Barreras y facilitadores de los médicos de atención primaria para abordar las consultas vinculadas a la sexualidad de pacientes durante el climaterio / Barriers and facilitators of primary care physicians to address consultations related to the sexuality of patients during the climacteric

Introducción. Pese a la alta prevalencia de disfunciones sexuales femeninas durante el climaterio y a que existen intervenciones para mejorarlas, este problema no suele ser consultado por las pacientes ni explorado por los profesionales de la salud. Si bien suponemos que existen condicionamientos culturales que actuarían como barreras para su abordaje, no conocíamos las percepciones, incomodidades y experiencias de los profesionales que atienden en el ámbito de la atención primaria a pacientes que transitan su climaterio. Objetivos. Comprender desde la perspectiva de los médicos de atención primaria los factores que contribuyen a la invisibilidad de la problemática de las disfunciones sexuales femeninas durante el climaterio en mujeres de clase media atendidas en el Área Metropolitana de Buenos Aires. Diseño. Estudio exploratorio transversal con enfoque cualitativo realizado en el Hospital Italiano de Buenos Aires durante2020 y 2021. Resultados. A partir del análisis de diez entrevistas semiestructuradas a médicos de atención primaria (de familia, clínicos y ginecólogos) identificamos seis ejes temáticos: 1) un modelo institucional en el que el tiempo limitado para la consulta y forma de pago capitada incentivaría a que las las disfunciones sexuales femeninas permanezcan invisibilizadas; 2) la longitudinalidad de la relación médico-paciente contribuiría como un facilitador del abordaje de problemáticas vinculadas con la esfera sexual; 3) la discordancia de género entre los profesionales y las pacientes operaría como un obstáculo para abordar aspectos de la sexualidad durante el climaterio; 4) la biografía y la formación de los profesionales de la salud influiría sobre sus habilidades para abordar la problemática de la sexualidad de sus pacientes; 5) el examen ginecológico y/o la detección de síntomas de depresión contribuyen a abrir la puerta para indagar sobre la disfunción sexual femenina; y 6) el prejuicio de que el fin de la etapa reproductiva implicaría el fin de la actividad sexual. Conclusiones. Si bien no existen recomendaciones formales para la pesquisa sistemática de disfunciones sexuales femeninas, su elevada prevalencia, su fácil diagnóstico y la existencia de herramientas terapéuticas para aliviarlas, ameritan que estén más disponibles entre nuestras hipótesis diagnósticas. (AU)

Background. Despite the high prevalence of female sexual dysfunctions during the climacteric and the existence of interventions to improve them, this problem is not usually consulted by patients or explored by health professionals. Although weassume that there are cultural conditioning factors that would act as barriers to its approach, we were unaware of the perceptions, discomforts, and experiences of the professionals who care for patients who are going through their climactericin the field of primary care. Objectives. To understand, from the perspective of primary care physicians, the factors that contribute to the invisibility of the female sexual dysfunctions problem during the climacteric in middle-class women treated in the Buenos Aires Metropolitan Area. Design. Cross-sectional exploratory study with a qualitative approach carried out at Hospital Italiano de Buenos Aires during 2020 and 2021. Results. From the analysis of ten semi-structured interviews with primary care physicians (family, clinicians and gynecologists) we identified six thematic axes: 1) an institutional model in which the limited time for consultation and capitated form of payment would encourage female sexual dysfunctions to remain invisible; 2) the longitudinality of the doctor-patient relationship would contribute as a facilitator in addressing problems related to the sexual sphere; 3) the gender discrepancy between professionals and patients would operate as an obstacle to address aspects of sexuality during the climacteric; 4) the biography and training of health professionals would influence their abilities to address the problems of their patients'sexuality; 5) gynecological examination and/or the detection of symptoms of depression contribute to opening the door toinquire about FSD; 6) the prejudice that the end of the reproductive stage would imply the end of sexual activity. Conclusions. Although there are no formal recommendations for the systematic screening of female sexual dysfunctions, its high prevalence, its easy diagnosis and the existence of therapeutic tools to alleviate them, deserve that they be more available among our diagnostic hypotheses. (AU)

Hipoacusia súbita asociada a depresión: síntoma inusual en adultos mayores infectados por Sars-CoV-2 / Sudden hearing loss associated with depression: an unusual symptom in older adults infected with Sars-CoV-2

Se comienza acumular información sobre las alteraciones en pacientes positivos a Covid-19, donde relacionan el virus con el daño del oído medio y oído interno, tanto en la porción vestibular como la auditiva en adultos mayores, generando episodios depresivos. Por tal razón, se propuso como objetivo evaluar la relación hipoacusia súbita asociada a depresión en adultos mayores infectados por Sars-CoV-2 atendidos en el Hospital Básico Pillaros, perteneciente al sector Ciudadela Ciudad Nueva, Ecuador 2020-2021. El estudio fue cuantitavo, descriptivo correlacional de corte transversal con una muestra de 87 pacientes >65 años positivos para Sars-CoV-2. Para la recolección de datos se aplicó el Test audiométrico y la escala de depresión geriátrica de Yesavage. El análisis de los datos fue con estadística descriptiva en base a frecuencias, porcentajes, IC 95% y X2 a través de SPSS. Como resultado 73,6% eran fememnino y 26,4% masculino, 54,0% tenían de 65-75 años, el tipo de presbiacusia más existente fue neural (31,2%) y coclear (31,0%). Así mismo, 81,6% presentaron signos de depresión, mientras que 18,4% no. En el test Vasayage 88,5% expresó no sentirse lleno de energía y 59,8% sienten temor a que algo malo suceda. Como conclusión, la presencia de trastornos auditivos constituye un problema para la comunicación de los adultos mayores que pudiese conllevar a estados depresivos, por ello, incentivar el desarrollo de investigaciones pudieran orientar hacia el desarrollo de alternativas de intervención temprana que favorezcan el mejoramiento de la calidad de vida de este grupo poblacional(AU)

Information is beginning to accumulate on the alterations in patients positive for Covid -19, where they relate the virus to damage to the middle ear and inner ear, both in the vestibular and auditory portions in older adults, generating depressive episodes. For this reason, the objective was to evaluate the relationship between sudden hearing loss associated with depression in older adults infected with Sars-CoV- treated at the Pillaros Basic Hospital, belonging to the Ciudadela Ciudad Nueva sector, Ecuador 2020-2021. The study was quantitative, descriptive correlational cross-sectional with a sample of 87 patients >65 years positive for Sars-CoV-2. For data collection, the audiometric test and the Yesavage geriatric depression scale were applied. The analysis of the data was with descriptive statistics based on frequencies, percentages, CI 95% and X2 through SPSS. As a result, 73.6% were female and 26.4% male, 54.0% were 65-75 years old, the most common type of presbycusis was neural (31.2%) and cochlear (31.0%). Likewise, 81.6% presented signs of depression, while 18.4% did not. In the Vasayage test, 88.5% expressed not feeling full of energy and 59.8% were afraid that something bad would happen. In conclusion, the presence of hearing disorders constitutes a problem for the communication of older adults that could lead to depressive states, therefore, encouraging the development of research could guide the development of early intervention alternatives that favor quality improvement. life of this population group(AU)

Psiquiatría transcultural y depresión en China: un relato clínico / Cross-cultural psychiatry and depression in the eastern population

El siguiente trabajo presenta la historia de una paciente de 19 años oriunda de China, que cursó una internación en una sala de psiquiatría de un hospital general por un cuadro de características depresivas. El caso es notable por el polimorfismo en la sintomatología clínica que presentó. El objetivo es analizar, a partir de él, la necesidad de un enfoque interdisciplinario que trate a la cultura como una variable significativa en la construcción de una enfermedad, entendiendo que los modelos fisiopatológicos resultan necesarios pero no suficientes para comprender de qué modo se constituye. Para dicho fin se hará un breve recorrido por los estudios efectuados en la década del 80 en China por el psiquiatra y antropólogo Arthur Kleiman y se desarrollará la perspectiva de la psicoanalista Helena Lunazzi, quien en su libro Alexitimia desarrolla cómo la cultura influye en la expresión verbal de las emociones. (AU)

The following work presents the history of a 19-year-old patient from China who was hospitalized in a psychiatric ward of a general hospital due to a depressive illness, being the case remarkable for the polymorphism in the clinical symptoms that she presented. The objective is to analyze the need for an interdisciplinary approach that treats culture as a significant variable in the construction of a disease, understanding that pathophysiological models are necessary but not sufficient to comprehend how they are constituted. For this purpose, a brief review will be made of the studies carried out in the 1980s in China by the psychiatrist and anthropologist Arthur Kleiman and the perspective of the psychoanalyst Lunazzi Helena, who in her book "Alexithymia" develops how culture influences the verbal expression of emotions. (AU)

Depression and Cardiovascular Disease in Women

Abstract The prevalence of depression varies from 1 to 17% in different geographic regions, and its incidence is 70% higher in women than men. Today, depression affects more than 300 million people worldwide, affecting twice as many women from adolescence to adulthood. In addition to this earlier onset, depression in women tends to be more severe. Cardiovascular disease and depression are chronic diseases that have a major impact on cardiovascular and all-cause morbidity and mortality, with evidence of a two-way relationship between them, in which depression is a predictor of cardiovascular disease and vice versa. In females, the degree of illness and prognosis are more severe when both diseases are present, than when diagnosed alone. In patients with acute or chronic cardiovascular disease, especially women, a systematic screening for depression should be considered as a preventive strategy of cardiovascular events, aiming to reduce the risk of future events. There are still no clinical studies designed to assess the impact of antidepressant treatment on cardiovascular outcomes in women.

Impacto del tratamiento de adultos mayores con ISRS y su relación con los tratamientos odontológicos / The impact of treating older adults with SSRI and its relationship with dental treatments

La población mayor de 60 años es el grupo etario de mayor crecimiento en el mundo. Debido a que la depresión es una patología frecuente en la persona adulta mayor y anciana, los inhibidores de la recap- tación de la serotonina (ISRS) son el tratamiento de primera línea de elección. Este trabajo referencia la asociación del consumo de estos fármacos con la disminución de la densidad ósea mineral (DMO), el riesgo de fracturas y su repercusión en la atención odontológica. Además, incluye una breve descripción de la homeostasis ósea y la relación depresión-carga alostática. El trabajo interdisciplinario y una correcta anamnesis pueden detectar posibles complicaciones y riesgos vinculados con este tipo de medicamen- tos. Ello facilitaría un mejor manejo, más aún en el adulto mayor, donde una pequeña variable puede repercutir en su integridad (AU)

The population over 60 is the fastest growing age group in the world. Depression is a frequent pathology in the elderly and the elderly, with serotonin reuptake inhibitors (SSRI) being the 1st line treatment of choice. The association of the consumption of this drug with a decrease in bone mineral density (BMD), risk of fractures and its impact on dental care are referenced in this work. In addition, it includes a brief description of bone homeostasis and the depression-allostatic load relationship. Interdisciplinary work and a correct anamnesis can detect possible complications and risks linked to this type of medication, facilitating better management and even more so in the elderly, where a small variable can affect their integrity (AU)

Olho seco e COVID-19: uma revisão narrativa / Dry eyes and COVID-19: a narrative review

RESUMO Com o advento do cenário pandêmico causado pelo SARS-CoV-2, no início do ano de 2020, foi notado um vasto quadro clínico entre os indivíduos infectados. Dentre os sintomas oculares mais comuns ocasionados pela COVID-19, o olho seco tornou-se bastante prevalente nesse meio. O estudo do tipo revisão narrativa busca avaliar os fatores de risco associados ao surgimento ou à intensificação dos quadros de olho seco na população durante o período pandêmico. A partir da análise bibliográfica, foi descrita a influência da ventilação por pressão positiva, do uso de máscaras de forma incorreta e de telas eletrônicas e da ansiedade e da depressão como fatores predisponentes ao desenvolvimento da doença do olho seco. No entanto, ainda é notada a necessidade de estudos mais explicativos para estabelecer a relação direta entre a causalidade dos fatores.

ABSTRACT With the advent of the pandemic scenario caused by SARS-CoV-2 in the beginning of the year 2020, a vast clinical picture was noticed among the infected individuals. Among the most common eye symptoms caused by Covid-19, dry eye (DE) has become quite prevalent in this environment. The narrative review study seeks to assess the risk factors associated with the emergence or intensification of DE conditions in the population during the pandemic period. A literature review showed the influence of positive pressure ventilation, incorrect use of masks, as well as electronic screens, in addition to anxiety and depression as predisposing factors for the development of dry eye disease. However, the need for more explanatory studies and for establishing a direct relationship between the causality of the factors is still noted.

Factores asociados con rigidez de las articulaciones del hombro y la cadera en adultos mayores / Factors associated with stiffness of the shoulder and hips joints in the elderly

Introducción: mantener el nivel adecuado de flexibilidad en la edad adulta es importante para realizar las actividades básicas de la vida diaria; sin embargo, esta puede verse afectada negativamente por distintos factores, como el sedentarismo, la artrosis, la diabetes y el estado emocional. Objetivo: analizar la prevalencia de la rigidez en las articulaciones del hombro y coxofemoral, con factores asociados en los adultos mayores de la ciudad de Cuenca, Ecuador. Metodología: estudio analítico transversal con una muestra de 160 adultos mayores de las residencias geriátricas de la ciudad de Cuenca, Ecuador. La información se recolectó aplicando dos tests que valoran la flexibilidad, incluidos en la batería Senior fitness test (SFT): el Back scratch (TBS) y el test Chair sit and reach (TCSAR), para valorar el grado de rigidez de las articulaciones del hombro y coxofemoral. El nivel de actividad física se evaluó utilizando el test Rapid Assessment of Physical Activity (RAPA), y se utilizaron el test Yesavege para valorar el grado de depresión y la historia clínica de cada paciente, para conocer antecedentes de diabetes mellitus o artrosis. Se analizaron los datos con el programa SPSS versión 20.0®, por medio de medidas de frecuencia, dispersión, análisis bivariado (OR, IC, valor P). Resultados: se evidenció la inactividad física como factor de riesgo importante para padecer rigidez de articulación del hombro p=0,023, articulación coxofemoral p<0,001; además, la artrosis como factor de riesgo para rigidez en miembros superiores. La pre-valencia de rigidez articular fue de 40,6% en miembros inferiores y el 70,6%en los miembros superiores. Conclusión: los hallazgos de esta investigación corroboran que la inactividad física pue-de llevar a la pérdida progresiva de la flexibilidad en adultos mayores, con disminución en el rango de movimiento articular y limitación funcional. (AU)

Introduction: maintaining the appropriate level of flexibility in adulthood is important to carry out the basic activities of daily life; however, this can be negatively affected by different factors, such as a sedentary lifestyle, osteoarthritis, diabetes and emotional state. Objective: to analyze the prevalence of stiffness in the shoulder and coxofemoral joints, with associated factors in older adults in the city of Cuenca, Ecuador. Methodology: cross-sectional analytical study with a sample of 160 older adults from nursing homes in the city of Cuenca. The information was collected by applying two tests that assess flexibility, included in the senior fitness test (SFT) battery: the back scratch (TBS) and the chair sit and reach test (TCSAR), to assess the degree of stiffness of the knee joint. shoulder and coxofemoral. The level of physical activity was evaluated using the Rapid Assessment of Physical Activity (RAPA) test, the Yesavege test was used to assess the degree of depression and the clinical history of each patient to determine a history of diabetes mellitus or osteoarthritis. The data were analyzed with the SPSS version 20.0 program, through measures of frequency, dispersion, and bivariate analysis (OR, CI, P value). Results: physical inactivity was evidenced as an important risk factor for shoulder joint stiffness p=0.023, coxofemoral joint p=<0.001; in addition, osteoarthritis as a risk factor for stiffness in the upper limbs. The prevalence of joint stiffness was 40.6% in the lower limbs and 70.6% in the upper limbs. Conclusion: the findings of this research corroborate that physical inactivity can lead to progressive loss of flexibility in older adults, with decreased range of joint movement and functional limitation. (AU)

Clinical Characteristics and Therapeutic Adherence of Women in a Referral Outpatient Clinic for Severe Hypertension

Abstract Background Cardiovascular disease is the main cause of death worldwide. There is a lack of studies addressing this issue in women and its risk factors, such as hypertension. Objective To evaluate the clinical and therapeutic profile of women with hypertension and to determine which factors are related to treatment adherence and blood pressure control. Methods Cross-sectional study of 181 hypertensive women treated at an outpatient referral clinic. Data were obtained from medical records, face-to-face interviews, and physical examination, using a standardized form. Statistical analysis was performed with prevalence ratio, chi-square and Student's t test. Significance was accepted at p<0.05. Results Most patients were mixed-race or black (91.7%) and the mean age was 66.09 years. Only 44.2% of patients had controlled blood pressure. The prevalence of stroke was 14.9%, whereas the prevalence of coronary artery disease was 19.3%. The mean number of oral antihypertensive drugs prescribed to each individual was 3.41. A history of stroke was more often found in patients with uncontrolled blood pressure (p=0.013) and in those using three or more antihypertensives (p=0.023). Eighty patients (44.2%) had high treatment adherence. Depression was more frequently reported by patients with poorer adherence to treatment (p=0.026). Conclusion Women with hypertension presented a high prevalence of cardiovascular risk factors and cardiovascular events, including a significantly higher prevalence of stroke in those with uncontrolled hypertension. Self-reported depression may help identify patients at risk of nonadherence to treatment.

Disfunción sexual en mujeres de 60 años y más / Sexual dysfunction in women age 60 and older

La sexualidad es un aspecto importante en la calidad de vida de la mujer, sin embargo, los estudios sobre sexualidad dedicados a las mujeres de 60 años y más son escasos. El objetivo de este estudio fue determinar la prevalencia de la disfunción sexual femenina y sus dominios en mujeres de 60 años y más, e identificar la asociación entre enfermedades asociadas y consumo de medicamentos con la disfunción sexual. Se realizó un estudio descriptivo y transversal, en mujeres de 60 años y más, de La Habana, Cuba. Participaron 112 mujeres a las cuales se les aplicaron dos encuestas: el Índice de Función Sexual Femenino (IFSF) y otra que recogía antecedentes médicos y sociales. El 66,1% de las mujeres presentó algún grado de disfunción sexual, la prevalencia aumentaba con la edad. Los dominios más afectados fueron el deseo, la excitación y la lubricación. Se identificó una fuerte asociación entre la enfermedad de Parkinson, la depresión y la artrosis con la aparición de disfunción sexual en la población estudiada, así como el uso de antidepresivos, hipoglicemiantes orales y diuréticos. La disfunción sexual estuvo presente en el 100% de las mujeres octogenarias. Todas las mujeres con enfermedad de Parkinson presentaron disfunción sexual.

Sexuality is an important aspect in women's quality of life, however, sexuality studies dedicated to women age 60 and older are scarce. The objective of this study was to determine the prevalence of female sexual dysfunction and its domains in women age 60 and older, and to identify the association between diseases and drug use with sexual dysfunction. A descriptive and cross-cutting study was conducted, in women 60 years and older, in Havana, Cuba. Two surveys participated in 112 women: The Female Sexual Function Index (IFSF) and another who collected a medical and social history. 66.1% of women had some degree of sexual dysfunction, the prevalence increased with age. The domains most affected were desire, excitement, and lubrication. A strong association between Parkinson's disease, depression and osteoarthritis was identified with the onset of sexual dysfunction in the studied population, as well as the use of antidepressants, oral hypoglycemics and diuretics. Sexual dysfunction was present in 100% of octogenary women. All women with Parkinson's disease had sexual dysfunction.

Depressão em pacientes com doença renal crônica em hemodiálise e transplante renal / Depression in patients with chronic renal disease on hemodialysis and renal transplantation

O desenvolvimento de pesquisas, diante da relevância do tema, propicia suporte teórico, favorecendo a atuação da assistência multidisciplinar, no intuito de fortalecer o vínculo terapêutico, a relação com a família e o cuidado de modo integral. O objetivo deste estudo foi revisar os principais aspectos clínicos da depres- são entre pacientes com doença renal crônica em hemodiálise e transplantados renais com base nas evidências científicas atuais. O aumento da expectativa de vida acarreta a elevação da inci- dência das doenças crônicas não transmissíveis ­ dentre elas a doença renal crônica ­, que são vistas como fatores que afetam o paciente, tanto no âmbito físico como no psicológico, gerando a associação de doenças crônicas com distúrbios psicoafetivos. Estudos prévios mostram que a depressão é três a cinco vezes mais prevalente no estágio avançado da doença renal crôni- ca do que na população em geral. A prevalência de depressão nos pacientes em hemodiálise está em torno de 20% a 40%, re- presentado uma questão de saúde pública. Apesar de sua alta prevalência, a depressão é subdiagnosticada e subtratada, pois os profissionais de saúde assemelham os sintomas depressivos com os das doenças crônicas, focalizando apenas nos aspectos físicos da enfermidade. É essencial que os profissionais da saúde estejam qualificados para reconhecer as manifestações iniciais para o diagnóstico correto da depressão, posto que esse distúrbio possui ligação direta com o sucesso terapêutico.

The development of research, given the relevance of the theme, provides theoretical support favoring the performance of multi- disciplinary care, to strengthen the therapeutic bond, the rela- tionship with the family, and care in an integral way. The objective of this study was to review the main clinical aspects of depression among patients with chronic kidney disease on hemodialysis and with kidney transplantation based on current scientific evidence. The increase in life expectancy leads to an increase in the inciden- ce of noncommunicable chronic diseases, among them chronic kidney disease, which are seen as factors that affect the patient both physically and psychologically, leading to the association of chronic diseases with psycho-affective disorders. Previous studies show that depression is five to three times more prevalent in the advanced stage of chronic kidney disease than in the general po- pulation. The prevalence of depression in hemodialysis patients is around 20% to 40%, representing a public health issue. Despite its high prevalence, depression is underdiagnosed and undertrea- ted, because health professionals relate depressive symptoms to those of chronic diseases, focusing only on the physical aspects of the disease. It is essential that health care professionals are qualified to recognize the initial manifestations for the correct diagnosis of depression, since this disorder has a direct connec- tion with therapeutic success.

Risco de depressão e ansiedade em gestantes na atenção primária / Risk of depression and anxiety in pregnant women in primary care / Riesgo de depresión y ansiedad en mujeres embarazadas

Objetivo: Identificar os riscos para depressão e ansiedade em gestantes de uma unidade de saúde da Atenção Primária. Métodos: Estudo descritivo exploratório de abordagem quantitativa realizado entre fevereiro a abril de 2020 em uma unidade de Saúde de Olinda-PE (Brasil); foi utilizado o instrumento validado "Cartão de Babel". A análise dos dados foi realizada pelo Statistical Package for Social Sciencies por meio do teste Qui-quadrado com correção de Yates (significância de 5% - p≤0,05). Resultados: 71 gestantes foram analisadas, dentre os quais 32,3% referiram já ter sofrido violência psicológica. Por meio do Cartão de Babel verificou-se que 49,3% das gestantes tinham alto risco para o desenvolvimento de transtorno de ansiedade (p-valor: 0,004) e 29,5% apresentou risco moderado para depressão (p-valor: 0,004). Conclusão: Iniciativas preventivas à ocorrência da depressão e ansiedade na gestação, como o monitoramento da saúde mental e o seu rastreio durante a consulta de pré-natal são necessários.(AU)

Objective: To identify the risks for depression and anxiety in pregnant women in a Primary Health Care unit. Methods: Descriptive exploratory study with a quantitative approach carried out between February and April 2020 at a Health Unit in Olinda-PE (Brazil); the validated instrument "Babel Card" was used. Data analysis was performed using the Statistical Package for Social Sciencies using the Chi-square test with Yates correction (significance of 5% - p≤0.05). Results: 71 pregnant women were analyzed, among which 32.3% reported having suffered psychological violence. Through the Babel Card, it was found that 49.3% of pregnant women were at high risk for the development of anxiety disorder (p-value: 0.004) and 29.5% had a moderate risk for depression (p-value: 0.004). Conclusion: Preventive initiatives for the occurrence of depression and anxiety during pregnancy, such as monitoring mental health and tracking it during the prenatal consultation are necessary.(AU)

Objetivo: Identificar los riesgos de depresión y ansiedad en gestantes en una unidad de Atención Primaria de Salud. Métodos: Estudio descriptivo exploratorio con abordaje cuantitativo realizado entre febrero y abril de 2020 en una Unidad de Salud de Olinda-PE (Brasil); Se utilizó el instrumento validado "Babel Card". El análisis de los datos se realizó mediante el paquete estadístico para ciencias sociales mediante la prueba de Chi-cuadrado con corrección de Yates (significancia del 5% - p≤0.05). Resultados: Se analizaron 71 mujeres embarazadas, de las cuales el 32,3% refirió haber sufrido violencia psicológica. A través de la Tarjeta Babel, se encontró que el 49,3% de las mujeres embarazadas tenían alto riesgo de desarrollar trastorno de ansiedad (valor p: 0,004) y el 29,5% tenían un riesgo moderado de depresión (valor p: 0,004). Conclusión: Son necesarias iniciativas preventivas para la aparición de depresión y ansiedad durante el embarazo, como el seguimiento de la salud mental y su seguimiento durante la consulta prenatal.(AU)

Low Chronic Self-Esteem and Low Situational Self-Esteem: a literature review / Baja Autoestima Crónica y Baja Autoestima Situacional: una revisión de la literatura / Baixa Autoestima Crônica e Baixa Autoestima Situacional: uma revisão de literatura

ABSTRACT Objective: to develop a literature review about low self-esteem and components of the nursing diagnoses Low Chronic Self-Esteem and Low Situational Self-Esteem in patients with depressed mood. Method: an integrative literature review carried out in the Pubmed portal and in the Scopus and Web of Science electronic bibliographic databases. Depression and self-esteem descriptors were used, resulting in 32 articles. Results: literature indicated 7 clinical indicators and 14 etiological factors for low self-esteem. Conclusion: The clinical indicators Suicidal ideation and Ineffective treatment were more prevalent in the study. The etiological factors Stressful events and Stigmatization were the most frequent, both of which were suggested as new related factors for low self-esteem. Nursing diagnosis recognition can contribute to intervention strategy elaboration by the nurse, according to the urgent diagnostic and the individual's particularities.

RESUMEN Objetivo: desarrollar una revisión de la literatura sobre la baja autoestima y los componentes de los diagnósticos de enfermería Baja Autoestima Crónica y Baja Autoestima Situacional en pacientes con estado de ánimo deprimido. Método: una revisión integradora de la literatura realizada en el portal Pubmed y en las bases de datos bibliográficas electrónicas Scopus y Web of Science. Se utilizaron los descriptores depression y self-esteem, resultando en 32 artículos. Resultados: Los indicadores clínicos Ideación suicida y Afrontamiento ineficaz fueron más frecuentes en el estudio. Conclusión: los indicadores clínicos Ideación suicida y Afrontamiento ineficaz fueron más frecuentes en el estudio. Los factores etiológicos Eventos estresantes y Estigmatización fueron los más frecuentes, los cuales fueron sugeridos como nuevos factores relacionados para la baja autoestima. El reconocimiento del diagnóstico de enfermería puede contribuir a la elaboración de estrategias de intervención por parte de la enfermera, según la urgencia diagnóstica y las particularidades del individuo.

RESUMO Objetivo: desenvolver uma revisão de literatura acerca da baixa autoestima e dos componentes dos diagnósticos de enfermagem "Baixa Autoestima Crônica" e "Baixa Autoestima Situacional" em pacientes com humor deprimido. Método: revisão integrativa de literatura realizada no portal Pubmed e nas bases bibliográficas eletrônicas Scopus e Web of Science. Utilizaram-se os descritores depression e self-esteem, resultando em 32 artigos. Resultados: a literatura apontou 7 indicadores clínicos e 14 fatores etiológicos para baixa autoestima. Conclusão: os indicadores clínicos "Ideação suicida" e "Enfretamento ineficaz" apresentaram maior predominância no estudo. Os fatores etiológicos "Eventos estressantes" e "Estigmatização" foram os mais frequentes, sendo ambos sugeridos como novos fatores relacionados para baixa autoestima. O reconhecimento do diagnóstico de enfermagem pode contribuir para elaboração de estratégias de intervenções pelo enfermeiro, conforme a urgência diagnóstica e as particularidades do indivíduo.

Síndrome dos ovários policísticos, complicações metabólicas, cardiovasculares, psíquicas e neoplásicas de longo prazo: uma revisão sistematizada / Polycystic ovary syndrome and long-term metabolic, cardiovascular, psychic, and neoplastic health consequences: a systematized review

A Síndrome dos Ovários Policísticos (SOP) é uma das disfunções endócrinas mais comuns em mulheres em idade reprodutiva, com uma prevalência que varia entre 6 e 16%, sendo motivo frequente de consulta em um ambulatório de Ginecologia e Obstetrícia. Esta revisão enfoca alguns dos principais riscos tardios para a saúde das pacientes com SOP na meia idade e após a menopausa. A busca da literatura foi realizada no Pubmed utilizando-se as seguintes palavras-chave: Polycystic Ovary Syndrome; time. Identificou-se 229 artigos relacionando SOP e suas consequências tardias que foram publicados em periódicos indexados no Pubmed entre 1o de janeiro de 2010 e 19 de junho de 2020. Desses, excluiu-se 3 por não estarem em língua inglesa (2 em chinês, 1 em russo), 177 pelo título e pelo abstract, e 27 com base na análise do texto. Os 22 artigos restantes estão contemplados nesta revisão sistematizada. Evidenciam-se complicações metabólicas, cardiovasculares, neoplásicas e psíquicas, bem como uma complexa, e ainda não totalmente elucidada, relação com a obesidade. Apesar das complicações cardiovasculares, não existem evidências de que estas levem a maior mortalidade em pacientes com SOP, tampouco de que a mortalidade por todas as causas seja maior nessas mulheres. (AU)

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age, with a prevalence of 6-16%. It is also one of the most frequent reasons for encounter at Obstetrics and Gynecology clinics. This review focuses on some of the main late health impacts of PCOS in middle-aged and postmenopausal patients. A literature search with the keywords "polycystic ovary syndrome" and "time" was conducted in PubMed, and 229 articles related to PCOS and late health consequences published between January 1, 2010, and June 19, 2020, were analyzed. Three articles were excluded because they did not meet the language criterion (being written in English), 177 were excluded based on the title and abstract, and 27 were excluded based on the analysis of the text, resulting in the inclusion of 22 articles in this systematized review. Metabolic, cardiovascular, neoplastic, and psychic complications were made evident, as well as a complex, not yet fully elucidated relationship between PCOS and obesity. Despite cardiovascular complications, there is no evidence that they lead to higher mortality in patients with PCOS, or that all- cause mortality is higher in women with the syndrome. (AU)

Ocorrência de dor combinada na coluna lombar, cintura pélvica e sínfise púbica entre gestantes do extremo sul do Brasil / Occurrence of combined pain in the lumbar spine, pelvic girdle and pubic symphysis among pregnant women in the extreme south of Brazil

RESUMO: Objetivos: Estimar a prevalência e caracterizar a ocorrência de dor lombar gestacional (DLG), dor na cintura pélvica posterior (DCPP) e dor na sínfise púbica (DSP) entre gestantes residentes em Rio Grande, RS. Métodos: Estudo transversal realizado com todas as puérperas com parto em 2016. Foram utilizadas duas figuras para investigar a presença de DLG, DCPP e DSP de forma isolada ou combinada. Regressão logística multinomial foi usada para avaliar os fatores associados a cada sintoma. Resultados: DLG foi referida por 42,2% das entrevistadas, DSP por 4,9%, e DCPP por 2%, enquanto DLG + DSP por 9%, DLG + DCPP por 2,8%, DCPP + DSP por 1,1% e dor nas três regiões por 3,9% delas. Quanto maior era a idade da gestante, menor foi o risco de DLG e de DLG combinada a uma das regiões da cintura pélvica e maior o risco de DCPP + DSP. Depressão na gestação aumentou o risco de todas as combinações dos sintomas. Conclusão: Este estudo realizou uma descrição mais detalhada da ocorrência dos desfechos avaliados e de seus fatores associados. Estudos como este são raros no país, sobretudo com baixas taxas de perdas e recusas. A elevada prevalência dos sintomas avaliados sugere que sua investigação seja rotineira nas consultas de pré-natal, atendo-se a idade das gestantes, sintomas depressivos e a dores combinadas e intensas.

ABSTRACT: Objectives: To estimate the prevalence and characterize the occurrence of low back pain (LBP), posterior pelvic girdle pain (PPGP) and pubic symphysis pain (PSP) among pregnant women resident in Rio Grande, RS. Methods: This was a cross-sectional study of all postpartum women who gave birth in 2016. Two pictures were used to investigate the presence of LBP, PPGP and PSP, both isolated and combined. Multinomial logistic regression was used to evaluate the factors associated with each symptom. Results: LBP was reported by 42.2%, PSP by 4.9%, and PPGP by 2%, while LBP + PSP was reported by 9%, LBP and PPGP by 2.8% and PPGP + PSP by 1.1%, and pain in all three regions was reported by 3.9% of the sample. The more advanced the age of the pregnant women, the risk for LBP and of LBP combined with one of the pelvic girdle regions was reduced, while the risk for PPGP + PSP was increased. Depression during pregnancy increased the risk for all symptom combinations. Conclusion: This study provided a detailed description of the occurrence of the evaluated outcomes and its associated factors. Studies like this are rare in Brazil, especially a census with low rates of losses and refusals. The high prevalence of the evaluated symptoms suggests that it should be investigated routinely in prenatal care, taking into account the age of the pregnant women, depressive symptoms and those experiencing combined or intense pain.

Prevalência de sintomas depressivos no idoso hospitalizado: estudo comparativo / Prevalence of depressive symptoms in hospitalized older adults: a comparative study / Prevalencia de síntomas de depresión en el anciano hospitalizado: estudio comparativo

Objetivo: comparar a prevalência dos sintomas depressivos no idoso hospitalizado, mediante uso da Escala de Depressão Geriátrica­15 e por meio da avaliação realizada pelo enfermeiro na admissão do idoso. Método: estudo descritivo de abordagem transversal em hospital público de ensino. Utilizou-se a Escala de Depressão Geriátrica e instrumento com lista de sintomas depressivos, extraídos das características definidoras dos diagnósticos de enfermagem. Resultados: a prevalência de sintomas depressivos em idosos hospitalizados foi de 47%, segundo a Escala de Depressão Geriátrica, e de 25% segundo a avaliação do enfermeiro, no momento da admissão do paciente. Conclusão: a avaliação realizada pelo enfermeiro detectou baixa porcentagem dos sintomas depressivos no idoso em comparação ao instrumento específico para depressão.

Objective: : to compare the prevalence of depressive symptoms in hospitalized elderly using the Geriatric Depression Scale­15 and the nursing assessment of the older adult at admission. Method: this descriptive, cross-sectional study at a public teaching hospital used the Geriatric Depression Scale and an instrument listing depressive symptoms drawn from defining characteristics of nursing diagnoses. Results: the Geriatric Depression Scale returned a 47% prevalence of depressive symptoms in the hospitalized older adults, while the nursing assessment at admission found 25% prevalence. Conclusion: the nursing assessment detected a lower percentage of depressive symptoms in the older adults than the specific instrument for depression.

Objetivo: comparar la prevalencia de síntomas de depresión en el anciano hospitalizado, mediante uso de Escala de Depresión Geriátrica­15 y por medio de evaluación realizada por el enfermero en el momento de la admisión del anciano. Método: estudio descriptivo de abordaje transversal en hospital universitario. Se utilizó la Escala de Depresión Geriátrica y un instrumento con lista de síntomas de depresión, extraídos de las características definidoras de diagnósticos de enfermería. Resultados: la prevalencia de síntomas depresivos en ancianos hospitalizados fue del 47% según la Escala de Depresión Geriátrica y del 25% según evaluación del enfermero durante la admisión del paciente. Conclusión: la evaluación realizada por el enfermero detectó bajo porcentaje de síntomas de depresión en ancianos en comparación con el instrumento específico para la depresión.

La depresión: un desafío en la práctica médica general / La depresión: un desafío en la práctica médica general

Asociada o no a una enfermedad orgánica, la depresión tiene gran prevalencia en la práctica médica pero es subdiagnosticada. El trastorno del ánimo suele coexistir con variadas quejas somáticas y dolores crónicos, configurando síndromes mixtos con un diagnóstico diferencial complejo. En este artículo se describen distintas presentaciones clínicas de la depresión en medicina general, con énfasis en los estados depresivos atípicos, depresiones enmascaradas muy relevantes por su frecuencia y consecuencias: depresión posquirúrgica, cuadros dolorosos crónicos como cefaleas o lumbago, la fatiga crónica y la fibromialgia. Solo el reconocimiento y diagnóstico de la depresión subyacente posibilitará la implementación de las adecuadas intervenciones terapéuticas. Se revisan también algunas recomendaciones para el uso de antidepresivos en atención primaria y la eventual consulta psiquiátrica. (AU)

Associated or not with an organic disease, depression has a high prevalence in medical practice but is underdiagnosed. The mood disorder usually coexists with varied somatic complaints and chronic pain, forming mixed syndromes with a complex differential diagnosis. This article describes different clinical presentations of depression in general medicine, with emphasis on atypical depressive states, masked depressions very relevant for their frequency and consequences: post-surgical depression, chronic painful conditions such as headaches or lumbago, chronic fatigue and fibromyalgia. Only the recognition and diagnosis of the underlying depression will enable the implementation of appropriate therapeutic interventions. Some recommendations for the use of antidepressant drugs in primary care and the eventual psychiatric consultation are also reviewed. (AU)

Prevalence of depression among patients with presumptive pulmonary tuberculosis in Rio de Janeiro, Brazil

Objective: To estimate the prevalence of major depressive episode (MDE) in patients with presumptive pulmonary tuberculosis (pre-PTB, defined by cough lasting ≥ 3 weeks) and compare it between patients with pulmonary tuberculosis (PTB) and without PTB. Methods: Patients with pre-PTB (n=260) were screened for depression using the Patient Health Questionnaire (PHQ-9). Those individuals with scores ≥ 10 were subsequently assessed with the depression module of the Mini International Neuropsychiatric Interview (MINI-Plus) to confirm diagnosis. Associations of categorical variables with PTB and MDE were calculated using the chi-square test and OR. Results: PTB was confirmed in 98 patients (37.7%). A high proportion of both groups (active PTB and no PTB) screened positive for depression (60.2 vs. 62.1%, respectively). Among 159 patients who screened positive for depression, a subset of 97 (61.0%) were further evaluated with the MINI-Plus; current MDE was confirmed in 54.6% (53/97). On univariate and multivariate analysis, female sex was the only factor associated with the diagnosis of current MDE (p = 0.04). Conclusion: The prevalence of MDE was high among individuals with prolonged respiratory symptoms, independent of PTB diagnosis. This is consistent with other studies of depression in primary care in Brazil.

Confección de un modelo predictor para infección de herida operatoria en pacientes adultos intervenidos de artroplastía total de cadera en un hospital de alta complejidad, años 2012 y 2014 / Predictive model preparation for surgical wound infection in adult patients undergoing total hip arthroplasty in high complexity hospital for years 2012 and 2014

Resumen Introducción: Las infecciones de herida operatoria de pacientes intervenidos de artroplastía total de cadera, presentan una incidencia desde 2 a 5%, generando impacto en la estadía hospitalaria, uso de recursos, antibioterapia prolongada y secuelas temporales o definitivas. Objetivo: Generar un modelo predictivo para la infección de herida operatoria en pacientes intervenidos de artroplastía total de cadera, entre los años 2012 y 2014, en un hospital de alta complejidad. Material y Método: Cohorte de pacientes con artroplastía total de cadera. Se efectuó la descripción de las variables epidemiológicas y se generó un modelo predictivo por regresión logística. Resultados: Se analizaron 441 pacientes. El modelo predictivo obtenido incluyó las variables: días de estadía post operatoria (OR 1,11 IC95% [1,03-1,20]), transfusión de al menos una unidad de glóbulos rojos (OR 3,13 IC95% [1,17-10,86]), diagnóstico de depresión previo a la cirugía (OR 5,75 IC95% [1,32-25,32], incumplimiento del tiempo de administración de la antibioprofilaxis (OR 5,46 IC95% [1,68-17,78]; p < 0,001) y pseudo R2 = 0,2293. Punto de corte de "score" de 13 puntos con sensibilidad 44,4%, especificidad de 91,6%, LR (+) 5,29, LR (-) 0,61, considerando además la siguiente clasificación: 1 a 6 puntos "bajo riesgo", 7 a 12 puntos "mediano riesgo", 13 a 18 puntos "alto riesgo", desde 19 puntos como "máximo riesgo". Conclusión: El modelo presenta una buena capacidad de predicción de infección de herida operatoria y representa adecuadamente a la cohorte en estudio.

Introduction: Operative wound infections of patients undergoing total hip arthroplasty have an incidence from 2% to 5%, generating impact on hospital stay, resource use, prolonged antibiotic therapy, including temporary or definitive sequelae. Objective: To generate a predictive model for surgical wound infection in patients undergoing total hip arthroplasty between 2012 and 2014 at the High Complexity Hospital. Material and Method: Cohort of patients with total hip arthroplasty. A description of the epidemiological variables was made and a predictive model was generated by means of logistic regression. Results: 441 patients were analyzed. The predictive model obtained included the variables: days of post-operative stay (OR 1.11 IC95% [1.03 - 1.20]), transfusion of at least one unit of red blood cells (OR 3.13 IC95% [1.17 - 10.86]), diagnosis of previous depression to surgery (OR 5.75 IC95% [1.32 - 25.32], non-compliance with antibioprophylaxis administration time (OR 5.46 IC95% [1.68 - 17.78], P < 0.001) and pseudo R2 = 0.2293. Score point of 13 points with sensitivity 44.4%, specificity of 91.6%, LR (+) 5.29, LR (-) 0.61, 1 to 6 points "low risk", 7 to 12 points "medium risk", 13 to 18 points "high risk", from 19 points as "maximum risk". Conclusion: the model presents a good predictive capacity of operative wound infection and adequately represents the cohort under study.

Calidad de vida y variables psicológicas que afectan la adherencia al tratamiento anti-retroviral en pacientes mexicanos con infección por VIH/SIDA / Quality of life and psychological variables affecting adherence to antiretroviral treatment in Mexican patients with HIV/AIDS

Resumen Introducción: El tratamiento anti-retroviral (TAR) es indispensable en pacientes con infección por VIH/ SIDA; suprimir la carga viral requiere de un estricto apego a éste, por compromiso del paciente. El fracaso del TAR es primordialmente por falta de adherencia, que puede ser debida a una deficiente calidad de vida y/o a variables psicológicas. Objetivo: Determinar la calidad de vida, variables psicológicas y la adherencia al TAR, en pacientes con infección por VIH/SIDA. Material y Método: Se incluyeron 160 pacientes con diagnóstico de infección por VIH/SIDA y con TAR. Se recabaron los instrumentos MOS SF-36 y VPAD-24, una encuesta demográfica, y datos clínicos. Se hicieron asociaciones cuantitativas y cualitativas entre las variables. Resultados: La adherencia al TAR estuvo asociada con evitar comportamiento depresivo y con ausencia de adicciones. El comportamiento depresivo se encontró asociado con las adicciones. Un 87% de pacientes estaba en el rango de mejor calidad de vida. Por debajo del promedio del puntaje de salud general estuvieron masculinos, con orientación sexual HSH, solteros, en la vitalidad a los ≥ 38 años, en dolor corporal y función social a tres esquemas TAR. Conclusión: La buena adherencia al TAR estuvo asociada a evitar comportamiento depresivo y a la ausencia de adicciones y no se asoció a la calidad de vida.

Background: Antiretroviral treatment (ART) is essential in HIV/AIDS patients. Suppressing viral load requires strict adherence to ART in addition to the patient's commitment to treatment. The failure of ART is mainly due to lack of adherence, which may in turn be due to poor quality of life and/or to psychological variables. Aim: To determine the quality of life and psychological variables and adherence to ART, in patients with HIV/AIDS. Material and Method: 160 patients diagnosed with HIV/AIDS and with ART were included. The MOS SF-36 and VPAD-24 instruments, a socio-demographic survey, and clinical data were collected. Quantitative and qualitative associations were made between the variables. Results: The adherence to ART was associated with avoidance of depressive behavior and with the absence of addictions. Depressive behavior associated with addictions. 87% of patients ranked in the best quality of life. Below the average of the general health score were males, with MSM sexual orientation, single, in vitality at ≥ 38 years, in corporal pain and with social function to three ART schemes. Conclusion: Good adherence to ART was associated with avoiding depressive behavior and with non-addictions and not associated with quality of life.

Associations of parental bonding and adolescent internet addiction symptoms with depression and anxiety in parents of adolescents with attention deficit/hyperactivity disorder

Abstract Objectives The aim of the present study was to evaluate the associations of parental bonding and adolescents' Internet addiction symptoms with depression and anxiety in parents of adolescents with attention deficit/hyperactivity disorder (ADHD). Methods Parental depression and anxiety symptoms, parental bonding, and adolescents' Internet addiction symptoms were assessed in 46 parent-child dyads using the Center for Epidemiological Studies Depression Scale, State-Trait Anxiety Inventory, Parental Bonding Instrument (PBI), and Chen Internet Addiction Scale, respectively. Forward stepwise multiple regression analysis was used to examine the associations of parental bonding and adolescents' Internet addiction symptoms with parental depression and anxiety. Results Low care/affection on the PBI was significantly associated with parental depression, and overprotection on the PBI and adolescents' Internet addiction were significantly associated with parental anxiety. Discussion Parental bonding and adolescents' Internet addiction are related to depression and anxiety in parents of adolescents with ADHD.