Somos una banda: Los médicos como grupo antropológico / We are a band: an anthropological vision of the medical community

Este artículo trata de explicar cómo, desde el punto de vista antropológico, el colectivo médico se comporta como una tribu similar a las que pueblan el Amazonas o la sabana africana. La familia como unidad fundamental de la banda de cazadores define a su vez el centro de salud y a los médicos que lo habitan, como grupo igualitario en el que los miembros trabajan por el bien de la tribu. Los líderes de la tribu, también llamados directores de centro, también son similares a los grandes hombres de la Polinesia o a los aborígenes que lideran la partida de caza. Incluso los enfrentamientos entre médicos, en torno a sus competencias respecto a los pacientes, han sido descritas a lo largo de la historia por los antropólogos y repiten los patrones de los grupos segmentarios. Se concluye con que esta visión de tribus enfrentadas se ha de superar para avanzar hacia la mejora de la salud de la población

In this paper we try to explain, using an anthropological point of view, how the medical community behaves like a tribe like those who inhabit the Amazon forests or the African Savanna. The Family as fundamental unit of a band of hunter-gatherers also defines the Primary Care Centre and the professionals who work there, as an egalitarian group in which every member works for the good of the tribe. The leaders of the tribe, also called "Health Centre Managers", are also comparable to the "big men" of Polynesia or the aborigines, who leads hunting parties. Even the clashes between physicians about the responsibilities as regards patients have been described throughout history in the anthropological literature, and they repeat the patterns of the segmental groups. We finish by concluding that this vision of warring tribes has to be overcome in order to advance towards the improvement of our community's health

[We are a band: An anthropological vision of the medical community]. / Somos una banda: Los médicos como grupo antropológico.

In this paper we try to explain, using an anthropological point of view, how the medical community behaves like a tribe like those who inhabit the Amazon forests or the African Savanna. The Family as fundamental unit of a band of hunter-gatherers also defines the Primary Care Centre and the professionals who work there, as an egalitarian group in which every member works for the good of the tribe. The leaders of the tribe, also called "Health Centre Managers", are also comparable to the "big men" of Polynesia or the aborigines, who leads hunting parties. Even the clashes between physicians about the responsibilities as regards patients have been described throughout history in the anthropological literature, and they repeat the patterns of the segmental groups. We finish by concluding that this vision of warring tribes has to be overcome in order to advance towards the improvement of our community's health.

Adecuación de la solicitud de la microalbuminuria en pacientes con diabetes mellitus en atención primaria / Adaptation of the request for microalbuminuria in patients with diabetes mellitus in primary care

Objetivo. Evaluar el grado de cumplimiento en la determinación anual de MAU en los pacientes diabéticos. Metodología. Estudio observacional descriptivo transversal, donde se seleccionaron 381 historias clínicas de pacientes con DM2 en 3 equipos de atención primaria de Madrid. Se recogieron datos sociodemográficos y de enfermedades concomitantes, se determinó la fecha de solicitud anual de MAU, así como la existencia de MAU patológica y se evaluó el cumplimiento en la solicitud de la HbA1c y del perfil lipídico en el último año. Resultados. Fueron evaluados 298 pacientes (edad media: 55,7 años; desviación estándar 7,51 y el 57,7% varones). Se ha solicitado la MAU en el 42,3% (IC 95%: 36,5–48,05) de los casos, pero en los pacientes con antecedentes de ECV, desciende al 25,6% (p: 0,017). El 59% presentaba HTA, el 43,3% tenía dislipemia, el 63,7% obesidad (IMC>30) y el 14,4% padecía alguna ECV asociada. En los 30 pacientes donde existen registros el 24,3%(IC 95%: 16,3–32,3) tenían la MAU alterada. El valor medio de la Hba1c fue de 6,87 (±1,57). Conclusiones. La petición de MAU en nuestro ámbito es deficiente. Los médicos y enfermeros deben concienciarse de la importancia de solicitar la MAU de forma sistemática (AU)

Objective. To evaluate the degree of compliance in the annual measurement of microalbuminuria in diabetic patients. Methods. A descriptive, cross-sectional observational study in which 381 clinical histories of patients with DM2 were selected in three teams of primary care centers of Madrid. Sociodemiographic and concomitant disease information were gathered, the date of the annual request for the microalbuminuria as well as the existence of pathological microalbuminuria were determined and compliance in the request for HbA1c and lipid profile in the last year was evaluated. Results. Two hundred ninety eight patients were evaluated (mean age: 55.7 years; SD 7.51 and 55.7% were males). Microalbuminuria was requested in 42.3% (95% CI: 36.5–48.05) of the cases, however, this decreased to 25.6% (p: 0.017) in patients with a background of cardiovascular disease (CVD). A total of 59% had arterial hypertension, 43.3% dyslipidemia, 63.7% obesity (BMI>30) and 10% had some associated cardiovascular disease. In the 30 patients for whom there were records, 24% (95% CI: 16.3–32.3) had altered microalbuminuria. The mean value of HbA1c was 6.87 (±1.57). Conclusions. Request for Microalbuminuria in our setting is deficient. Both physicians and nurses must become aware of the importance of the routine request for microalbuminuria (AU)

[Acute peri-traumatic dissociative experiences: assessment and course]. / Troubles dissociatifs aigus péritraumatiques: évaluation et évolution.

Previous research has identified acute stress symptoms, particularly peri-traumatic dissociative symptoms (the distortion of consciousness, depersonalization, derealization, automatic movements, flashbacks with illusions or hallucinations), as risk factors for the development of later posttraumatic stress disorder. Numerous retrospective assessments and current prospective studies confirm these findings. It is suggested that peri-traumatic dissociation be assessed immediately after traumatic exposure and during the weeks following. But traumatized victims may present other categories of acute reactions; panic attacks, acute depression, conversion reaction, excessive emotional expression, and psychotic reactions. Brief reactive psychosis is a major differential diagnosis with peri-traumatic dissociative experiences. During emergency interventions it may be difficult to distinguish between dissociative and psychotic symptoms. It is cautioned that these disorders be evaluated with a follow-up of several months.

[Schizophrenias in DSM-IV and ICD-10 and French psychiatry]. / Les schizophrénies due DSM-IV et de la CIM-10 et la psychiatrie française.

DSM-IV and ICD-10 show the convergence of international nomenclatures of psychotic disorders. Their emphasis on antheorism and the definition of operational diagnostic criteria converge with one major trend in traditional French psychiatry which has been illustrated by Chaslin. The principal discrepancy which concerns chronic hallucinatory psychosis has been reduced by the restrictive conception of schizophrenic disorders in DSM-IV and ICD-10. Despite the attempt to define French empirical criteria, chronic hallucinatory psychosis has not been accepted by international classifications and is in pronounced decline in French scientific works. On the other had, the "bouffées délirantes aiguës", taken up by ICD-10, are acknowledged internationally.

[Father-child hospitalization in the separation anxiety]. / Hospitalización padre-hijo en la ansiedad de separación.

Severe forms of separation anxiety disorder with school refusal can be difficult to treat: on the one hand the resistance to outpatient treatment is usual, on the other hand, fear of separation is so overwhelming that hospitalization can be seen as too dramatic. We suggest hospitalizing the child with his or her father as fear of separation with the mother is usually the main problem. We report a case study of a 13 year old child with separation anxiety disorder who refused to go to school and to be separated from his mother. Treatment consisted of hospitalizing the child with his father and to gradually restore his autonomy. The father was given the role of a co-therapist: the main therapeutic decisions about graduated exposure to separation were taken after discussion with the father who passed them on to the child. These structuring interventions re-established the father's control which helped to sedate the child's anxiety.

[Personality disorders in childhood. Classifications and clinical aspects of border-line personalities and narcissism]. / Personnalités pathologiques dans l'enfance. Classifications et clinique à propos des personnalités limites et narcissiques.

The diagnosis of personality disorders is particularly difficult in childhood and requires prolonged psychiatric evaluation. Authors focus discussion upon the diagnosis of borderline and narcissistic personality disorders in children. Although Misès recently favours the term child borderline pathologies covering all personality disorders other than psychosis or neurosis, the american school of psychiatry tends to separate different personality disorders according to DSM-IV diagnosis propositions. The results of rare prospective studies suggest a pathological continuum which remains within the sphere of personality disorders. Further research is in fact necessary to determine the specific evolutive profiles of each personality disorder.

[Endogenous affective disorder, seasons of birth and photoperiodicity]. / Troubles de l'humeur endogènes, saisons de naissance et photopériodisme.

In a retrospective study, we compared the months of birth of 3,106 psychiatric inpatients to those of 1,943 surgical patients collected during the same period 1981-1991 in the same hospital, and of a sample of 10,003,572 births in France in 1977-1989. DSM III-R categories were modified so to allow a comparison with former studies, and psychiatric patients were distributed among seven categories: Bipolars (N = 294), Unipolars (N = 287), Neurotic-reactive depressions (N = 582), First Major Depressive episode (N = 214), Schizophrenia (N = 244), Schizo-Affectives (N = 52) and Other Diagnosies (N = 1,433). Months of birth were grouped in quarters and semesters, according to the usual calendar, but also to temperature and the photoperiodic cycle. The main results were: 1. A seasonnality of births in the General Population sample, with a spring maximum (p < 0.001). 2. An absence of deviation from the general population and the surgical sample among Neurotic-reactive Depressions and Other Diagnoses. 3. A deviation from the general population and from other comparison groups (surgical cases and Other Diagnoses) among Unipolars and First Major Depressive Episodes (most of those being late episodes), with a significant excess of births during the "dark" or "cold" season of the year, especially around the winter solstice. The Bipolar group followed the same tendency, though to a lesser degree and for subjects born before 1940 only. The most significant results were found among Unipolars, which differ from the general population either by quarters (p < 0.0005) or by semesters (p < 0.0005) and from surgical cases by quarters (p < 0.01) and by semesters (p < 0.001). The results were similar for First Major Depressive episodes, although this category was theoretically "anosological". As the median age was high in this category, it might group a number of late depressive episodes, near to "involutionnal melancholia". Thus, our results seem to be relevant to the traditional endogenous-psychogenetic dichotomy, with a "cold" or "dark" seasonnality of births in the first case, and no particular seasonnality in the second case. Some former studies showed the same results, but the most significant deviation was found in mania. Our results cannot be explained by differences in the sex-ratio among the categories, and only partially by an age-incidence effect or an age-cohort effect.(ABSTRACT TRUNCATED AT 400 WORDS)

[Calcium channel blockers and dysthymic disorders. Recent data]. / Inhibiteurs calciques et troubles dysthymiques. Données récentes.

The authors review the use of the calcium antagonists in the treatment of dysthymic disorders. Verapamil is mainly studied, but present researches focus on drugs with specific action on the CNS, particularly nimodipine. Their most constant therapeutic efficiency concerns hypomanic states; but their effect when prescribed alone remains inconstant on the manic states of bipolar disorders; in a preventive purpose, alone, or associated with lithium, their efficiency is real but inconstant. Their particular interest in dysthymic disorders is due to their absence of cognitive perturbations contrary to neuroleptics, and their less side-effects than lithium.