Porcentaje de peso perdido y su recuperación en pacientes bariátricos: un análisis desde la perspectiva temporal / Percentage of total weight loss and weight regain in bariatric patients: a time perspective analysis

RESUMEN La perspectiva temporal se ha asociado a hábitos relacionados con salud. Específicamente, el futuro ha sido asociado a cambios en el estilo de vida como la incorporación de ejercicio físico. En cambio, el presente hedonista se ha asociado a la perdida sub-óptima de peso en pacientes bariátricos. Objetivo: Evaluar la relación entre las variables de la perspectiva temporal y el porcentaje de peso total perdido; su mantención o re-ganancia desde el nadir, en pacientes bariátricos. Material y métodos: Se aplicó a 97 pacientes bariátricos el Inventario de la Perspectiva Temporal de Zimbardo y Boyd, y un cuestionario de estilo de vida construido para esta investigación. Resultados: Un mayor porcentaje de peso total perdido se asoció significativamente a futuro (r= 0,221; p<0,05) y desviación del perfil temporal negativo (r= 0,324; p<0,05). La pérdida de peso insuficiente estuvo asociada al presente fatalista (t= −2,16; p= 0,033) y desviación del perfil temporal balanceado (t= −2,81; p= 0,006). La re-ganancia del %PTP se asoció significativamente a la desviación del perfil temporal balanceado (t= −2,09; p= 0,045) y al consumo de dulces (X2= 13,42; p= 0,009). Conclusiones: Una mayor desviación de la perspectiva temporal balanceada y un mayor consumo de dulces se asociaron a una pérdida de peso insuficiente y a la recuperación desde el nadir.

ABSTRACT Background: A person's perspective of time has been associated with health-related habits. Specifically, future has been associated with changes in lifestyle as well the incorporation of physical exercise. In contrast, current hedonism is associated with sub-optimal weight loss in bariatric patients. Aim: To evaluate the relationship between seven variables of a time perspective and percentage of total weight loss; maintenance or weight regain among bariatric patients. Material and Methods: A sample of 97 bariatric patients answered the Inventory of Temporary Orientation and lifestyle questionnaires. Results: A greater percentage of total weight loss was significantly associated with future (r= 0.221; p<0.05) and deviations from negative time profile (r= 0.324; p<0.05). Insufficient weight loss was associated with a fatalistic present (t= −2.16, p= 0.033) and deviations from a balanced time perspective (t= −2.81; p= 0.006). Regaining weight was significantly associated to deviations from a balanced time perspective (t= −2.09; p=0.045) and consumption of sweets (X2= 13.42; p= 0.009). Conclusions: Deviations from a balanced time perspective and consumption of sweets are associated with sub-optimal weight loss and regaining weight.

Propiedades psicométricas del PHQ-9 (Patient Health Questionnaire) en centros de atención primaria de Chile / Psychometric characteristics of the Patient Health Questionnaire (PHQ-9)

Background: Simple and brief questionnaires with adequate psychometric properties are useful for the early detection of depressive disorders. Aim: To analyze the psychometric behavior of the Patient Health Questionnaire (PHQ-9) in Chile. Material and Methods: Data were collected from 1,738 adult patients, consulting in primary health care centers. The values obtained in the PHQ-9 were compared with those of the Composite International Diagnostic Interview (CIDI). Results: The mean score of PHQ-9 was 4.85 ± 5.57. Internal consistency indices were high. McDonald's ω coefficient of was 0.90 and Cronbach alpha 0.89. A confirmatory factor analysis showed a good fit of the one-dimensional model. Using a cutoff score of seven determined with the receiver operating characteristic (ROC) curve, the sensitivity and specificity of the instrument were 0.8 and 0.7, when compared with CIDI diagnoses. Conclusions: PHQ-9 is a useful instrument for the screening of depressive disorders in primary health care centers in Chile.

Prevalencias y brechas hoy: salud mental mañana / Prevalence and gaps today: mental health tomorrow / Prevalências e lacunas hoje: saúde mental amanhã

La OMS coloca a Chile entre los países con mayor carga de morbilidad por enfermedades psiquiátricas (23,2%) en el mundo. La depresión mayor y los trastornos por consumo de alcohol ocupan el primer y segundo lugar en las discapacidades atribuidas entre adultos. Casi un tercio de la población mayor de 15 años ha sufrido un trastorno psiquiátrico en su lapso de vida y un 22,2% ha tenido uno durante el año pasado. Los trastornos de ansiedad son los más prevalentes, seguidos por depresión mayor y trastornos por consumo de alcohol. Solo el 38,5% de quienes han sido diagnosticados reciben algún tipo de servicio de salud mental, ya sea de un especialista o un médico de atención primaria. En niños y adolescentes, la prevalencia de cualquier trastorno psiquiátrico es de 22,5% (19,3% para niños y 25,8% para niñas). Estos trastornos son principalmente de ansiedad y disruptivos. La prevalencia es más alta entre niños de cuatro a once años de edad (27,8%) que entre aquellos de 12 a 18 años, y esta diferencia se debe principalmente a trastornos disruptivos. La prevalencia de trastornos de ansiedad es la segunda más alta, aunque menos asociada con discapacidades, mientras que muchos niños y adolescentes con trastornos afectivos están discapacitados y solo un quinto de las personas con necesidad de servicios buscan alguna forma de asistencia. Casi un cuarto de aquellos que usan los servicios no presentaron diagnóstico psiquiátrico durante el año pasado. La comorbilidad ocurre en el 27% de aquellas personas que presentan trastornos, pero solo el 7% tienen tres o más diagnósticos. No abordar la brecha de tratamiento en salud mental tiene serias implicaciones en la salud pública.

WHO places Chile among countries with greater morbidity burden for psychiatric diseases in the world (23,2%). Major depression and alcohol consumption disorders hold the first and second place in disabilities attributed to adults. Almost a third of the population older than 15 years have suffered a psychiatric disorder during life span and 22,2% persons have had one in the last year. Anxiety disorders have more prevalence, followed by major depression and alcohol consumption disorders. Only 38,5% of those diagnosed receive some type of mental health care, by an specialist or a primary health care physician. In children and adolescent, prevalence of any psychiatric disorder is 22,5% (19,3% for boys and 25,8% for girls). These disorders are mainly disruptive and of anxiety. Prevalence is higher for children between 4 to 11 years (27,8%) than between 12 and 18 years, and this difference is due mainly to disruptive disorders. Prevalence of anxiety disorders is the second highest, even though less associated with disabilities, while many children and adolescents with affective disorders are disabled and only a fifth of persons with health care needs look for some form of care. Almost a fourth of those that use health care services did not present psychiatric diagnosis during last year. Co morbidity occurs in 27% of those with disorders, but only 7% have three or more diagnosis. Not addressing treatment gap in mental health has serious implications in public health.

A OMS coloca o Chile entre os países com maior carga de morbidade por enfermidades psiquiátricas (23,2%) no mundo. A depressão maior e os transtornos por consumo de álcool ocupam o primeiro e segundo lugar nas descapacidades atribuidas entre adultos. Quase um terço da população maior de 15 anos tem sofrido um transtorno psiquiátrico em seu lapso de vida e cerca de 22,2% tiveram um durante o ano passado. Os transtornos de ansiedade são os mais prevalentes, seguidos por depressão maior e transtornos por consumo de álcool. Somente 38,5% daqueles que foram diagnosticados recebem algum tipo de serviço de saúde mental, seja de um especialista ou de um médico de atenção primária. Em crianças e adolescentes, a prevalência de qualquer transtorno psiquiátrico é de 22,5% (19,3% para meninos e 25,8% para meninas). Estes transtornos são principalmente de ansiedade e disruptivos. A prevalência é mais alta entre meninos de quatro a onze anos de idade (27,8%) do que entre aqueles de 12 a 18 anos, e esta diferença se deve principalmente a transtornos disruptivos. A prevalência de transtornos de ansiedade é a segunda mais alta, embora menos associada com descapacidades, enquanto muitos meninos e adolescentes com transtornos afetivos estão descapacitados e somente um quinto das pessoas com necessidade de serviços busca alguma forma de assistência. Quase um quarto daqueles que usam os serviços não apresentou diagnóstico psiquiátrico durante o ano passado. A comorbidade ocorre em 27% daquelas pessoas que apresentam transtornos, porém só 7% têm três ou mais diagnósticos. Não abordar a lacuna de tratamento em saúde mental tem sérias implicações para a saúde pública.

Inventario Concepción: desarrollo y validación de un instrumento de tamizaje de depresión para atención primaria / Concepción inventory: development of a screening instrument for depression in primary care in Chile

Background: Screening instruments are required for the detection of depressive disorders by primary care practitioners. Aim: To develop a screening instrument to detect depression, based on data gathered interviewing patients attending primary health care settings. Material and Methods: The instrument was constructed with data about factors associated or triggering a depressive disorder obtained from 3,000 patients consulting for general morbidity. All patients answered the Composite International Diagnostic Interview, (version 2.1, section depression) and an inventory containing 39 risk factors for depression, obtained from the literature. A multiple imputation method using chained equations was carried out. Using a binary logistic regression with backward selection, an equation for depression screening was obtained. The c-index was calculated to estimate discriminating power of the model. A shrinkage factor was estimated to adjust the predictive model. Results: Estimations were carried out with data from 2,552 patients with a median age of 47 years (73% women). Fifty five percent lived with a partner and 45% had basic studies. The method selected 14 significant predictors, with a shrinkage value of 0.861 and a c-index of 0.838 (95% confidence intervals 0.82-0.86). Conclusions: The instrument has adequate psychometric properties as a screening tool for depression in primary health care.

Asociación entre los polimorfismos 5HTTLPR, uMAOA y depresión en una cohorte de pacientes de atención primaria / Association between serotonin transporter and monoamine oxidase A gene polymorphisms and depression

Background: Serotonin plays a central role regulating mood and on the development of depressive disorders. Aim: To study whether 5HTTLPR functional polymorphisms in the serotonin transporter gene or the Monoamine oxidase A gene (uMAOA) were risk markers for depression. Material and Methods: The Composite International Diagnostic Interview (CIDI) was applied to 1,062 consultants in primary health care centers aged between 18 and 75 years to establish the diagnosis of depression. A sample of saliva was obtained for DNA extraction and genetic analyses. Results: No association between the presence of depressive disorders and 5HTTLPR (ss) or uMAOA (3/3) risk genotypes was found. Psychological abuse and the presence of two or more life events were found to be predictors of depression in the studied sample. Conclusions: In this study, 5HTTLPR and uMAOA polymorphisms were not risk factors for depression. However, psychological abuse and the presence of two or more life events were risk factors for depressive disorders.

Desarrollo y validación de un algoritmo para predecir riesgo de depresión en consultantes de atención primaria en Chile / Development of an algorithm to predict the incidence of major depression among primary care consultants

Background: The reduction of major depression incidence is a public health challenge. Aim: To develop an algorithm to estimate the risk of occurrence of major depression in patients attending primary health centers (PHC). Material and Methods: Prospective cohort study of a random sample of 2832 patients attending PHC centers in Concepción, Chile, with evaluations at baseline, six and twelve months. Thirty nine known risk factors for depression were measured to build a model, using a logistic regression. The algorithm was developed in 2,133 patients not depressed at baseline and compared with risk algorithms developed in a sample of 5,216 European primary care attenders. The main outcome was the incidence of major depression in the follow-up period. Results: The cumulative incidence of depression during the 12 months follow up in Chile was 12%. Eight variables were identified. Four corresponded to the patient (gender, age, depression background and educational level) and four to patients' current situation (physical and mental health, satisfaction with their situation at home and satisfaction with the relationship with their partner). The C-Index, used to assess the discriminating power of the final model, was 0.746 (95% confidence intervals (CI = 0,707-0,785), slightly lower than the equation obtained in European (0.790 95% CI = 0.767-0.813) and Spanish attenders (0.82; 95% CI = 0.79-0.84). Conclusions: Four of the factors identified in the risk algorithm are not modifiable. The other two factors are directly associated with the primary support network (family and partner). This risk algorithm for the incidence of major depression provides a tool that can guide efforts towards design, implementation and evaluation of effectiveness of interventions to prevent major depression.

Conducta suicida y trastornos psiquiátricos en Chile, un estudio poblacional / Suicidal behavior and psychiatric disorders in Chile. A population-based study

Background: Suicidal behavior ranges from ideation to consummation of suicide. In Chile, rates of suicide increased from 4.8 to 12.7/100,000 in the period 1992-2009. Aim: To evaluate the prevalence of suicidal behavior and its relationship with sociodemographic factors and psychiatric diseases. Material and Methods: The Composite International Diagnostic Interview (CIDI), was applied to a representative sample of 2,978 Chilean participants. The prevalence of four suicidal behaviors (thinking about or wishing death, suicide ideation and suicide attempts) and of psychiatric diseases according to the revised third version of the Diagnostic and Statistical Manual of Mental Disorders (DSM III-R), was calculated. Results: The lifetime prevalence of suicidal conception was 14.3% and the suicide attempt 7.7%, the latest associated with sex, age, school years, smoking habits, being married or having a relationship, depressive disorders, dysthymia, and alcohol, drug and tobacco dependence. Conclusions: Rates founded exceed international prevalence data and extrapolated to current rates of completed suicide, higher levels of suicidal behavior should be expected. Considering the associated disorders we can infer that it is essential a correct diagnosis and treatment of mood disorders and substance consumption to any other specific interventions.

Salud mental infanto-juvenil en Chile y brechas de atención sanitarias / Prevalence of psychiatric disorders among Chilean children and adolescents

Background: Psychiatric disorders that appear during childhood or adolescence should be a public health priority. Aim: To report the results of a national representative survey in the Latin American region examinig the prevalence of DSM-IV psychiatric disorders in children and adolescents. Material and Methods: Subjects aged 4 to 18 years were selected using a stratified multistage design. The Diagnostic Interview Schedule for Children Version IV (DISC-IV) was used to obtain 12-month DSM-IV diagnoses, and was supplemented with questionnaires examining family riskfactors, socioeconomic status and service use. Results: A sample of1558 children and adolescents (51% males) was evaluated. Fifty three percent of the sample were children aged 4 to 11 years and the rest were adolescents aged 12 to 18 years. The prevalence rate for any psychiatric disorder without impairment was 38.3% (33.5% for boys and 43.3% for girls). The prevalence rate was higher among children as compared to adolescents (42.9% and 33.2%, respectively). A third of participants receiving a diagnosis sought some form of assistance. Nearly a quarter of those using services, did not have a psychiatric diagnosis in the past year. Comorbidity was found in 27% of those with a disorder, but only 7% had three or more diagnoses. Conclusions: The prevalence of psychiatric disorders in Chile is high among children and adolescents. This study highlights the increasing need to re-evaluate mental health services provided to children and adolescents in our country.

Epidemiología de trastornos mentales infanto juveniles en la Provincia de Cautín / Prevalence of mental health disorders among children and adolescents living in southern Chile

Background: The knowledge about prevalence of psychiatric disorders in all age groups is fundamental to plan an adequate mental health care. Aim: To determine the prevalence of DSM-IV psychiatric disorders in a representative sample of children and adolescents living in the province of Cautin, Chile. Material and Methods: Subjects aged between 4 and 18 years were selected in an aleatory stratified multistage fashion. As part of a national sample, four counties in Cautín were selected, then blocks, homes and the child or adolescent to be interviewed. Psychology graduate students applied the Spanish computer version of DISC-IV, as well as a questionnaire on family risk factors, socioeconomic index and service use. Results: A sample of 272 children and adolescents was evaluated, obtaining 93,4 percent of participation. Using the most stringent impairment algorithm, the prevalence rate for any psychiatric disorder was 16.8 percent, being 16.5 percent in boys and 17.1 percent in girls and mainly explained by anxiety and affective disorders. Prevalence was practically the same in the group aged 4 to 11 years than in those aged 12 to 18 years (16.7 percent and 16.8 percent respectively). Prevalence of anxiety disorders was the highest, but less associated with impairment. On the other hand, all children and adolescents with affective disorders were impaired. Conclusions: The prevalence of psychiatric disorders in Cautín is high in children and adolescents.

Los trastornos mentales en América Latina y el Caribe: asunto prioritario para la salud pública / Mental disorders in Latin America and the Caribbean: a public health priority

OBJETIVO: La creciente carga de trastornos mentales que afecta a las poblaciones de América Latina y el Caribe es demasiado grande para hacer caso omiso de ella. Por lo tanto, es una necesidad impostergable conocer la prevalencia de los trastornos mentales y la brecha de tratamiento, que está dada por la diferencia entre las tasas de prevalencia verdadera y las de las personas que han sido tratadas, que en algunos casos es grande pese a la existencia de tratamientos eficaces. Si se dispone de mayor informacion, se hace más factible 1) abogar mejor por los intereses de las personas que necesitan atención, 2) adoptar políticas más eficaces, 3) formular programas de intervención innovadores y 4) adjudicar recursos en conformidad con las necesidades observadas. MÉTODOS: Los datos se obtuvieron de estudios comunitarios publicados en América Latina y el Caribe entre 1980 y 2004. En esas investigaciones epidemiológicas se usaron instrumentos diagnósticos estructurados y se estimaron tasas de prevalencia. Las tasas brutas de diversos trastornos psiquiátricos en América Latina y el Caribe se estimaron a partir de las tasas media y mediana extraídas de los estudios, desglosadas por sexo. También se extrajeron los datos correspondientes al uso de servicios de salud mental para poder calcular la brecha en el tratamiento según trastornos específicos. RESULTADOS: Las psicosis no afectivas (entre ellas la esquizofrenia) tuvieron una prevalencia media estimada durante el año precedente de 1,0 por ciento; la depresión mayor, de 4,9 por ciento; y el abuso o la dependencia del alcohol, de 5,7 por ciento. Más de la tercera parte de las personas afectadas por psicosis no afectivas, más de la mitad de las afectadas por trastornos de ansiedad, y cerca de tres cuartas partes de las que abusaban o dependían del alcohol no habían recibido tratamiento psiquiátrico alguno, sea en un servicio especializado o en uno de tipo general. CONCLUSIONES: La actual brecha en el tratamiento de los trastornos mentales en América Latina y el Caribe sigue siendo abrumadora. Además, las tasas actuales probablemente subestiman el número de personas sin atención. La transición epidemiológica y los cambios en la composición poblacional acentuarán aun más la brecha en la atención en América Latina y el Caribe, a no ser que se formulen nuevas políticas de salud mental o que se actualicen las existentes, procurando incluir en ellas la extensión de los programas y servicios.

Las enfermedades mentales en el ámbito de la medicina científica y popular, desde la perspectiva de los pehuenches del Alto Bío-Bío / The mental diseases in the scientific and popular medicine from perspective of the pehuenches from Alto Bío-Bío

Se presentan los resultados más relevantes de un estudio antropológico orientado a conocer la percepción que tienen los pehuenches de la medicina científica y popular en el ámbito de la salud mental. Se utilizó una muestra de 58 familias de las comunidades de Callaqui y Quepuca Ralco del Alto Bío Bío, VIII Región, Chile. Un cuestionario de 33 preguntas fue aplicado a los sujetos seleccionados, además de recoger datos sociodemográficos relevantes. Como resultados destaca el que estas comunidades reconocen el quehacer médico oficial aunque ignoran sus conceptos y clasificaciones. Para el tratamiento recurren tanto a los agentes de la medicina científica como popular, minoritariamente a la machi o a agentes tradicionales. Hay un claro conocimiento de enfermedades populares y sus métodos de resolución. Finalmente se concluye que en el área de la salud mental existe una enorme brecha entre las comunidades pehuenches y el resto de la sociedad chilena lo que debe ser considerado en el diseño de políticas y en la ejecución de acciones de atención de la salud de los indígenas de nuestro país

Salud mental y trabajo del conductor de movilización colectiva / Mental health and work of the urban bus drivers

Se investiga la prevalencia de algunos síntomas de enfermedades psiquiátricas en conductores de locomoción colectiva interurbana y los agentes de riesgo laboral asociados. Se aplicaron un cuestionario sobre agentes de riesgo y el SRQ

Validación en Chile del instrumento de screening y diagnóstico epidemiológico DISSI / Validity in Chile of the screening and epidemiologic diagnosis instrument DISSI

Se presentan los resultados de la traducción, adaptación y validación para Chile del instrumento de screening DISSI (Diagnostic Interview Schedule Screening Interview). Además de hacer diagnóstico psiquiátrico estandarizado, puede ser utilizado en el diagnóstico epidemiológico con un considerable menor costo debido a sus especiales características. El instrumento se aplicó por entrevistadores legos a una muestra de 74 pacientes y sujetos sanos previamente diagnosticados por psiquiatra de acuerdo con el Cheklist del DSM-III-R. Los resultados, en especial la proporción de falsos positivos de la mayoría de las secciones estudiadas y del instrumento completo, lo hacen aparecer como una alternativa válida para el diagnóstico psiquiátrico en los niveles no especializados de salud

A propósito de la normalidad crónica / Apropose of chronic normality

Se intenta cuestionar nuestro habitual problema para entender la cronicidad de muchos estados mentales. postulándose que parte del problema surge de no dimensionar adecuadamente la producción sociohistórica de nuestra normalidad, la que es más aceptable que correcta, y a su vez cronificada por el miedo al caos que seguiría a un cambio, o simple cuestionamiento profundo, en nuestra manera de ver las cosas. Quizás el psicótico tenga un problema parecido, pero agravado por su rechazo a aceptar su lugar en nuestro mundo