment naïve FEP patients than haloperidol and, possibly ziprasidone. Global psychopathology was significantly less reduced by haloperidol than with each individual SGA in this earliest phase of treatment.

The prevalence of mental disorders in Spanish prisons.

BACKGROUND: The prevalence of mental disorders among prisoners has been researched in a few countries worldwide but never previously in Spain. AIM: Our aim was to estimate the lifetime and last month prevalence of mental disorders in a Spanish prison population. METHODS: This is a descriptive, cross-sectional, epidemiological study of 707 male prisoners. Sociodemographic, clinical and offending data were collected by interviewers. Offending data were confirmed using penitentiary records. Mental disorders were assessed with the clinical version of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition Axis I Disorders, and personality disorders were assessed through the Spanish version of the International Personality Disorders Examination. RESULTS: The lifetime prevalence of mental disorder was 84.4%. Substance use disorder (abuse and dependence) was the most frequent disorder (76.2%) followed by anxiety disorder (45.3%), mood disorder (41%) and psychotic disorder (10.7%). The period (last month) prevalence of any mental disorder was 41.2%. Anxiety disorder was the most prevalent (23.3%) followed by substance use disorder (abuse and dependence; 17.5%), mood disorder (14.9%) and psychotic disorder (4.2%). CONCLUSION: Although period prevalence figures, which are those generally provided in research into rates of mental disorder among prisoners, are useful for planning improvements to services within prisons, the fact that almost all of these men had a lifetime prevalence of at least one mental disorder suggests a much wider need for improving services, including community services, for this group.

Cannabis use and striatal D2 receptor density in untreated first-episode psychosis: an in vivo SPECT study.

The biological basis of the association between cannabis-induced dopamine dysregulation and psychosis remains poorly understood. This (123)I-IBZM SPECT study assessed striatal dopamine D2 receptor (D2R) binding in 37 untreated first-episode psychosis (FEP) subjects, and 18 healthy controls. The aim was to examine if there were differences between FEP subjects with (n=14) and without (n=23) cannabis use in uptake ratios in the D2R. Striatal/Frontal cortex (S/F) uptake ratios were obtained. Healthy controls showed the lowest D2R binding ratios. No differences were found in S/F ratios between users and non-users, suggesting similar dopaminergic mechanisms underlying psychotic symptoms in both groups.

Density of striatal D2 receptors in untreated first-episode psychosis: an I123-IBZM SPECT study.

There is as yet no definite prognostic marker to determine whether a first-episode psychosis will become schizophrenia or not. The aim of the present study is to address whether the mechanism of sensitization of the subcortical dopaminergic pathway - yielding to an increase of the postsynaptic D2 receptors - may serve as a prognostic marker of clinical outcome in drug naïve patients with a first-episode psychosis, by means of a prospective and multicentric study with untreated first-episode psychosis patients (n=37). 123I-IBZM SPECT was performed at the time of the inclusion in the study, before antipsychotic medication was initiated. One year later, patients were assessed again so as to determine their diagnosis. There was a significant group effect at baseline in D2 Striatal/Frontal (S/F) ratios (F=10.2, p<0.001). Bonferroni posthoc comparisons attested significant differences between diagnosis (p=0.006), and between schizophrenia and control groups (p<0.001) but no differences between non-schizophrenia and control groups (p=0.9). The logistic regression model showed that D2R binding (p=0.02) and PAS (Premorbid Adjustment Scale) adulthood score (p=0.03) were predictive of the final diagnosis (schizophrenia/non-schizophrenia; Nagelkerke R(2)=0.59; X(2)=11.08, p=0.001). These findings replicate previous results on the usefulness of D2R binding as an objective prognostic parameter, together with the evaluation of premorbid adjustment, of the evolution of first-episode psychosis. In this regard, the results may provide a new view in the approach of early and personalized treatment in the debut of a psychosis.

Predictors of schizophrenia in patients with a first episode of psychosis.

Early identification of schizophrenia in patients with a first episode of psychosis (FEP) may help to avoid inappropriate treatment and may enhance long-term outcome by addressing issues such as family network, treatment adherence and functional and symptomatic outcome. It was the aim of the study to determine baseline variables that significantly predicted a diagnosis of schizophrenia in patients with FEP. The sample consisted of 133 FEP patients hospitalized for at least 6 weeks, in whom a DSM-IV diagnosis was confirmed after 1 year follow-up. Patients were divided into two groups, those with a diagnosis of schizophrenia (Schizophrenia group, n=63; 47.8%), and those with other psychosis, who were grouped under Non-Schizophrenic Psychosis (NSP, n=70; 52.2%). Sociodemographic (marital status, educational level) and clinical variables were recorded for each patient. Substance use (alcohol, cannabis and cocaine) did not statistically differ between the two groups. Absence of characteristics defined as criteria for good prognosis, lack of > or = 20% improvement in the total Positive and Negative Syndrome Scale score at 6 weeks, and a poor premorbid adjustment as determined by the Premorbid Adjustment Scale score significantly predicted the presence of schizophrenia. The regression model including these three variables achieved a predictive value of 76.3%, with a sensitivity of 74.6% and a specificity of 77.9%.

Community-based study to estimate prevalence and burden of illness of rheumatic diseases in Cuba: a COPCORD study.

OBJECTIVE: To estimate the prevalence, burden of illness, and help-seeking behavior of patients with musculoskeletal complaints and provide point prevalence estimates of osteoarthritis, low back pain, fibromyalgia, rheumatoid arthritis, gout, and bone fractures not related to trauma among the adult population in a urban community in Havana City. METHODS: Home survey of adults validated against physical examination. Forty-eight trained family doctors and 3 rheumatologists supervised the interviews and confirmed diagnoses. Family doctors applied a validated Community Oriented Program for the Control of Rheumatic Diseases core questionnaire. A diagnosis using American College of Rheumatology criteria was established. Analysis was based on descriptive statistics and point prevalence estimates with 95% confidence intervals (CIs) of most common diseases and associated disability rate. RESULTS: One thousand two hundred thirty-eight men and 1917 women were included. Prevalence of musculoskeletal pain was estimated in 43.9% (95% CI: 42.2-45.7). The knees were the most affected area (11.7%; 95% CI: 10.6-12) followed by low back pain (11.6%; 95% CI: 10.5-12.8). Point prevalence and 95% CI were as follows: osteoarthritis, 20.4% (95% CI: 19-21.8); gout, 0.38% (95% CI: 0.2-0.6); fibromyalgia, 0.22% (95% CI: 0.09-0.4); systemic lupus erythematosus, 0.06% (95% CI: 0.01-0.25); spondyloarthropathies, 0.19% (95% CI: 0.07-0.4); and rheumatoid arthritis,1.24% (95% CI: 0.8-1.7). Bone fractures not related to trauma were found in 1.14%, hip fracture being the most common (30.5%). Most patients were seen by the general practitioner (65.4%) and 6.2% described some disability. CONCLUSIONS: Musculoskeletal pain is highly prevalent in Cuba. Prevalence estimates are similar to those described in other surveys except for rheumatoid arthritis that seems more prevalent in Cuba and fibromyalgia less prevalent.

Low baseline serotonin-2A receptors predict clinical response to olanzapine in first-episode schizophrenia patients.

The purpose of this study was to determine whether platelet serotonin-2A (5-HT2A) binding sites and inositol 1,4,5 trisphosphate (IP3) concentrations before treatment can identify olanzapine-responsive patients. The study included 21 never medicated, first-episode schizophrenia patients (antipsychotic-naïve) and 21 patients with a DSM-IV-TR diagnosis of paranoid schizophrenia who had not received depot antipsychotic treatment in the previous 6 months or oral antipsychotic or antidepressant treatment in the previous 2 months (antipsychotic-free). In the antipsychotic-naïve group, olanzapine responders had a significantly lower number of 5-HT2A receptors and lower IP3 concentrations at baseline than non-responders. The combination of baseline 5-HT2A and IP3 values significantly predicted an improvement in negative symptomatology after 6 weeks of treatment with olanzapine. In the antipsychotic-free group, responders had significantly higher positive and lower negative symptomatology at baseline, together with a reduced number of 5-HT2A receptors. However, basal 5-HT2A receptors or IP3 concentrations did not significantly predict positive, negative or general clinical response. The reported results suggest that platelet 5-HT2A binding might be a trait marker that could help to identify those patients likely to show greater improvement in negative symptomatology after olanzapine treatment.

Validación de la escala de Calgary en pacientes con esquizofrenia crónica / No disponible

Antecedentes: La Escala de Depresión de Calgary para la Esquizofrenia (CDSS) es un instrumento válido para la medición de los síntomas depresivos tanto en primeros episodios y descompensaciones agudas como en esquizofrénicos estabilizados. Objetivo: Determinar la validez y fiabilidad de la versión española de la CDSS en una población de esquizofrénicos crónicos e institucionalizados. Métodos: Fueron incluidos 137 pacientes ingresados en la unidad de larga estancia y diagnosticados de esquizofrenia según criterios DSM-IV. Fueron evaluados por dos evaluadores, el primero confirmaba el diagnóstico mediante la entrevista SCID -IV y administraba la Escala de Síntomas Positivos y Negativos (PANSS), la escala de Depresión de Hamilton (HDRS -17 y HDRS -21 ítems), la escala de depresión de Montgomery-Åsberg (MADRS), la escala de Síntomas Extrapiramidales (ESRS), y la escala de acatisia de Barnes. El segundo evaluador pasaba, ciego a los resultados previos y en un intervalo no superior a las 48 horas, la CDSS-S. Resultados: La fiabilidad (consistencia interna) fue buena (alfa de Cronbach 0.81) y sólo el ítem C7 (Despertar precoz) no fue consistente con el resto de ítems. La validez mostró una buena validez de constructo con correlaciones estadísticas con las escalas de depresión y no con las PANSS total ni sus subescalas. La estructura interna mostró un factor único que acumulaba el 42,4% de la variancia. Conclusiones: La CDSS es un instrumento válido para medir los síntomas depresivos en los esquizofrénicos crónicos

Backgroud: The Calgary Depression Scale for Schizophrenia (CDSS) has emerged as a valid instrument for measuring depressive symptoms in first episodes, acute exacerbations and stabilized schizophrenics. Objective: To determine the validity and reliability of CDSS in a population of chronic schizophrenics. Methods: One hundred and thirtyseven in -patients in the long-stay unit with diagnoses of schizophrenia according to DSM-IV criteria were included. The diagnosis was confirmed using the SCID-IV interview and the patients were evaluated with the Positive and Negative Syndrome Scale (PANSS), the Hamilton Depression Rating Scale (HDRS -17 and HDRS-21 ítems), the Montgomery-Åsberg Depression Rating Scale (MADRS), the Extrapyramidal Symptoms Rating Scale (ESRS), the Barnes Akathisia Rating Scale and the CDSS. Results: The reliability (internal consistency) was good (Cronbach’s alpha 0,81) and inconsistency was found only on item C7 (Early morning waking). Construct validity was high; statistically significant correlations were found with depression scales, and there was no correlation with the PANSS subscales or total score. The internal structure showed a single factor that accounted for 42,4% of the variance. Conclusions: The CDSS is a valid instrument for assessing depressive episodes in chronically ill, institutionalized schizophrenics

Insulin resistance and increased leptin concentrations in noncompliant schizophrenia patients but not in antipsychotic-naive first-episode schizophrenia patients.

BACKGROUND: The onset of diabetes and impaired glucose metabolism among schizophrenic patients has been the topic of numerous recently published articles, with research implicating weight gain, the use of antipsychotic medication, history of diabetes mellitus in family members, and the diagnosis of schizophrenia itself as risk factors. Therefore, it was the aim of this study to determine the glucose metabolism parameters in noncompliant unmedicated schizophrenic patients (antipsychotic-free) and first-episode antipsychotic-naive schizophrenic patients to investigate whether there is a preexisting impairment of glucose metabolism in never-medicated schizophrenic patients. METHOD: Plasma glucose, insulin, C-peptide, and leptin concentrations were determined in 50 antipsychotic-free and 50 antipsychotic-naive DSM-IV schizophrenia patients and 50 healthy control subjects. Insulin resistance was calculated through the homeostatic model assessment (HOMA). The General Linear Model (univariate) procedure was used to perform analysis of covariance. Patients were recruited from July 2001 to December 2002. RESULTS: Antipsychotic-free patients showed significantly increased insulin (p = .001) and C-peptide (p = .02) concentrations and a significantly higher degree of insulin resistance (p = .003), as measured with the HOMA index, in comparison with the antipsychotic-naive patients and the control group. Significantly increased leptin concentrations (p = .000) were also noted in the antipsychotic-free patients and were attributed to the effects of body mass index (p = .000) and sex (p = .000). CONCLUSIONS: The results reported in this study suggest the effect of previous antipsychotic treatment on glucose metabolism parameters and weight-related hormones such as leptin, while ruling out a preexisting impairment of glucose metabolism in never-medicated first-episode schizophrenic patients.

Cross-cultural adaptation and validation of the Spanish version of the Calgary Depression Scale for Schizophrenia.

BACKGROUND: The Calgary Depression Scale for Schizophrenia (CDSS) is a valid tool to assess depression in schizophrenics and has been translated, adapted, and validated to be used in different non-English languages. Therefore, it may be predicted that a Spanish version of this scale will be also a valid instrument to assess symptoms of depression in patients with schizophrenia. OBJECTIVE: We determined the validity of the Spanish version of the Calgary scale (CDSS-S). METHODS: Outpatients and inpatients (n=93) diagnosed as having schizophrenia by DSM-IV criteria confirmed by SCID-IV interview were included. The Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HDRS-17 and HDRS-21 items), Montgomery-Asberg Depression Rating Scale (MADRS), Extrapyramidal Symptoms Rating Scale (ESRS), and Barnes Acathisia Rating Scale were administered by a first rater, whereas the CDSS-S was assessed by a second independent rater. RESULTS: The internal consistency (Cronbach's alpha 0.83) and the interrater reliability (>0.73 intraclass correlation coefficient [ICC] for single items and 0.92 for total score) were good. The test-retest reliability was high (ICC of 0.89). The scale showed a good construct validity with statistically significant correlations with HDRS-17, HDRS-21, MADRS, and G6 item (depression) of PANSS. The CDSS showed no correlation with the positive subscale of PANSS and a weak correlation with the negative subscale, general psychopathology subscale, and total score of PANSS. A cut point of five showed 94.7% sensitivity, 86.5% specificity, and 70% and 98% positive and negative predictive values, respectively. CONCLUSIONS: The Spanish version of CDSS is a valid instrument to assess depressive episodes for stabilized and acute patients with schizophrenia.

El trastorno delirante. Revisando los aspectos de la paranoia / Delusional disorder. Revision of some aspects of paranoia

Se revisa el trastorno delirante desde su historia y concepto hasta sus posibilidades terapéuticas en la actualidad, analizando la epidemiología, clínica, aspectos diagnósticos, curso y pronóstico. Nos encontramos ante una patología poco común que se caracteriza por la presencia de ideas delirantes de instauración insidiosa, basadas en un mecanismo interpretativo y que habitualmente aparecen en una estructura de personalidad premórbida determinada. La prevalencia es de 1-4 por ciento de todos los pacientes ingresados en hospitales psiquiátricos. La media de la edad de inicio está alrededor de los 40 años y es ligeramente más frecuente en mujeres. Muchos pacientes están casados y trabajan, existiendo cierta asociación con la inmigración reciente y un estatus socioeconómico bajo. Suele haber un factor ambiental favorecedor al inicio del trastorno. Es frecuente la existencia de antecedentes familiares de trastorno psiquiátrico aunque la prevalencia de esquizofrenia y psicosis afectivas no está incrementada. El tipo de trastorno delirante más frecuente es el persecutorio. Se cree que el trastorno delirante es un diagnóstico estable, de tal forma que menos de un 25 por ciento de los pacientes evolucionan hacia la esquizofrenia y menos de un 10 por ciento evolucionan hacia los trastornos del estado de ánimo. Con un tratamiento adecuado tiene un buen pronóstico si bien la mayoría presentan dificultades de aceptación del mismo (AU)

Altered platelet serotonin 5-HT2A receptor density but not second messenger inositol trisphosphate levels in drug-free schizophrenic patients.

The 5-HT2A receptor binding parameters using [3H]ketanserine and its intracellular signal inositol 1,4,5 trisphosphate (IP3) concentrations were determined in platelets from schizophrenic patients so as to assess differences with respect to a control group and to a standardized antipsychotic drug treatment. Seventy-five antipsychotic-free patients with a DSM-IV diagnosis of paranoid schizophrenia were included in the study. Blood samples were collected before the onset of antipsychotic treatment (baseline values) and after 3 weeks of treatment. Antipsychotic-free schizophrenic patients showed significantly increased basal 5-HT2A densities in comparison to the control group, together with a significantly increase (23%) in the 5-HT2A binding density in those patients treated with risperidone. These changes could be attributed to an up-regulation of 5-HT2A receptors caused by previous treatment with antipsychotic drugs, which is consistent with the chronic effect of 5-HT2A antagonists to up-regulate the number of binding sites. With regard to second messenger IP3 concentrations, basal concentrations in schizophrenic patients were not significantly different from control values, nor was there any significant difference between basal vs. posttreatment values. These results are possibly related to failure of second messenger systems of 'translating' extracellular messages generated presynaptically into effective neurotransmitter signals in schizophrenic patients.

Percepción de riesgos en una comunidad insalubre

Se realiza una investigación sobre percepción de riesgos, en el barrio insalubre "La Dionisia" del área de salud "19 de Abril" pertenecen al municipio Plaza de la Revolución. Se aplica un cuestionario que contempla diversos riesgos empleándose una escala de diferencial semántico, con 4 gradaciones (muy riesgoso, riesgoso, poco riesgoso y sin riesgo); cada una recibió una puntuación del 4 al 1. Se agruparon estos riesgos en 3 categorías: ambientales, psicosociales y relacionados con la salud. Se utilizaron los análisis de correlación y de regresión múltiple para determinar variables con influencia en cada uno de los riesgos objeto de estudio. Y las conclusiones son: la percepción entre los diferentes grupos de riesgo, no guardó diferencias entre ellos; se eleva la percepción de riesgos, si los individuos tienen hijos menores de 13 años; y en general, la variable hijo, resultó la de mayor influencia en todos los tipos de riesgos estudiados.

An investigation on risk perception was made at "La Dionisia" insalubrious neighborhood of the "19 de Abril" health area belonging to Plaza de la Revolución municipality. A questionnarie including diverse risks was applied and a scale of semantic differential with 4 gradations (very risky, risky, little risky and riskless) was used. Each of them was given a value from 4 to 1 points.These risks were grouped in 3 categories: environmental, psychosocial and related to health. The analyses of correlation and of multiple regression were used to determine variables influencing on every risk object of study. It was concluded that the perception among the different risk groups showed no differences, that risk perception was higher when the individuals had children under 13 and that, in general, the child variable proved to be that with the highest influence on all the studied types of risks.

Estilos de vida, bienestar subjetivo y salud de los ancianos / Life style, subjective welfare and health of the elderly

Se realizó un estudio descriptivo en 3 municipios de ciudad de La Habana durante 1994-1997. A todos los ancianos seleccionados se les aplicó el test de PFEIFFER para descartar déficit intelectual; el deterioro intelectual era un criterio de exclusión. Fueron estudiados 324 ancianos a los que se les aplicó el cuestionario de Neugarten para determinar bienestar psicológico y una encuesta confeccionada por los investigadores donde se recogen variables generales (edad, sexo, estado civil, ocupación y escolaridad) y algunas variables de estilo de vida como son: actividad laboral y sus características, tiempo libre y su empleo, ejercicio físico, hábitos de consumo (alcohol y cigarros), relaciones personales y contactos sociales. Además se exploraron algunos elementos del modo de vida que podían influir en los sentimientos de confort, la percepción de salud y la morbilidad reportada por el propio individuo en término de síntomas o molestias, así como las enfermedades crónicas en cada uno de ellos tomando como fuente el Médico de Familia

Estilos de vida, bienestar subjetivo y salud de los ancianos / Life style, subjective welfare and health of the elderly

Se realizó un estudio descriptivo en 3 municipios de ciudad de La Habana durante 1994-1997. A todos los ancianos seleccionados se les aplicó el test de PFEIFFER para descartar déficit intelectual; el deterioro intelectual era un criterio de exclusión. Fueron estudiados 324 ancianos a los que se les aplicó el cuestionario de Neugarten para determinar bienestar psicológico y una encuesta confeccionada por los investigadores donde se recogen variables generales (edad, sexo, estado civil, ocupación y escolaridad) y algunas variables de estilo de vida como son: actividad laboral y sus características, tiempo libre y su empleo, ejercicio físico, hábitos de consumo (alcohol y cigarros), relaciones personales y contactos sociales. Además se exploraron algunos elementos del modo de vida que podían influir en los sentimientos de confort, la percepción de salud y la morbilidad reportada por el propio individuo en término de síntomas o molestias, así como las enfermedades crónicas en cada uno de ellos tomando como fuente el Médico de Familia(AU)

Estilos de vida, bienestar subjetivo y salud de los ancianos / Life styles, subjective welfare and health of the elderly

Se realizó un estudio descriptivo en 3 municipios de ciudad de La Habana durante 1994-1997. A todos los ancianos seleccionados se les aplicó el test de PFEIFFER para descartar déficit intelectual; el deterioro intelectual era un criterio de exclusión. Fueron estudiados 324 ancianos a los que se les aplicó el cuestionario de Neugarten para determinar bienestar psicológico y una encuesta confeccionada por los investigadores donde se recogen variables generales (edad, sexo, estado civil, ocupación y escolaridad) y algunas variables de estilo de vida como son: actividad laboral y sus características, tiempo libre y su empleo, ejercicio físico, hábitos de consumo (alcohol y cigarros), relaciones personales y contactos sociales. Además se exploraron algunos elementos del modo de vida que podían influir en los sentimientos de confort, la percepción de salud y la morbilidad reportada por el propio individuo en término de síntomas o molestias, así como las enfermedades crónicas en cada uno de ellos tomando como fuente el Médico de Familia (AU)

El diagnóstico de laboratorio de la sífilis: Revisión bibliográfica

El presente trabajo es una revisión bibliográfica acerca del diagnóstico de la sífilis. Se revisan los métodos de visualización directa y las pruebas serológicas, tanto no treponémicas como treponémicas, más utilizadas en la actualidad. Son referidas algunas de sus ventajas. Se explica la utilidad de la aplicación de estas pruebas en determinados momentos de la enfermedad con el objetivo de contribuir a la actualización de los médicos y los estudiantes de medicina en el diagnóstico de laboratorio de esta entidad que aún constituye un problema de salud para muchas regiones del mundo. Se concluye que el examen de campo oscuro y las pruebas de anticuerpos fluorescentes son los métodos definitivos para detectar sífilis temprana. Es posible realizar un diagnóstico presuntivo, con el uso de 2 tipos de pruebas serológicas de la sífilis: treponémicas y no treponémicas. Ninguna prueba por sí sola es suficiente para establecer el diagnóstico.

This current piece of work is a bibliographic review about the syphilis diagnosis. Direct visualization methods are reviewed, and also non-treponemic as well as treponemic serologic tests, mainly used currently. Several advantages of these methods are reported. The usefulness of the application of these tests in certain moments of the disease, is explained, with the aim of contributing to update the physicians and medicine students in the laboratory diagnosis of this entity, which still makes up a health problem in many regions of the worls. The conclusion is that the dark-field examination and the fluorescent treponemal antibody (absorption) test are the conclusive methods for an early detection of syphilis. It is possible to carry out a presumptive diagnosis, using two kinds of serological tests for syphilis: treponemic and non-treponemic. Any test on its own is not sufficient to establish the diagnosis.

El diagnóstico de laboratorio de la sífilis. Revisión bibliográfica / The laboratory diagnosis for syphilis. Bibliographic review

El presente trabajo es una revisión bibliográfica acerca del diagnóstico de la sífilis. Se revisan los métodos de visualización directa y las pruebas serológicas, tanto no treponémicas como treponémicas, más utilizadas en la actualidad. Son referidas algunas de sus ventajas. Se explica la utilidad de la aplicación de estas pruebas en determinados momentos de la enfermedad con el objetivo de contribuir a la actualización de los médicos y los estudiantes de medicina en el diagnóstico de laboratorio de esta entidad que aún constituye un problema de salud para muchas regiones del mundo. Se concluye que el examen de campo oscuro y las pruebas de anticuerpos fluorescentes son los métodos definitivos para detectar sífilis temprana. Es posible realizar un diagnóstico presuntivo, con el uso de 2 tipos de pruebas serológicas de la sífilis: treponémicas y no treponémicas. Ninguna prueba por sí sola es suficiente para establecer el diagnóstico (AU)

Metodología para la evaluación de la calidad en instituciones de atención primaria de salud / Methodology for the assessement of quality in primary health care institutions

Se propone una metodología que permite evaluar la calidad, utilización para ello la selección de actividades y/o problemas de salud que puedan ser consederados como "trazadores" para el proceso y métodos participativos para la selección de criterios, indicadores y estándares a utilizar en la evaluación, en los que interviene el propio personal de la institución objeto de la misma, y se refieren no sólo a los resultados de la atención, sino también a la estructura y el proceso. Se incluye la opinión de los usuarios del servicio. La aplicación de esta metodología permite un mayor compromiso de los proveedores de los servicios con los resultados del proceso y con las medidas correctoras que de él se deriven, por lo que se hacen más factibles las soluciones a los problemas que se detecten. Se demuestra cómo su aplicación práctica en una institución de atención primaria de salud, permitió conocer la calidad de la atención a pacientes hipertensos, mediante la evaluación de 2 importantes dimensiones de la calidad: calidad cientificotécnica de la atención y satisfactión del usuario. Se utiliza esta metodología también para la evaluación de la calidad de la atención a la madre y al niño y se diseña un proyecto para la evaluación de la calidad de los servicios de Higiene y Epidemiología de un sistema local de salud (AU)