Healthy dietary patterns and risk of cardiovascular disease in US Hispanics/Latinos: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

BACKGROUND: Multiple dietary patterns have been recommended by the 2015-2020 Dietary Guidelines for Americans for the prevention of cardiovascular disease (CVD). The adherence to these patterns and its relation with risk of CVD remain unclear in the US Hispanic/Latino population. OBJECTIVES: We aimed to evaluate 3 healthy eating patterns measured by 3 dietary pattern scores [the Alternate Mediterranean diet (aMED), the Healthy Eating Index (HEI)-2015, and the healthful Plant-based Diet Index (hPDI)] across different Hispanic/Latino backgrounds and generations. We further examined the associations of these dietary scores with incident CVD in US Hispanics/Latinos. METHODS: We included 10,293 adult participants of US Hispanics/Latinos of 6 backgrounds (Mexican, Puerto Rican, Cuban, Dominican, Central American, and South American), free of CVD or cancer at baseline, in the Hispanic Community Health Study/Study of Latinos. Dietary pattern scores were derived at the baseline visit using two 24-h dietary recalls. The primary outcome was major incident CVD (n = 232), comprised of coronary heart disease and stroke, during an average 6-y follow-up. RESULTS: Mean levels of all 3 dietary scores were significantly different across the 6 Hispanic/Latino background groups (all P < 0.001), with the highest (i.e., healthiest) in those of Mexican background and lowest in those of Puerto Rican background. Compared with non-mainland-US-born Hispanics/Latinos, mainland-US-born Hispanics/Latinos had significantly lower dietary scores (P < 0.001). Differences in dietary scores between mainland-US-born and non-mainland-US-born Hispanics/Latinos were majorly driven by differences in dietary intakes of healthy plant-based foods. After adjusting for multiple covariates, significantly lower risk ratios (95% CI) of CVD were observed for 1-SD increments of the dietary scores, with 0.74 (0.60, 0.91) for aMED, 0.80 (0.63, 1.00) for HEI-2015, and 0.74 (0.60, 0.93) for hPDI. CONCLUSIONS: Although adherence to healthy eating patterns varied by Hispanic/Latino backgrounds and generations, greater adherence to these eating patterns was associated with lower risk of CVD across diverse US Hispanics/Latinos.

Dietary Patterns and Years Living in the United States by Hispanic/Latino Heritage in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

BACKGROUND: Previous diet findings in Hispanics/Latinos rarely reflect differences in commonly consumed and culturally relevant foods across heritage groups and by years lived in the United States. OBJECTIVES: We aimed to identify and compare a posteriori heritage-specific dietary patterns (DPs) and evaluate their associations with "healthfulness" [using the Alternative Healthy Eating Index-2010 (AHEI-2010)] and years living in the United States. METHODS: We used baseline data from a population-based cohort of 14,099 Hispanics/Latinos aged 18-74 y in the Hispanic Community Health Study/Study of Latinos. We performed principal factor analysis using two 24-h recalls to derive DPs, separately, in each heritage group (Cuban, Dominican, Mexican, Puerto Rican, Central American, and South American), and identified overarching DPs based on high-loading foods shared by ≥2 groups. We used multivariable linear regression to test associations of DPs with AHEI-2010 and years living in the United States. RESULTS: We identified 5 overarching DPs (Burgers, Fries, & Soft Drinks; White Rice, Beans, & Red Meats; Fish; Egg & Cheese; and Alcohol). All Burgers, Fries, & Soft Drinks DPs were inversely associated with AHEI-2010, whereas all Fish DPs (except Dominican) were positively associated with this index (all P-trend < 0.001). White Rice, Beans, & Red Meats DPs showed inverse associations in Cuban and Central American groups and positive associations in Mexican-origin individuals (all P-trend < 0.001). Fewer years living in the United States was associated with higher scores for White Rice, Beans, & Red Meats DPs in Cuban and Mexican heritage groups and lower scores on Burgers, Fries, & Soft Drinks DPs in Cuban, Mexican, and Puerto Rican groups (all P-trend < 0.01). CONCLUSIONS: Our findings show substantial variation in DPs across Hispanics/Latinos and adherence to DPs by time in the United States, which could inform dietary interventions targeting this diverse US population. This trial was registered at clinicaltrials.gov as NCT02060344.

Diet quality, excess body weight and cardiometabolic risk factors in adolescents living in São Paulo, Brazil and in the USA: differences and similarities.

OBJECTIVE: To compare diet quality and its association with excess body weight (EBW: overweight/obesity), central adiposity (CA) and CVD risk factors (CVDR) among adolescents from Brazil and USA. DESIGN: Data from two cross-sectional surveys: Health Survey of São Paulo (ISA-Nutrition) and Hispanic Community Health Study/Study of Latino Youth (SOL-Youth). Dietary intake was assessed from 24-h recalls, and diet quality using the Alternate Healthy Eating Index-2010 (AHEI) developed in the USA and the Revised Brazilian Healthy Eating Index (BHEI-R). CVDR was defined as ≥3 of: obesity, elevated blood pressure, dyslipidaemia, high plasma glucose and insulin resistance. Adjusted OR for EBW, CA and CVDR by diet quality were tested using logistic regression. SETTING: São Paulo, Brazil; and Chicago, IL; Miami, FL; Bronx, NY; San Diego, CA. PARTICIPANTS: Adolescents (12-16 years) living in São Paulo (n 189) and USA (n 787). RESULTS: ISA-Nutrition individuals with EBW (v. without) had marginally lower (unhealthier) scores for whole grains using BHEI-R and sugary beverages using AHEI. SOL-Youth individuals with EBW had lower scores of nuts/legumes using AHEI, and Na using BHEI-R, but higher scores of whole grains and dairy using BHEI-R. In ISA-Nutrition, BHEI-R was inversely associated with EBW (OR = 0·87; 95 % CI 0·80, 0·95) and CVDR (OR = 0·89; 95 % CI 0·80, 0·98). In SOL-Youth, AHEI was inversely associated with EBW (OR = 0·93; 95 % CI 0·87, 0·99). CONCLUSIONS: Dietary improvements should be made by adolescents in both USA and Brazil. Healthier diet quality as measured with the country-specific index was associated with lower odds of EBW in Brazilian and USA-Hispanic/Latino adolescents, and with lower CVDR in Brazilian adolescents.

Comparing Methods from the National Cancer Institute vs Multiple Source Method for Estimating Usual Intake of Nutrients in the Hispanic Community Health Study/Study of Latino Youth.

BACKGROUND: The Multiple Source Method (MSM) and the National Cancer Institute (NCI) method estimate usual dietary intake from short-term dietary assessment instruments, such as 24-hour recalls. Their performance varies according to sample size and nutrients distribution. A comparison of these methods among a multiethnic youth population, for which nutrient composition and dietary variability may differ from adults, is a gap in the literature. OBJECTIVE: To compare the performance of the NCI method relative to MSM in estimating usual dietary intakes in Hispanic/Latino adolescents. DESIGN: Data derived from the cross-sectional population-based Hispanic Community Health Study/Study of Latino Youth, an ancillary study of offspring of participants in the adult Hispanic Community Health Study/Study of Latino Youth cohort. Dietary data were obtained by two 24-hour recalls. PARTICIPANTS/SETTING: One thousand four hundred fifty-three Hispanic/Latino youth (aged 8 to 16 years) living in four urban US communities (Bronx, NY; Chicago, IL; Miami, FL; and San Diego, CA) during 2012 through 2014. MAIN OUTCOME MEASURES: The NCI method and the MSM were applied to estimate usual intake of total energy, macronutrients, minerals and vitamins, added sugar, and caffeine. STATISTICAL ANALYSES: Mean, standard deviation, minimum and maximum values, coefficient of variation, variance ratio, and differences between NCI and MSM methods and the 2-day mean were estimated in several percentiles of the distribution, as well as concordance correlation coefficients and Bland-Altman plot analysis. RESULTS: The distributions of all nutrients studied were very similar between NCI and MSM. The correlation between NCI and MSM was >0.80 for all nutrients (P<0.001), except dietary cholesterol, vitamin C, and n-3 fatty acids. In individual estimations, NCI method predicted higher estimates and lower variance than the MSM. The lowest level of agreement was observed in the values at the tails of the distribution, and for nutrients with high variance ratio. CONCLUSIONS: Overall, both MSM and NCI method provided acceptable estimates of the usual intake distribution using 24-hour recall, and they better represented the usual intake compared with 2-day mean, correcting for intraindividual variability.

APOE alleles' association with cognitive function differs across Hispanic/Latino groups and genetic ancestry in the study of Latinos-investigation of neurocognitive aging (HCHS/SOL).

INTRODUCTION: Apolipoprotein E (APOE) alleles are associated with cognitive decline, mild cognitive impairment (MCI), and Alzheimer's disease in Whites, but have weaker and inconsistent effects reported in Latinos. We hypothesized that this heterogeneity is due to ancestry-specific genetic effects. METHODS: We investigated the associations of the APOE alleles with significant cognitive decline and MCI in 4183 Latinos, stratified by six Latino backgrounds, and explored whether the proportion of continental genetic ancestry (European, African, and Amerindian) modifies these associations. RESULTS: APOE ε4 was associated with an increased risk of significant cognitive decline (odds ratio [OR] = 1.15, P-value = 0.03), with the strongest association in Cubans (OR = 1.46, P-value = 0.007). APOE-ε2 was associated with decreased risk of MCI (OR = 0.37, P-value = 0.04) in Puerto Ricans. Amerindian genetic ancestry was found to protect from the risk conferred by APOE ε4 on significant cognitive decline. DISCUSSION: Results suggest that APOE alleles' effects on cognitive outcomes differ across six Latino backgrounds and are modified by continental genetic ancestry.

Diet quality indices and risk of metabolic syndrome among postmenopausal women of Mexican ethnic descent in the Women's Health Initiative Observational Study.

BACKGROUND: The prevalence of metabolic syndrome is higher among minority populations, including individuals of Mexican ethnic descent. Whether alignment to healthy dietary patterns is associated with lower risk of metabolic syndrome in this population is largely unknown. OBJECTIVE: To prospectively evaluate the associations between a priori diet quality scores and risk of metabolic syndrome and its components among postmenopausal women of Mexican ethnic descent. METHODS: A total of 334 women of Mexican ethnic descent who participated in the Women's Health Initiative (WHI) observational study without metabolic syndrome or diabetes at baseline (1993-1998) were included. Baseline diets were scored with the Alternate Mediterranean Diet (aMED), the Dietary Approaches to Stop Hypertension (DASH), the Healthy Eating Index (HEI-2010), the Mediterranean Diet Score (MDS), and the traditional Mexican Diet (MexD) score. Multivariable linear and logistic regression models were used to test the associations between baseline diet quality and risk of metabolic syndrome and its individual components at follow-up (2012-2013). RESULTS: Approximately 16% of women met the criteria for metabolic syndrome at follow-up. None of the diet quality indices were associated with risk of metabolic syndrome. However, higher vs lower DASH scores were associated with lower waist circumference (85.2 vs 88.0 cm) and glucose concentrations (90.0 vs 95.1 mg/dL), and higher HDL cholesterol (62.6 vs 59.0 mg/dL), while higher vs lower HEI-2010 scores were associated with lower waist circumference (83.9 vs 88.1 cm), triglycerides (103 vs 117 mg/dL) and glucose concentrations (89.5 vs 94.4 mg/dL), and higher HDL cholesterol levels (63.9 vs 58.5 mg/dL). CONCLUSIONS: Diet quality was not associated with risk of metabolic syndrome in this population. However, the results suggest that alignment to DASH and HEI-2010 recommendations may be beneficial for reducing some individual components of metabolic syndrome among postmenopausal women of Mexican descent.

Perceived Discrimination and Cardiometabolic Risk Among US Hispanics/Latinos in the HCHS/SOL Sociocultural Ancillary Study.

BACKGROUND: Metabolic syndrome (MetS) is a group of cardiovascular risk factors including elevated blood pressure, elevated triglycerides, decreased high-density lipoprotein cholesterol, impaired fasting glucose, and abdominal obesity, which disproportionately affects Hispanics/Latinos. The present study examined associations between perceived discrimination and MetS in Hispanic/Latino adults from various background groups (i.e., Dominican, Central American, Cuban, Mexican, Puerto Rican, South American). METHODS: Data were obtained from 5174 Hispanics/Latinos who participated in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. MetS components and covariates were measured at a baseline examination, and perceived discrimination was assessed within 9 months of baseline. Path analysis modeled associations of perceived discrimination with MetS prevalence and each of the six components of MetS, controlling for age, sex, income, acculturation, physical activity, diet, smoking, and alcohol use. RESULTS: Among the full cohort, perceived discrimination was not associated with MetS prevalence in any of the models evaluated. Higher perceived discrimination at work/school was associated with larger waist circumference. When examining background groups separately, higher perceived ethnicity-associated threat was related to increased MetS prevalence only among individuals of Central American background. Differential patterns of association between perceived discrimination and MetS components were found for different background groups. CONCLUSIONS: Overall results suggested that perceived discrimination was not strongly or consistently associated with MetS among Hispanics/Latinos.

Structural social support and cardiovascular disease risk factors in Hispanic/Latino adults with diabetes: results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

OBJECTIVE(S): Cross-sectional and longitudinal studies have yielded inconsistent findings on the associations of social support networks with cardiovascular health in Hispanic/Latino adults with diabetes. We examined the cross-sectional associations of structural social support and traditional cardiovascular disease (CVD) risk factors in a diverse sample of Hispanic/Latino adults with diabetes. RESEARCH DESIGN AND METHODS: This analysis included 2994 adult participants ages 18-74 with diabetes from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL - 2008-2011). Select items from the Social Network Inventory (SNI) were used to assess indices of structural social support, i.e. network size (number of children, parents, and in-laws) and frequency of familial contact. Standardized methods were used to measure abdominal obesity, BMI, hypertension, hypercholesterolemia, and smoking status. Multivariate regression was used to examine associations of structural support with individual CVD risk factors with demographics, acculturation, physical health, and psychological ill-being (depressive symptoms and anxiety) included as covariates. RESULTS: There were no significant cross-sectional associations of structural support indices with abdominal obesity, hypertension, hypercholesterolemia, or smoking status. There was a marginally significant (OR: 1.05; 95%CI 0.99-1.11) trend toward higher odds of obesity in participants reporting a larger family unit (including children, parents, and in-laws) and those with closer ties with extended family relatives (OR: 1.04; 95%CI 0.99-1.09). CONCLUSIONS: Structural social support was marginally associated with higher odds of obesity in Hispanic/Latino adults with diabetes. Alternate forms of social support (e.g. healthcare professionals, friends, peers) should be further explored as potential markers of cardiac risk in Hispanics/Latinos with diabetes.

History of Adverse Pregnancy Outcomes, Blood Pressure, and Subclinical Vascular Measures in Late Midlife: SWAN (Study of Women's Health Across the Nation).

BACKGROUND: Adverse pregnancy outcomes, such as preterm birth (PTB), have been associated with elevated risk of maternal cardiovascular disease, but their effect on late midlife blood pressure (BP) and subclinical vascular measures remains understudied. METHODS AND RESULTS: We conducted a cross-sectional analysis with 1220 multiethnic parous women enrolled in SWAN (Study of Women's Health Across the Nation) to evaluate the impact of self-reported history of adverse pregnancy outcomes (PTB, small-for-gestational-age, stillbirth), on maternal BP, mean arterial pressure, and subclinical vascular measures (carotid intima-media thickness, plaque, and pulse wave velocity) in late midlife. We also examined whether these associations were modified by race/ethnicity. Associations were tested in linear and logistic regression models adjusting for sociodemographics, reproductive factors, cardiovascular risk factors, and medications. Women were on average aged 60 years and 255 women reported a history of an adverse pregnancy outcome. In fully adjusted models, history of PTB was associated with higher BP (systolic: ß=6.40; SE, 1.62 [P<0.0001] and diastolic: ß=3.18; SE, 0.98 [P=0.001]) and mean arterial pressure (ß=4.55; SE 1.13 [P<0.0001]). PTB was associated with lower intima-media thickness, but not after excluding women with prevalent hypertension. There were no significant associations with other subclinical vascular measures. CONCLUSIONS: Findings suggest that history of PTB is associated with higher BP and mean arterial pressure in late midlife. Adverse pregnancy outcomes were not significantly related to subclinical cardiovascular disease when excluding women with prevalent hypertension. Future studies across the menopause transition may be important to assess the impact of adverse pregnancy outcomes on midlife progression of BP.

Sex Differences in Cardiometabolic Risk Factors among Hispanic/Latino Youth.

OBJECTIVE: To determine the prevalence of obesity and cardiometabolic risk in US Hispanic/Latino youth and examine whether there are disparities by sex in cardiometabolic risk factors. STUDY DESIGN: Study of Latino Youth is a population-based cross-sectional study of 1466 Hispanic/Latino youth (8-16 years old) who were recruited from 4 urban US communities (Bronx, NY, Chicago, IL, Miami, FL, and San Diego, CA) in 2012-2014. The majority of children were US-born (78%) and from low-income and immigrant families. Cardiometabolic risk factors were defined by the use of national age- and sex-specific guidelines. RESULTS: The prevalence of obesity was 26.5%. The prevalence of class II-III obesity, diabetes, and dyslipidemia was high (9.7%, 16.5%, and 23.3%, respectively). The prevalence of cardiometabolic risk factors increased with severity of obesity in both boys and girls. Boys had a greater prevalence of diabetes and of elevated blood pressure than girls (20.9% vs 11.8% and 8.5% vs 3.3%). In multivariable analyses, younger boys were more likely to have obesity class II-III than girls (OR 3.59; 95% CI 1.44-8.97). Boys were more likely to have prediabetes than girls (OR 2.02; 95% CI 1.35-3.02), and the association was stronger at older ages. CONCLUSIONS: The prevalence of cardiometabolic risk factors was high in this sample of Hispanic youth. Boys had a more adverse cardiometabolic profile compared with girls that may put them at higher risk of diabetes and cardiovascular disease later in life. Reasons for this disparity and the long-term clinical implications remain to be elucidated.

Relationships of nativity and length of residence in the U.S. with favorable cardiovascular health among Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

Individuals with favorable levels of all readily measured major CVD risk factors (low CV risk) during middle age incur lower cardiovascular morbidity and mortality, lower all-cause mortality, and lower Medicare costs at older ages compared to adults with one or more unfavorable CVD risk factors. Studies on predictors of low CV risk in Hispanics/Latinos have focused solely on Mexican-Americans. The objective of this study was to use data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL; enrolled 2008 to 2011) to assess relationships of nativity and length of residence in the US, a commonly used proxy for acculturation, with low CV risk (not currently smoking; no diabetes; untreated total cholesterol <200mg/dL; untreated blood pressure<120/<80; body mass index <25kg/m(2); and no major ECG abnormalities) in 15,047 Central American, South American, Cuban, Dominican, Mexican, Puerto Rican men and women, and Hispanic/Latino men and women identifying as other or >1 heritage. We also tested whether associations varied by Hispanic/Latino background. Women living in the US<10years were 1.96 (95% confidence interval: 1.37, 2.80) times more likely to be low CV risk than US-born women after adjusting for sociodemographic characteristics, diet, physical activity, and self-reported experiences of ethnic discrimination. Findings varied in men by Hispanic/Latino background, but length of residence was largely unrelated to low CV risk. These findings highlight the role acculturative processes play in shaping cardiovascular health in Hispanics/Latinos.

Anxious-depression among Hispanic/Latinos from different backgrounds: results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

BACKGROUND: Anxious-depression is a constellation of symptoms, frequently encountered among patients in primary care centers. There is a need to study how anxious-depression presents among Hispanic/Latinos of different backgrounds. OBJECTIVE: To study the construct of anxious-depression among 16,064 Hispanic/Latinos of different backgrounds participating in the Hispanic Community Health Study/Study of Latinos. We hypothesized that Hispanic/Latinos will cluster in 3 classes: low anxiety/high depression, high anxiety/low depression and a combined anxious-depression construct. METHODS: Using latent profile analysis, symptoms of depression and anxiety measured by the 10-item Center for Epidemiologic Studies Depression Scale and 10-item State-Trait Anxiety Inventory were evaluated to determine if an anxious-depression typology would result. A multinomial logistic regression analysis explored the association of the 3-class solution with different Hispanic/Latino backgrounds controlling for age, gender, language, education and income. RESULTS: A 3-class mixed anxious-depression structure emerged with 10% of Hispanic/Latinos in the high, 30% in the moderate and 60% in the low anxious-depression category. After adjusting for age, gender, language preference, income and education, individuals of Puerto Rican background were more likely to experience high (OR = 1.79, p < 0.05) and moderate (OR = 1.36, p < 0.05) (vs. low) anxious-depression symptomatology compared to those of Mexican background. Individuals of Central American and South American background were less likely to experience high (OR = 0.68, p < 0.05) and moderate (OR = 0.8, p < 0.05) (vs. low) anxious-depression compared to those of Mexican background. CONCLUSION: Anxious-depression symptomatology varied among this sample of Hispanic/Latino groups. These classes should be investigated as to their relationship with different health outcomes relevant to the Hispanic/Latino of different backgrounds.

Relaciones entre gratitud y variables de personalidad / Relationship between Gratitude and Personality Variables

Se aborda la probable relación entre la gratitud, medida por la Escala de Gratitud, desarrollada por el primer autor, y variables de personalidad, medidas con el Inventario de Personalidad NEO PI-R, de P.T. Costa & R. R. McCrae. Encontramos una alta correlación positiva entre Gratitud y el factor A. Amabilidad (r = .293; p < .01). A esta asociación contribuyen cinco de sus facetas: Confianza, Franqueza, Sensibilidad hacia los demás, Altruismo y Actitud Conciliadora, con correlaciones estadísticamente significativas fuertes y moderadas. El otro factor con el que gratitud tiene una relación estrecha y positiva es el factor C. Responsabilidad (r = .221; p < .01). Tres facetas de este factor: Sentido del Deber, Orden, y Competencia, contribuyen decisivamente al nexo asociativo. Por otro lado, hemos encontrado que entre Gratitud y Neuroticismo la relación es negativa (r = -.149; p < .05). El segundo problema se orientó a identificar las variables de personalidad que maximizan la predicción de la gratitud. El Análisis de Regresión Múltiple, por "pasos sucesivos", identificó dos facetas Confianza y Sentido del deber, en conjunto explican el 11.70% de la varianza total de la Gratitud. Estas son las variables de personalidad que, con mayor vigor, pueden predecir la gratitud.

The probability of a relationship between gratitude and personality is approached in this paper. Gratitude has been measured by the Scale of Gratitude, developed by the first author, and personality variables has been measured with the Inventory of Personality NEO PI-R, from P.T. Costa & R.R. McCrae. We find a high positive correlation between gratitude and the factor A. Agreeableness (r =293; p<.01), five facets contribute to this association: Trust, Straightforwardness, Tender mindedness, Altruism and Compliance with correlations statistically significant strong and moderate. Gratitude has a narrow and positive correlation with factor C. Conscientiousness (r = .221; p<.01); three facets of this factor: Dutifulness, Order and Competence, they contribute decisively to the associative nexus. The relationship between Gratitude and Neuroticism are negative (r = -.149; p<.05). The second problem was identified the personality variables that maximize the prediction of the gratitude. The Multiple Regression Analysis "stepwise", it identified two facets: "trust" and "sense of duty". All together, these explain 11.70% of total gratitude variance. These are the variables of personality that, with more vigor, can predict the gratitude.

Vías regias al inconsciente / Regal ways to the unconscious

El concepto de procesos mentales inconscientes es fundamental en la teoría psicoanalítica, Freud nunca se cansó de insistir en los argumentos a favor de este concepto y combatir las objeciones que se le oponían. El interés de Freud en este concepto no fue meramente filosófico, sino pragmático, encontrando que sin él no podría explicar ni describir muchos fenómenos. Mediante este concepto encontró el camino abierto a una inmensa y fértil región de nuevos conocimientos. A lo largo de toda la obra freudiana no está mencionada la palabra "psicosomática", sin embargo, el psicoanálisis contribuyó en gran medida al desarrollo de las bases de esta área de estudio. Clásicamente, se definen una serie de enfermedades en las que el daño somático está sustentado por un conflicto psíquico, es decir, un conjunto de situaciones que abarcan las interacciones entre lo psíquico y lo somático que van desde las enfermedades clásicamente descritas como tales hasta acontecimientos puntuales y esporádicos en el que el cuerpo responde ante la imposibilidad de procesar a nivel mental un conflicto. La enfermedad somática "oculta" un afecto, pero no se trata de un afecto cualquiera, sino que cada enfermedad diferente se constituye como un desarrollo que representa o equivale a un particular afecto inconsciente, enraizando en una historia, configurando un "capítulo" particular en la biografía del paciente.

The concept of mental unconscious processes is fundamental to psychoanalytic theory, Freud never stopped trying to prove arguments in favor o this concept and fight the objections against it. Freud's interests in this concept were not merely philosophical but pragmatic, without finding that he could not explain or describe many phenomena. With this concept he found an open way to a vast and fertile region of new knowledge. In Freud's work all along the word "psychosomatic" it's not mentioned at all, however, psychoanalysis, contributed greatly to the development of the foundations of this study area. Classically defined a number of diseases in which damage is sustained by a somatic psychic conflict, which means, a set of situations that include interactions between the psychic and somatic ranging from classically described diseases to sporadic and punctual events in which the body responds to the impossibility of processing at mental conflict. Somatic illness "hides" an affection, bt it is not anyone, but each different disease was established as a development that represents or corresponds to particular unconscious affection, the disease-specific, rooted in a history, forming a "chapter", in particular on the biography of the patient.

Evolución y características de la publicaciones biomédicas peruanas, 1985-1993 / Evolution and characteristc of peruvian biomedical publications, 1985-1993

Se realizó un estudio de la evolución y principales características de los artículos científicos de investigaciones realizadas en el Perú, publicadas en revistas nacionales y extranjeras en el período de 1985-1993. Durante este período se logró identificar 2412 artículos científicos publicados en 32 revistas biomédicas nacionales y 297 artículos científicos aparecidos en 134 revistas extranjeras. Se observó que la mayoría de revistas médicas nacionales tiene una periodicidad irregular, siendo las revistas de sociedades científicas la más constantes. También se observó que en 8 años el volumen de artículos científicos en revistas nacionales sólo se incrementó en 12 por ciento. Además, se describen las características de los autores nacionales y extranjeros, los tipos de artículos que se publican y las áreas temáticas. Finalmente, se hacen alcances acerca de los factores relacionados a las caracteristicas tendencias observadas.