Validez de una versión en español del Inventario de Depresión de Beck en pacientes hospitalizados de medicina general / Validity of a version in Spanish of the Beck Depression Inventory in medical in-patients

Objetivos: El objetivo del presente estudio es examinar en el Perú la validez de una versión en español del Inventario de Depresión de Beck (BDI) en pacientes hospitalizados de medicina general. Material y Métodos: Se tomó una muestra de 136 pacientes internados en los pabellones de medicina general del Centro Médico Naval (Lima-Perú), a quienes se les administró el BDI y la sección para el diagnóstico de depresión mayor de la Entrevista Clínica Estructurada para el DSM-IV (SCID). Resultados: El coeficiente alfa de Cronbach fue 0,889. La puntuación promedio del BDI fue significativamente más alta en los pacientes con depresión mayor que en los que no la tenían (26,71 frente a 6,79, p<0,001). Tomando 18,5 o 19,5 como punto de corte del BDI para el diagnóstico de depresión mayor, la sensibilidad fue 87,5% y la especificidad 98,21%. Ningún paciente con BDI menor de 7,5 tuvo depresión, mientras que todos los sujetos con BDI mayor de 24,5 la presentaron. A excepción de la pérdida de peso, todos los ítems tuvieron puntajes significativamente más altos en los pacientes deprimidos, siendo los ítems que mejor predecían la presencia de depresión: la inconformidad con uno mismo, la autopercepción negativa del aspecto físico, la autocensura, el insomnio y el sentirse castigado. Conclusiones: La versión en español del BDI utilizada tiene propiedades psicométricas adecuadas para la evaluación de depresión en pacientes hospitalizados de medicina general.

Objectives: The objective of the study is to assess in Peru the validity of a version in Spanish of the Beck Depression Inventory (BDI) in a general medicine ward. Method: We included 136 patients from a general medicine ward at the Naval Medical Centre (Lima-Peru), and administered them the BDI and the Structured Clinical Interview for DSM-IV (SCID) module for major depression. Results: The Cronbach’s alpha coefficient was 0.889. Patients with major depression had BDI scores significantly higher than those without it (26.71 versus 6.79, p<0.001). For a BDI cut-off score of 18.5 or 19.5, the sensitivity was 87.5% and the specificity was 98.21% for the diagnosis of major depression. No patient with BDI lower than 7.5 had depression, whereas all subjects with BDI greater than 24.5 had the disorder. Excluding weight loss, all items had scores significantly high in depressed patients; the items that best predicted depression were: self-discomfort, negative perception of the physical appearance, self-criticism, insomnia, and feelings of being punished. Conclusions: The version in Spanish of the BDI assessed in this study has adequate psychometric properties for the evaluation of depression in patients of a general medicine ward.

[Predictive factors of alcohol use problems among patients visiting an emergency room]. / Factores predictores de uso problemático de alcohol en personas atendidas en una sala de emergencia.

OBJECTIVES: To assess the predictive effect of key individual-level characteristics to identify cases of alcohol use problems among patients visiting an emergency room. MATERIALS AND METHODS: The study sample was composed of 371 people attending an emergency room in a public hospital in Lima, Peru, during a period of seven complete days in January, 2005. For data gathering, we used a questionnaire for demographic information, the SIDUC/CICAD for recent use (i.e., in the last 6 hours) of psychoactive substances before arriving to the emergency room, and the AUDIT, to identify alcohol use problems in the last year. Univariate and multivariate logistic regression models were used to estimate the predictive effect of age, sex, area of attention in the emergency room, presence of physical injuries and recent use of alcohol. RESULTS: The odds of being a case of alcohol use problem for males is 26 times the odds of having that problem for females (p-value<0,001). Stratified analysis by sex and adjusted by age and area of attention in the emergency room, showed that males who had recent use of alcohol were more likely of having alcohol use problems as compared to those who did not have recent alcohol use (OR=5.2; 95% CI: 2.4 - 11.5; p<0,001), while for females such an association did not exist. CONCLUSIONS: These results support screening initiatives for those males who have recent alcohol use before arriving to an emergency room in order to identify cases of alcohol-related problems and refer them for an appropriate counseling or medical treatment.

Factores predictores de uso problemático de alcohol en personas atendidas en una sala de emergencia / Predictive factors of alcohol use problems among patients visiting an emergency room

Objetivos. Valorar el efecto predictivo de características claves de pacientes atendidos en salas de emergencia para detectar casos de uso problemático de alcohol. Materiales y Métodos. La muestra de estudio estuvo constituida por 371 personas atendidas en el lapso de siete días completos de enero de 2005 en el servicio de emergencia de un hospital público de Lima, Perú. Se aplicó un cuestionario demográfico, el SIDUC/CICAD para uso reciente de sustancias psicoactivas en salas de emergencias (i.e., uso dentro de las seis horas previas a la atención) y el AUDIT para uso problemático de alcohol en el último año. El análisis de regresión logística simple y multivariada permitió valorar el efecto predictor de la edad, sexo, especialidad del servicio de atención, presencia de daño físico y el uso reciente de alcohol para detectar casos problemáticos de su uso. Resultados. El odds de tener uso problemático de alcohol en los varones es 26 veces el odds de tener dicho problema entre las mujeres (p<0,001). El análisis estratificado por sexo y ajustado por edad y especialidad del servicio de emergencia, mostró que para los varones el uso reciente de alcohol estuvo fuertemente asociado con presentar uso problemático (OR=5,2; IC al 95 por ciento: 2,4-11,5; p<0,001), mientras que para las mujeres no se encontró dicha asociación. Conclusiones. Se debe tamizar uso problemático de alcohol en aquellos varones con uso reciente de alcohol atendidos en salas de emergencia, para poder identificarlos y darles la oportunidad de recibir consejería o un manejo médico adecuado.

Objectives. To assess the predictive effect of key individual-level characteristics to identify cases of alcohol use problems among patients visiting an emergency room. Materials and methods. The study sample was composed of 371 people attending an emergency room in a public hospital in Lima, Peru, during a period of seven complete days in January, 2005. For data gathering, we used a questionnaire for demographic information, the SIDUC/CICAD for recent use (i.e., in the last 6 hours) of psychoactive substances before arriving to the emergency room, and the AUDIT, to identify alcohol use problems in the last year. Univariate and multivariate logistic regression models were used to estimate the predictive effect of age, sex, area of attention in the emergency room, presence of physical injuries and recent use of alcohol. Results. The odds of being a case of alcohol use problem for males is 26 times the odds of having that problem for females (p-value<0,001). Stratified analysis by sex and adjusted by age and area of attention in the emergency room, showed that males who had recent use of alcohol were more likely of having alcohol use problems as compared to those who did not have recent alcohol use (OR=5.2; 95 percent CI: 2.4 - 11.5; p<0,001), while for females such an association did not exist. Conclusions. These results support screening initiatives for those males who have recent alcohol use before arriving to an emergency room in order to identify cases of alcohol-related problems and refer them for an appropriate counseling or medical treatment.

Factores predictores de uso de drogas ilegales en personas atendidas en una sala de emergencia / Predictor factors of illegal drug use in subjects attended in an emergency room

Objetivo: Valorar el consumo reciente de alcohol y otras variables como predictores del uso reciente y consumo de vida de alguna droga ilegal, entre personas atendidas en una sala de emergencia (SE) de un hospital de Lima. Materiales y Métodos: Este estudio es un análisis secundario de datos de un trabajo previo observacional de corte transversal realizado por Mazzotti et al. (2005), cuya muestra estuvo constituida por 371 pacientes, que involucraron a todos los que fueron atendidos en la SE (Medicina y Cirugía) del Hospital Nacional Cayetano Heredia durante siete días completos de enero del año 2005. Se aplicó la encuesta del Sistema Interamericano de Datos sobre el Uso de Drogas (SIDUC) desarrollada por la Comisión Interamericana para el Control del Abuso de Drogas (CICAD) para uso reciente de sustancias psicoactivas. Resultados: El consumo reciente de alguna droga ilegal estuvo fuertemente asociado con el consumo reciente de alcohol (OR=32,21; IC 95%=9,0-114,5; p<0,001) y el sexo masculino (OR=4,52; IC 95%=1,2-15,8; p=0,018), lo cual se mantuvo aún después de ajustar por posibles variables de confusión. Asimismo, estas variables (consumo reciente de alcohol y sexo) mostraron asociación significativa con el consumo de vida de marihuana y cocaína. Conclusiones: El consumo reciente de alcohol y el sexo predicen fuertemente tanto uso reciente como uso de vida de alguna droga ilegal en el contexto de una SE, por lo que estas características pueden ser utilizadas para estrategias de tamizaje dirigidas a la intervención y manejo de problemas de drogas a nivel de servicios hospitalarios.

Objective: To assess recent alcohol consumption and other variables as predictors of recent use and lifetime use of illegal drugs among people visiting an emergency room in a hospital in Lima. Materials and Methods: This study is a secondary analysis of data from a previous study by Mazzotti et al. (2005). It had a cross-sectional observational design, and the sample consisted of 371 patients, involving all patients who were treated in the emergency room (Medicine and Surgery) of the Hospital Nacional Cayetano Heredia for seven full days in January 2005. The Inter-American System of Uniform Drug-Use Data (SIDUC) survey developed by the Inter-American Drug Abuse Control Commission (CICAD) was applied for recent use of psychoactive substances in emergency rooms. Results: We found strong association between recent use of any illegal drugs and both having recent alcohol use (OR=32.21;95% CI=9.0-114.5; p<0.001) and being a male (OR=4.52; 95% CI=1.2-15.8; p=0.018). These associations were kept even after adjustment for meaningful covariates. In addition, these characteristics (recent alcohol consumption and male) showed significant association with lifetime use of marijuana and cocaine. Conclusions: Recent alcohol use and sex were strong predictors of both recent and lifetime use of illegal drugs. Therefore, these individual-level features can be used in hospital-based screening strategies aimed to identify drug-related problems and provide timely help.

Scarcity and inequity of mental health research resources in low-and-middle income countries: a global survey.

OBJECTIVE: To map mental health research capacity and resources in low-and-middle-income countries (LAMIC) for the years 1993-2003. METHOD: Mental health researchers from 114 LAMIC in three continents were identified through their publications in two databases (Medline and PsycInfo) and from local grey literature. A questionnaire was developed and sent to authors to elicit information about researchers' background, available resources and details of up to three recent projects. RESULTS: 4208 researchers from 83 countries were identified through 6340 mental health indexed-publications and 3598 publications from the grey literature. 912 researchers from 52 countries completed the questionnaires. Researchers and publications were concentrated in 10% of the countries. Respondents reported participation in 1847 projects, most of which were devoted to depression and anxiety disorders, substance misuse and psychoses. Epidemiologic studies, social, psychological and clinical research accounted for 80% of all projects. Two-thirds of projects had received external funding, and less than one-third of them were conducted in collaboration with other countries. CONCLUSION: Mental health research capacity is scarce and unequally distributed in LAMIC. Global agencies for health research as well as LAMIC with higher concentrations of researchers and scientific output should play a more decisive role in strengthening the capacity of other LAMIC enhancing South-South partnerships and networks.

Improving mental and neurological health research in Latin America: a qualitative study.

BACKGROUND: Research evidence is essential to inform policies, interventions and programs, and yet research activities in mental and neurological (MN) health have been largely neglected, particularly in low- and middle-income countries. Many challenges have been identified in the production and utilization of research evidence in Latin American countries, and more work is needed to overcome this disadvantageous situation. This study aims to address the situation by identifying initiatives that could improve MN health research activities and implementation of their results in the Latin American region. METHODS: Thirty-four MN health actors from 13 Latin American countries were interviewed as part of an initiative by the Global Forum for Health Research and the World Health Organization to explore the status of MN health research in low- and middle-income countries in Africa, Asia and Latin-America. RESULTS: A variety of recommendations to increase MN health research activities and implementation of their results emerged in the interviews. These included increasing skilled human resources in MN health interventions and research, fostering greater participation of stakeholders in the generation of research topics and projects, and engendering the interest of national and international institutions in important MN health issues and research methodologies. In the view of most participants, government agencies should strive to have research results inform the decision-making process in which they are involved. Thus these agencies would play a key role in facilitating and funding research. Participants also pointed to the importance of academic recognition and financial rewards in attracting professionals to primary and translational research in MN health. In addition, they suggested that institutions should create intramural resources to provide researchers with technical support in designing, carrying out and disseminating research, including resources to improve scientific writing skills. CONCLUSION: Fulfillment of these recommendations would increase research production in MN health in Latin American countries. This, in turn, will raise the profile of these health problems, and consequently will underscore the need of continued high-quality and relevant research, thus fostering a virtuous cycle in the decision-making process to improve MN health care.

What challenges does mental and neurological health research face in Latin American countries? / ¿Qué desafíos enfrenta la investigación en salud mental y neurológica en los países latinoamericanos?

OBJECTIVE: The World Health Organization Atlas Project identified important deficiencies in world mental and neurological health resources. These deficiencies, especially evident in low and middle-income countries, can be overcome by improving research capacity. The objective of this study is to assess the status of mental and neurological research in Latin American countries and identify the main difficulties encountered in conducting research, publishing results, and shaping health policies, interventions, and programs. METHOD: Semi-structured interviews were conducted with 34 key informants from 13 Latin American countries. RESULTS: Participants reported that production of mental and neurological research in Latin American countries is low. Lack of financial and human resources, including lack of support from government agencies, were identified as the main factors contributing to the dearth of local research. The few research projects that do take place in Latin American countries are often funded at researchers' personal expense. Few policies, interventions, or programs are generated from research results. To address these deficiencies, participants called for training in research methodology, mechanisms for identifying funding opportunities, and greater recognition of their research products. CONCLUSIONS: Researchers and stakeholders recognize the need to mobilize local and international efforts aimed at strengthening research capacity and results implementation. This will lead to an overall optimization of mental and neurological research in the region.

OBJETIVO: El proyecto Atlas de la Organización Mundial de la Salud identifica importantes deficiencias en salud mental y neurológica. Estas deficiencias, especialmente evidentes en países de medianos y bajos ingresos, pueden resolverse mejorando las capacidades en investigación. El objetivo de este estudio es evaluar el estado de la investigación en salud mental y neurológica en países Latinoamericanos, e identificar las principales dificultades encontradas al hacer investigación, publicar resultados, y generar políticas, intervenciones, y programas. MÉTODO: Entrevistas semi-estructuradas fueron realizadas a 34 informantes de 13 países Latinoamericanos. RESULTADOS: La producción de investigación en salud mental y neurológica en países Latinoamericanos es escasa, debido principalmente a la carencia de recursos financieros y humanos, incluyendo el casi ausente apoyo de agencias gubernamentales. Los pocos proyectos de investigación que se llevan a cabo son financiados mayormente con recursos propios de los investigadores. Pocas políticas, intervenciones o programas son generados a partir de resultados de investigación. Resolver estas deficiencias requerirá entrenar profesionales en metodología de la investigación, identificar oportunidades de financiación y lograr un mayor reconocimiento de los productos de la investigación. CONCLUSIONES: Hay necesidad de movilizar esfuerzos locales e internacionales orientados a fortalecer las capacidades en investigación y la implementación de resultados. Esto llevará a una optimización general de la investigación.

Geographic patterns of genome admixture in Latin American Mestizos.

The large and diverse population of Latin America is potentially a powerful resource for elucidating the genetic basis of complex traits through admixture mapping. However, no genome-wide characterization of admixture across Latin America has yet been attempted. Here, we report an analysis of admixture in thirteen Mestizo populations (i.e. in regions of mainly European and Native settlement) from seven countries in Latin America based on data for 678 autosomal and 29 X-chromosome microsatellites. We found extensive variation in Native American and European ancestry (and generally low levels of African ancestry) among populations and individuals, and evidence that admixture across Latin America has often involved predominantly European men and both Native and African women. An admixture analysis allowing for Native American population subdivision revealed a differentiation of the Native American ancestry amongst Mestizos. This observation is consistent with the genetic structure of pre-Columbian populations and with admixture having involved Natives from the area where the Mestizo examined are located. Our findings agree with available information on the demographic history of Latin America and have a number of implications for the design of association studies in population from the region.

What challenges does mental and neurological health research face in Latin American countries?

OBJECTIVE: The World Health Organization Atlas Project identified important deficiencies in world mental and neurological health resources. These deficiencies, especially evident in low and middle-income countries, can be overcome by improving research capacity. The objective of this study is to assess the status of mental and neurological research in Latin American countries and identify the main difficulties encountered in conducting research, publishing results, and shaping health policies, interventions, and programs. METHOD: Semi-structured interviews were conducted with 34 key informants from 13 Latin American countries. RESULTS: Participants reported that production of mental and neurological research in Latin American countries is low. Lack of financial and human resources, including lack of support from government agencies, were identified as the main factors contributing to the dearth of local research. The few research projects that do take place in Latin American countries are often funded at researchers' personal expense. Few policies, interventions, or programs are generated from research results. To address these deficiencies, participants called for training in research methodology, mechanisms for identifying funding opportunities, and greater recognition of their research products. CONCLUSIONS: Researchers and stakeholders recognize the need to mobilize local and international efforts aimed at strengthening research capacity and results implementation. This will lead to an overall optimization of mental and neurological research in the region.

Genetic variation and population structure in native Americans.

We examined genetic diversity and population structure in the American landmass using 678 autosomal microsatellite markers genotyped in 422 individuals representing 24 Native American populations sampled from North, Central, and South America. These data were analyzed jointly with similar data available in 54 other indigenous populations worldwide, including an additional five Native American groups. The Native American populations have lower genetic diversity and greater differentiation than populations from other continental regions. We observe gradients both of decreasing genetic diversity as a function of geographic distance from the Bering Strait and of decreasing genetic similarity to Siberians--signals of the southward dispersal of human populations from the northwestern tip of the Americas. We also observe evidence of: (1) a higher level of diversity and lower level of population structure in western South America compared to eastern South America, (2) a relative lack of differentiation between Mesoamerican and Andean populations, (3) a scenario in which coastal routes were easier for migrating peoples to traverse in comparison with inland routes, and (4) a partial agreement on a local scale between genetic similarity and the linguistic classification of populations. These findings offer new insights into the process of population dispersal and differentiation during the peopling of the Americas.

A genomewide admixture map for Latino populations.

Admixture mapping is an economical and powerful approach for localizing disease genes in populations of recently mixed ancestry and has proven successful in African Americans. The method holds equal promise for Latinos, who typically inherit a mix of European, Native American, and African ancestry. However, admixture mapping in Latinos has not been practical because of the lack of a map of ancestry-informative markers validated in Native American and other populations. To address this, we screened multiple databases, containing millions of markers, to identify 4,186 markers that were putatively informative for determining the ancestry of chromosomal segments in Latino populations. We experimentally validated each of these markers in at least 232 new Latino, European, Native American, and African samples, and we selected a subset of 1,649 markers to form an admixture map. An advantage of our strategy is that we focused our map on markers distinguishing Native American from other ancestries and restricted it to markers with very similar frequencies in Europeans and Africans, which decreased the number of markers needed and minimized the possibility of false disease associations. We evaluated the effectiveness of our map for localizing disease genes in four Latino populations from both North and South America.

Outcomes for Latin American versus White patients suffering from acute mania in a randomized, double-blind trial comparing olanzapine and haloperidol.

Data from a published double-blind randomized trial comparing olanzapine versus haloperidol in acute mania were used to address the response and tolerability of Latin American patients. Primary efficacy end point was the remission rate (Young Mania Rating Scale score

Recent-onset ecstasy use: association with deviant behaviors and psychiatric comorbidity.

BACKGROUND: Despite increases in ecstasy (MDMA) use in the United States, little is known about characteristics linked with recent-onset ecstasy use, especially psychiatric symptoms and deviant behaviors. AIMS: To test whether individuals with high levels of other drug use are more likely to be recent-onset ecstasy users; to test whether psychiatric symptoms in adults are associated with recent-onset ecstasy use; to explore the association between recent-onset ecstasy use and concomitant deviant behaviors in adolescents and adults. METHODS: Data from the 2001 National Survey on Drug Use and Health. FINDINGS: Recent-onset ecstasy use was significantly more likely to occur among adolescents and adults (18-34 years old) who engaged in deviant behaviors during the past year as compared with those who did not engage in deviant behaviors during the past year. Higher levels of deviancy indicated a higher likelihood of being a recent-onset ecstasy user, and associations were strongest with nonviolent deviant behaviors such as selling illegal drugs and stealing. Associations between deviant behaviors and recent-onset ecstasy use were similar in strength to associations between deviant behaviors and recent-onset cocaine and marijuana use, respectively. Adults who had past-year psychiatric symptoms (both depressive and panic symptoms) were twice as likely to be recent-onset ecstasy users as compared with those without past-year psychiatric symptoms. Greater levels of drug involvement increased the odds of being a recent-onset ecstasy user. CONCLUSION: Recent-onset ecstasy use seems to be associated with a range of other behavioral problems and may reflect one aspect of a larger problem behavior syndrome.

Validation study of the Multicultural Quality of Life Index (MQLI) in a Peruvian sample.

OBJECTIVE: The Multicultural Quality of Life Index is a concise instrument for comprehensive, culture-informed, and self-rated assessment of health-related quality of life. It is composed of 10 items (from physical well-being to global perception of quality of life). Each item is rated on a 10-point scale. The objective was to evaluate the reliability (test-retest), internal structure, discriminant validity, and feasibility of the Multicultural Quality of Life Index in Lima, Peru. METHOD: The reliability was studied in general medical patients (n = 30) hospitalized in a general medical ward. The Multicultural Quality of Life Index was administered in two occasions and the correlation coefficients ("r") between both interviews were calculated. Its discriminant validity was studied statistically comparing the average score in a group of patients with AIDS (with presumed lower quality of life, n = 50) and the average score in a group of dentistry students and professionals (with presumed higher quality of life, n = 50). Data on its applicability and internal structure were compiled from the 130 subjects. RESULTS: A high reliability correlation coefficient (r = 0.94) was found for the total score. The discriminant validity study found a significant difference between mean total score in the samples of presumed higher (7.66) and lower (5.32) quality of life. The average time to complete the Multicultural Quality of Life Index was less than 4 minutes and was reported by the majority of subjects as easily applicable. A high Cronbach's a (0.88) was also documented. CONCLUSIONS: The results reported that the Multicultural Quality of Life Index is reliable, has a high internal consistency, is capable of discriminating groups of presumed different quality of life levels, is quite efficient, and easy to use.

Validation study of the Multicultural Quality of Life Index (MQLI) in a Peruvian sample / Estudo de validação do índice de Qualidade Multicultural (IQVM) em uma amostra peruana

OBJETIVE: The Multicultural Quality of Life Index is a concise instrument for comprehensive, culture-informed, and self-rated assessment of health-related quality of life. It is composed of 10 items (from physical well-being to global perception of quality of life). Each item is rated on a 10-point scale. The objective was to evaluate the reliability (test-retest), internal structure, discriminant validity, and feasibility of the Multicultural Quality of Life Index in Lima, Peru. METHOD: The reliability was studied in general medical patients (n = 30) hospitalized in a general medical ward. The Multicultural Quality of Life Index was administered in two occasions and the correlation coefficients ("r") between both interviews were calculated. Its discriminant validity was studied statistically comparing the average score in a group of patients with AIDS (with presumed lower quality of life, n = 50) and the average score in a group of dentistry students and professionals (with presumed higher quality of life, n = 50). Data on its applicability and internal structure were compiled from the 130 subjects. RESULTS: A high reliability correlation coefficient (r = 0.94) was found for the total score. The discriminant validity study found a significant difference between mean total score in the samples of presumed higher (7.66) and lower (5.32) quality of life. The average time to complete the Multicultural Quality of Life Index was less than 4 minutes and was reported by the majority of subjects as easily applicable. A high Cronbach's a (0.88) was also documented. CONCLUSIONS: The results reported that the Multicultural Quality of Life Index is reliable, has a high internal consistency, is capable of discriminating groups of presumed different quality of life levels, is quite efficient, and easy to use.

OBJETIVO: O índice Multicultural de Qualidade de Vida é um instrumento conciso para a avaliação ampla, culturalmente informada e auto-aplicável da qualidade de vida relativa à saúde. É composto de 10 itens (do bem-estar físico à percepção global da qualidade de vida). Cada item é classificado de acordo com uma escala de 10 pontos. O objetivo foi o de avaliar a confiabilidade (teste-reteste), estrutura interna, validade discriminante e a viabilidade do índice Multicultural de Qualidade de Vida em Lima, Peru. MÉTODO: A confiabilidade foi estudada em pacientes da clínica geral (n = 30) hospitalizados em uma enfermaria clínica geral. O índice Multicultural de Qualidade de Vida foi ministrado em duas ocasiões e os coeficientes de correlação ("r") entre ambas as entrevistas foram calculados. Sua validade discriminante foi estudada comparando estatisticamente o escore médio em um grupo de pacientes com AIDS (com presumida menor qualidade de vida, n = 50) e o escore médio em um grupo de estudantes e profissionais de odontologia (com presumida maior qualidade de vida, n = 50). Os dados sobre sua aplicabilidade e estrutura interna foram compilados a partir de 130 indivíduos. RESULTADOS: Achou-se um alto coeficiente de correlação de confiabilidade no escore total (r = 0,94). O estudo de validade discriminante encontrou diferença significativa entre o escore médio total nas amostras de qualidade de vida presumida mais alta (7,66) e mais baixa (5,32). O tempo médio para completar o índice Multicultural de Qualidade de Vida foi de menos de 4 minutos e foi relatado pela maioria dos indivíduos como facilmente aplicável. Foi também documentado um alto alfa de Cronbach (0,88). CONCLUSÕES: Os resultados relatam que o índice Multicultural de Qualidade de Vida é confiável, possui uma alta consistência interna, é capaz de discriminar grupos de diferentes níveis de qualidade de vida presumidos, é muito eficiente e é de fácil utilização.

Trends in ecstasy use in the United States from 1995 to 2001: comparison with marijuana users and association with other drug use.

This study aims to estimate changes in the prevalence of ecstasy use over time, analyze the overlap of ecstasy use and other drug use, and compare other drug use in ecstasy versus marijuana users. The authors hypothesized that ecstasy users early in the "epidemic" would be polydrug users and that associations between ecstasy and other drug use would diminish as the prevalence of ecstasy use increased. Data were drawn from public use data files from the 1995, 1997, 1999, and 2001 National Household Survey on Drug Abuse. Ecstasy use increased in the U.S. population and the prevalence was greater in younger age groups. Ecstasy users were likely to use a variety of other drugs; however, association of ecstasy use with other drug use was strongest early in the "epidemic," diminishing as the number of new users increased. Later, more drug-naive adolescents and young adults began experimenting with ecstasy. These results can orient prevention strategies that target ecstasy users.

Tratamiento ambulatorio de pacientes con depresión mayor. estudio sobre eficacia, seguridad y tolerancia de sertralina / Ambulatory treatment of patients with major depression. a study of efficacy, safety and tolerance of sertraline

En el presente estudio multicéntrico, abierto y no comparativo de 8 semanas de duración, para evaluar la eficacia y la tolerabilidad de la sertralina en el trastorno depresivo mayor (según criterios DSM-IV), participaron 60 pacientes, 41 mujeres (68.4 por ciento) y 19 varones (31.6 por ciento); con edades promedio de 39.6ñ10.7 años. Luego de un período libre de fármacos de dos semanas de duración, se les administró sertralina; la dosis promedio empleada fue de 102.7ñ43.3 mg/día, siendo la dosis inicial de 50 mg/día y la dosis máxima permitida de 200 mg/día. Las escalas Hamilton-Depresión, Hamilton-Ansiedad y las escalas de Impresión Clínica Global fueron aplicadas quincenalmente; 55 pacientes fueron considerados en el análisis estadístico y 39 pacientes completaron el estudio. Se encontró disminución significativa en los valores basales y finales en las escalas HAM-D y HAM-A (p<0.000001); los efectos benéficos de la medicación se observaron a partir de la segunda semana de sustancia activa. Se encontró mejor respuesta en pacientes mujeres y en depresiones con características melancólicas. Los efectos adversos más importantes fueron náuseas, sequedad de boca, cefalea, hipotensión postural y diarrea; efectos que no dependían de la dosis empleada. Se concluye que la sertralina es un fármaco eficaz y bien tolerado en el tratamiento del trastorno depresivo mayor en una población de pacientes peruanos.

Depresión: aspectos clínicos fundamentales / Depression: fundamental clinic aspects

Se hace una revisión de la literatura actual concerniente a la depresión, se dan pautas clínicas generales para el diagnóstico y tratamiento de este trastorno en la práctica médica general.

Síndrome neuroléptico maligno: una revisión / Neuroleptic malignant syndrome: a review

El síndrome neuroléptico maligno (SNM), caracterizado por fiebre, rigidez muscular, inestabilidad autonómica, confusión y alteraciones de laboratorio, es una complicación severa del tratamiento con fármacos antipsicóticos. El SNM debe ser diferenciado de entidades similares como hipertemia maligna, catatonía letal, golpe de calor y síndrome serotoninérgico. La etiopatogenia de SNM radica en el bloqueo de los receptores dopaminérgicos. El tratamiento consiste principalmente en medidas de soporte y uso de agonistas dopaminérgicos y dantroleno.

Aspectos biológicos de la depresión / Biological aspects of depression

Alteraciones en la neurotransmisión por serotonina, noradrenalina y dopamina están involucradas en la génesis de la depresión. Los glucocorticoides pueden causar depresión, tener efecto antidepresivo o inducir manía, y parecer mediar las alteraciones cognitivas relacionadas a la depresión. Existe una hiperactividad corticoadrenal asociada a la depresión, especialmente a la de tipo psicótico. Una sensibilidad excesiva a las variaciones fisiológicas de los niveles de hormonas sexuales parece ser el origen de la depresión postparto y del síndrome premenstrual. La deficiencia de folato se asocia a depresión. la S-adenosilmetionina y el inositol tiene actividad antidepresiva. Algunos deprimidos tienen predisposición a presentar episodios en invierno, mientras que con otros estos sucede en verano. El efecto antidepresivo de la privación de sueño sugiere que al dormir ocurre un proceso necesario para perpetuar la depresión. En algunos casos, la infección por virus Borna puede ser causa de trastornos afectivos.