Recommendations of the Colombian Consensus Committee for the Management of Traumatic Brain Injury in Prehospital, Emergency Department, Surgery, and Intensive Care (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol [BOOTStraP]).

Background Traumatic brain injury (TBI) is a global public health problem. In Colombia, it is estimated that 70% of deaths from violence and 90% of deaths from road traffic accidents are TBI related. In the year 2014, the Ministry of Health of Colombia funded the development of a clinical practice guideline (CPG) for the diagnosis and treatment of adult patients with severe TBI. A critical barrier to the widespread implementation was identified-that is, the lack of a specific protocol that spans various levels of resources and complexity across the four treatment phases. The objective of this article is to present the process and recommendations for the management of patients with TBI in various resource environments, across the treatment phases of prehospital care, emergency department (ED), surgery, and intensive care unit. Methods Using the Delphi methodology, a consensus of 20 experts in emergency medicine, neurosurgery, prehospital care, and intensive care nationwide developed recommendations based on 13 questions for the management of patients with TBI in Colombia. Discussion It is estimated that 80% of the global population live in developing economies where access to resources required for optimum treatment is limited. There is limitation for applications of CPGs recommendations in areas where there is low availability or absence of resources for integral care. Development of mixed methods consensus, including evidence review and expertise points of good clinical practices can fill gaps in application of CPGs. BOOTStraP (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol) is intended to be a practical handbook for care providers to use to treat TBI patients with whatever resources are available. Results Stratification of recommendations for interventions according to the availability of the resources on different stages of integral care is a proposed method for filling gaps in actual evidence, to organize a better strategy for interventions in different real-life scenarios. We develop 10 algorithms of management for building TBI protocols based on expert consensus to articulate treatment options in prehospital care, EDs, neurological surgery, and intensive care, independent of the level of availability of resources for care.

Restricted feeding modulates the daily variations of liver glutamate dehydrogenase activity, expression, and histological location.

Glutamate dehydrogenase is an important enzyme in the hepatic regulation of nitrogen and energy metabolism. It catalyzes one of the most relevant anaplerotic reactions. Although its relevance in liver homeostasis has been widely described, its daily pattern and responsiveness to restricted feeding protocols has not been studied. We explored the daily variations of liver glutamate dehydrogenase transcription, protein, activity, and histochemical and subcellular location in a protocol of daytime food synchronization in rats. Restricted feeding involved food access for 2 h each day for three weeks. Control groups included food ad libitum as well as acute fasting (21 h fasting) and refeeding (22 h fasting followed by 2 h of food access). Glutamate dehydrogenase mRNA, protein, activity, and histological location were measured every 3 h by qPCR, Western blot, spectrophotometry, and immunohistochemistry, respectively, to generate 24-h profiles. Restricted feeding promoted higher levels of mitochondrial glutamate dehydrogenase protein and activity, as well as a loss of 24-h rhythmicity, in comparison to ad libitum conditions. The rhythmicity of glutamate dehydrogenase activity detected in serum was changed. The data demonstrated that daytime restricted feeding enhanced glutamate dehydrogenase protein and activity levels in liver mitochondria, changed the rhythmicity of its mRNA and serum activity, but without effect in its expression in hepatocytes surrounding central and portal veins. These results could be related to the adaptation in nitrogen and energy metabolism that occurs in the liver during restricted feeding and the concomitant expression of the food entrainable oscillator. Impact statement For the first time, we are reporting the changes in daily rhythmicity of glutamate dehydrogenase (GDH) mRNA, protein and activity that occur in the liver during the expression of the food entrained oscillator (FEO). These results are part of the metabolic adaptations that modulate the hepatic timing system when the protocol of daytime restricted feeding is applied. As highlight, it was demonstrated higher GDH protein and activity in the mitochondrial fraction. These results contribute to a better understanding of the influence of the FEO in the energy and nitrogen handling in the liver. They could also be significant in the pathophysiology of hepatic diseases related with circadian abnormalities.

Perceived versus Observed Patient Safety Measures in a Critical Care Unit from a Teaching Hospital in Southern Colombia.

Introduction. Patient safety is an important topic. The purpose of this study is to evaluate the perceived versus observed patient safety measures (PSM) in critically ill patients in a teaching hospital in Latin America. Materials and Methods. The level of perceived patient safety was evaluated with the patient safety hospital survey. Three months later, a qualitative study was conducted, including video recording of procedures, graded according to adherence to PSM. Levels of adherence were scored during patient mobilization (PM), placement of central catheters (PCC), other invasive procedures (OIP), infection control (IC), and endotracheal intubation (ETI). Results. The perceived adherence of PSM in the prestudy survey was considered fair by 89.1% of the ICU staff. After the survey, 829 ICU procedures were video-recorded. Mean observed adherence for fair patient safety measures was 20.8%. Perceived adherence was higher than the real patient safety protocol measures observed in the videos. Conclusion. Perception of PSM was higher than observed in the management of critically ill patients in a teaching hospital in southern Colombia.

[Patterns of violent death in Bogotá, 1997-2003]. / Comportamiento de las muertes violentas en Bogotá, 1997-2003.

OBJECTIVE: To describe patterns of violent deaths in Bogotá between 1997 and 2003. DESIGN: Descriptive methods for analyzing time series were applied to a group of 84 observations corresponding to mortality due to violent causes during seven years in Bogotá. Box-Jenkins methodology was used to generate forecasts for 12 months. Primary and secondary sources of information: Instituto de Medicina Legal Bogotá, Departamento Administrativo Nacional de Estadística, Colombia. RESULTS: For the 4 types of violent deaths analyzed (homicide, transit accident, suicide and others accidents), a decreasing tendency in the number of deaths during the analyzed period was observed, more evident in homicide and transit accidents. In all cases, except in the group of suicides, evidence of seasonality, with an increase in frequency of deaths in December, has been observed. The forecasting suggests persistence of decreasing trends, more apparent in the series of homicide and transit accidents. CONCLUSIONS: In Bogotá, the mortality caused by violence has presented a decreasing trend. Stabilization of trend is observed in cases of suicides and accidental deaths. Further study is required to characterize and evaluate the contribution of different factors in this dynamic of violent death.

Methodology to develop endemic channels and notification trends for dengue in Valle del Cauca, Colombia, 2009-2013.

INTRODUCTION: Dengue is the fastest spreading disease in the world and a permanent threat to global public health. It is a viral illness for which approximately 2.5 million people are at high risk of infection. Given the severity of the disease at national and global levels, new predictive methodologies need to be generated to facilitate decision-making in public health.  OBJECTIVE: To characterize cases of dengue reported from 2009 to 2013 in Valle del Cauca department, Colombia, and to establish a methodology to develop endemic channels that can be applied to this event.  MATERIALS AND METHODS: This was a retrospective descriptive study. Notification forms were used as a secondary database to characterize dengue cases from 2009 to 2013. Two endemic channels were developed, one using running means and the other through exponential smoothing.  RESULTS: Dengue in the department of Valle del Cauca showed a positive tendency, indicating that the number of cases had increased in the last five years. An important variation was observed that could be explained by a three-year cycle beginning in the first epidemiological period of the year.  CONCLUSION: The development of the dengue endemic channel for Valle del Cauca illustrates the importance of applying these monitoring methodologies to events of public health interest. As can be seen from the results, there were some years in which the number of cases was very low and others in which the epidemic reached very high levels.

[Prevalence and factors associated with suicidal thinking among university students]. / Prevalencia y factores asociados a ideación suicida en estudiantes universitarios.

OBJECTIVES: To quantify the prevalence of suicidal ideation in a population of university students, to characterize groups in connection with ideation and suicidal behavior, and to determine the variables associated with suicidal ideation and suicide attempts. METHODS: Observational, analytic and cross-sectional study of a probabilistic sample of the population studied. An instrument for measuring suicide risk and associated variables was applied to this sample. RESULTS: The prevalence of the current suicidal ideation was 3.6%, and 18% in the last year. Both suicidal ideation and history of suicide attempts were higher among female students. Rape history, being alone more than eight hours a day, and female gender were the factors more strongly related to suicidal ideation. A relationship suicidal ideation and awareness of the suicide of others was not found in this sample. CONCLUSION: A history of rape, remaining alone for more than eight hours during the day, and being a woman should alert the clinician about the possibility of suicidal ideation. It is recommended to explore and assess suicidal ideation in all people with these factors.

The Global Mental Health Assessment Tool Primary Care and General Health Setting Version (GMHAT/PC) - Spanish version: A validity and feasibility study

Background and Objectives: The study aims to assess the feasibility and the level of agreement between the Spanish version GMHAT/PC diagnosis and psychiatrists’ ICD-10 based clinical diagnosis. Methods: Participants in the study ranged from those who were in remission to others who had different mental illnesses. They were recruited from inpatient and outpatient mental health settings. All consecutive patients were interviewed using Spanish version of GMHAT/PC and they were assessed independently by psychiatrists to in order to get their ICD-10 based diagnosis. Results: Two hundred ninety-nine patients participated in the study. The mean duration of interview was 12.5 minutes. There is an acceptable to good level of agreement between the GP’s (GMHAT/PC) diagnoses and the psychiatrists’ (clinical) diagnoses of any mental illness, Kappa 0.58 95% C.I (0.46, 0.72). There is good level of sensitivity (81%) and specificity (92%), with GPs correctly identifying 242 out of the 250 participants diagnosed with mental illness and 27 out of 35 of those without. Conclusions: The finding of the study suggest that GMHAT/PC Spanish version used by GPs detected mental disorders accurately and it was feasible to use GMHAT/PC (Spanish version) in Latin America settings (AU)

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Metodología para la elaboración de canales endémicos y tendencia de la notificación del dengue, Valle del Cauca, Colombia, 2009-2013 / Methodology to develop endemic channels and notification trends for dengue in Valle del Cauca, Colombia, 2009-2013

Introducción. El dengue es la enfermedad de más rápida propagación en el mundo y una permanente amenaza para la salud pública mundial, con aproximadamente 2,5 millones de personas en alto riesgo de infección. Ante la gravedad del cuadro de la enfermedad a nivel nacional y mundial, es necesario generar nuevas metodologías de predicción útiles para la adopción de decisiones en salud pública. Objetivo. Caracterizar los casos notificados de dengue entre el 2009 y el 2013 en el departamento del Valle del Cauca y presentar la metodología para elaborar canales endémicos en el caso del dengue. Materiales y métodos. Se hizo un estudio descriptivo retrospectivo, utilizando la base de datos secundaria de las fichas de notificación, y se caracterizaron los casos de dengue entre el 2009 y el 2013. Se elaboraron dos canales endémicos, uno mediante promedios móviles y el otro con suavización exponencial. Resultados. Se evidenció que la tendencia del dengue en el departamento del Valle del Cauca es positiva, lo que indica que en los últimos cinco años se ha incrementado el número de casos, aunque se observa una variación importante que podría explicarse por el ciclo de tres años que se inicia a partir del primer periodo epidemiológico del año. Conclusión. La elaboración del canal endémico del dengue en el Valle del Cauca evidenció la importancia de aplicar estas metodologías de vigilancia en las situaciones de interés en salud pública. Como se observó en los resultados, hubo años en los que el número de casos fue muy bajo y otros en los que la epidemia alcanzó cifras muy elevadas.

Introduction: Dengue is the fastest spreading disease in the world and a permanent threat to global public health. It is a viral illness for which approximately 2.5 million people are at high risk of infection. Given the severity of the disease at national and global levels, new predictive methodologies need to be generated to facilitate decision-making in public health. Objective: To characterize cases of dengue reported from 2009 to 2013 in Valle del Cauca department, Colombia, and to establish a methodology to develop endemic channels that can be applied to this event. Materials and methods: This was a retrospective descriptive study. Notification forms were used as a secondary database to characterize dengue cases from 2009 to 2013. Two endemic channels were developed, one using running means and the other through exponential smoothing. Results: Dengue in the department of Valle del Cauca showed a positive tendency, indicating that the number of cases had increased in the last five years. An important variation was observed that could be explained by a three-year cycle beginning in the first epidemiological period of the year. Conclusion: The development of the dengue endemic channel for Valle del Cauca illustrates the importance of applying these monitoring methodologies to events of public health interest. As can be seen from the results, there were some years in which the number of cases was very low and others in which the epidemic reached very high levels.

Revisión crítica sobre los instrumentos para la evaluación psiquiátrica en atención primaria / Critical revision of Mental health Assessment Tools in Primary Care

Antecedentes. Actualmente existen múltiples escalas y guías de entrevista en atención primaria en salud mental. Sin embargo, estas tienen limitaciones en la práctica clínica diaria. Muchas fueron creadas para realizar investigación, otras requieren gran entrenamiento de quien las aplica y en su gran mayoría cubren un rango limitado de síntomas, por ejemplo ansiedad y depresión. Escalas de gran uso clínico para síntomas ansiosos y depresivos permiten evaluar la presencia o ausencia de síntomas más que dar un diagnóstico específico y deja por fuera un espectro amplio de trastornos psiquiátricos como la demencia y la psicosis. Por estas razones, se han propuesto múltiples alternativas que permitan superar los problemas mencionados. Objetivo. Revisar de forma crítica los instrumentos utilizados para la evaluación psiquiátrica en atención primaria. Materiales y métodos. Revisión de la literatura. Resultados. Dentro de las herramientas desarrolladas y más utilizadas se encuentran la Primary Care Evaluation of Mental Disorders (PRIME-MD) y el Patient Health Questionnaire (PHQ). Otra estrategia es la Herramienta Mundial de Evaluación en Salud Mental (GMHAT). Esta herramienta permite hacer tamizajes amplios y diagnósticos de problemas mentales por personas con poco entrenamiento en psiquiatría y en poco tiempo. Conclusiones. Se recomiendan los instrumentos breves que realizan una valoración global del estado mental sobre aquellos que son específicos para un solo trastorno.

Background. There are many instruments to use in primary care in Mental Health. However, the overall limitations found are that some instruments were developed specifically for research purposes and scales cover a limited range of symptoms and mental disorders like anxiety and depression. Scales used in clinical settings for anxiety and depressive symptoms usually assess the presence or absence of symptoms rather than give a specific diagnosis and leaves out a broad spectrum of psychiatric disorders such as dementia and psychosis. For this reasons, multiple alternatives to overcome these problems have been proposed worldwide. Objective. To review in a critical way the instruments used in primary care. Materials and methods. Literatury review. Results. Among the tools developed and used are the Primary Care Evaluation of Mental Disorders (PRIME-MD) and the Patient Health Questionnaire (PHQ). Another instrument is the Global Mental Health Assessment Tool (GMHAT). This tool allows broad screening and diagnosis of mental health problems for people with little training in psychiatry and in a short time. Conclusion. Short Instruments that perform an overall assessment of the mental state are preferred over those that are specific to a single disorder.

Prevalencia y factores demográficos y laborales asociados al burnout de psiquiatras en Colombia / Prevalence and both Demographic and Work Factors Associated with Burnout of Psychiatrists in Colombia

La presencia de burnout puede afectar el bienestar de los médicos y la calidad del cuidado que brindan. El propósito de este estudio fue medir la prevalencia de burnout en los psiquiatras en Colombia, y determinar si su presencia está asociada con condiciones demográficas y otras variables laborales. Se realizó un estudio descriptivo transversal, encontrando que 9.9 % de los participantes presentaban altos niveles de burnout. La edad, el trabajo como empleado y la dedicación exclusiva al área clínica fueron los principales factores asociados a la presencia del síndrome en esta población. Debe destacarse el uso por primera vez en Colombia del instrumento del CESQT, el cual mostró propiedades psicométricas adecuadas, lo que indica que puede usarse para evaluar el síndrome de burnout.

Burnout can affect not only wellbeing of medical professionals but also the quality of care they can provide to their patients. Aims of the study were to assess prevalence of burnout in Colombian psychiatrist and determine the associations of experiencing burnout with other demographic and working conditions. Transversal descriptive study showed that 9.9% of the participants were experiencing high levels of burnout. Age, being employed and working exclusively with patients were the principal predictors of burnout in this population. This study showed the good psychometric properties of the CEQST that invite to use it to assess the syndrome in this country.

Percepción y experiencias frente a la hiperplasia epitelial focal en una comunidad indígena huitoto/ticuna del amazonas colombiano / Knowledge, attitude, and practices about focal epithelial hyperplasia in the Huitoto/Ticuna native community of Colombian Amazon

Antecedentes. La hiperplasia epitelial focal, es una enfermedad frecuente en ciertas comunidades indígenas, es producida por un tipo de virus, en la que además parecen participar algunos otros factores socio-demográficos en su desarrollo y presentación. Objetivo. Explorar los conocimientos, actitudes y prácticas de una comunidad indígena Huitoto Ticuna del Amazonas sobre la hiperplasia epitelial focal. Material y métodos. De acuerdo a la presentación de los casos por familia, se diseñó una guía de entrevista considerando: percepción del problema, experiencias previas, impacto y manejo de las lesiones. Se escogieron 10 viviendas con casos positivos realizando entrevistas semiestruc¬turadas y un análisis por subtópicos y por dominios, se aplicó metodología cualitativa para la obtención de la información, dentro de un estudio descriptivo. Resultados. Participaron tres hombres y nueve mujeres; 11 pertenecían a la etnia Ticuna y una a la etnia Yagua. Los entrevistados se encontraron entre 17 y 46 años. Sólo dos casos se reportaron en niñas, el resto fueron reportados en niños, cuyas edades oscilaban entre los dos y ocho años. La lesión es conocida por la comunidad, pero para ellos no constituye un problema importante, ya que aparte de la implicación estética, no ocasiona sintomatología que interfiera de forma importante con su vida cotidiana. Consideran que la enfermedad se produce por contacto con elementos contaminados, niegan la posibilidad de contagio persona a persona. Para el tratamiento utilizan sustancias, como sal y ceniza, raspan las lesiones considerando que al salir la sangre, sale la enfermedad y además aplican tópicamente sustancias referidas por ellos como resinas vegetales. Conclusiones. Como mecanismo etiológico principal refieren el contagio por medio de vectores, buscan eliminar la enfermedad por el aspecto estético; conocen métodos naturales para el tratamiento de estas lesiones, estos se caracterizan por utilizar los elementos de plantas y animales. Teniendo en cuenta la etiología viral, las campañas psicoeducativas deberán dirigirse a controlar factores de riesgo en el contagio no sólo por control de vectores, sino también persona a persona.

Aproximación narrativa a las intervenciones en salud para mujeres y niñas supervivientes de violencia sexual en la Red Suroccidental de Bogotá, 2003-2004 / Narrative Approaches to Health Interventions of Women and Girl Survivors of Sexual Assault in Bogotá’s “Souhwestern Network”, 2003-2004

Introducción: Esta investigación buscó dar cuenta de las características de la atención en salud a las víctimas de violencia sexual en la Red Suroccidental de Bogotá desde la perspectiva de los protagonistas, develando sus narrativas, la atención recibida y las recomendaciones para mejorar tales servicios. Métodos: Investigación social de segundo orden, con análisis narrativo y paradigmático de entrevistas en profundidad y equipos refl exivos. La muestra fue estructural y no probabilística, de 11 personas (4 pacientes, 4 terapeutas, 2 referentes de salud mental comunitaria y 1 familiar de la víctima) pertenecientes a los servicios de atención en salud de Fontibón, Bosa, Kennedy y Puente Aranda, en Bogotá. Resultados: Los lineamientos de política distrital en el tema y la calidad humana de los trabajadores de la salud involucrados son las principales fortalezas. Como aspectos negativos, la defi ciente cobertura de atención en salud mental, barreras de acceso, abandono del tratamiento, cobro por la prestación de servicios, poca intervención de redes sociales, defi ciente captación temprana del caso. Conclusiones: La riqueza conceptual sobre el tema exhibida por los entrevistados debería aprovecharse en planeación participativa de políticas y servicios sanitarios. Debe prevalecer el carácter urgente e integral de estas intervenciones sobre cualquier barrera administrativa entre la usuaria y el restablecimiento de sus derechos en salud.

Introduction: The purpose of this study is to describe the characteristics of health care offered to victims of sexual violence in the Southwestern of Bogotá, Colombia. The characterization is made from the perspective of those directly involved, based on their description of their individual experiences, the quality of the services received and their recommendations for the improvement of these services. Method: We employed narrative and paradigmatic analysis of interviews and group meetings. Sampling was structural and not probabilistic. It included 11 subjects (4 patients, 4therapists, 2 community mental health providers and 1 victim’s family member) from health care institutions in the district of Fontibón, Bosa, Kennedy and Puente Aranda, in Bogotá. Results: Our analysis suggests two positive aspects: the presence of a government-based citywide policy on this subject and the humane qualities of the healthcare workers involved. Negative aspects include the lack of mental health coverage, access barriers, discontinuity of treatment, lack of intervention by social networks and defi cient early detection of cases. Conclusions: The individuals exhibited a degree of conceptual richness in the topic of sexual violence that could be used in the process of planning policies and services in this area. Interventions in sexual violence should be considered urgent and administrative barriers between victims and interventions should be overcome.

Inimputabilida yy riesgo de violencia / Insanity and the Risk of Violence

En este artículo se presenta un reporte de caso de inimputabilidad en relación con el delito de lesiones personales. El paciente se encuentra interno bajo medida de seguridad en una clínica privada. En este caso, la estimación del riesgo de violencia ha permitido que el individuo se integre progresivamente al medio social. A partir del caso, se analiza cuán difícil es evaluar el riesgo de violencia, sobre todo cuando dicha acción, en algunos casos, no sólo está en manos de los psiquiatras forenses, sino en los psiquiatras generales. La bibliografía existente, en su mayoría, procede del ámbito legal, donde aplica a pacientes que han cometido un delito; de ahí la necesidad de definir el riesgo de que el evento violento se vuelva a presentar.

This paper presents a case report of insanity defense in relation to the crime of personal injuries. The patient is interned under safety measures in a private clinic. Estimation of the risk of violence in this case, has allowed the individual to integrate progressively with the social milieu. The evaluation of the risk of violence is a difficult task that is not exclusive of forensic psychiatrists, since on occasions it must also be done by general psychiatrists. The majority of the existing literature comes from the legal arena, where it applies to patients who have previously committed a crime and is necessary to define the risk of the violent event presenting again.

Comportamiento de las muertes violentas en Bogotá, 1997-2003 / Patterns of violent death in Bogotá 1997-2003

OBJETIVO: Describir los patrones que muestran las muertes violentas en Bogotá durante 1997 a 2003 DISEÑO: Se aplicaron técnicas de análisis de series de tiempo a 84 observaciones correspondientes a casos de mortalidad por causas violentas durante 7 años en Bogotá. Se efectuó modelamiento con la metodología de Box-Jenkins y se generó un pronóstico de la serie a 12 meses para prever su tendencia. Fuentes de información primaria y secundaria: Instituto de Medicina Legal de Bogotá y Departamento Administrativo Nacional de Estadística de Colombia RESULTADOS: Para cuatro tipos de muerte violenta analizados (homicidio, accidente de tránsito, suicidio y accidental diferente de accidente de tránsito), se observó una tendencia en la reducción del número de muertes durante el período analizado, más marcada en los casos de homicidio y accidente de tránsito. En todos los casos, excepto en los de suicidio, se evidenció un patrón estacional, con incremento de frecuencia de muertes en diciembre. Los pronósticos señalan un sostenimiento de las tendencias decrecientes de las series, más marcado en el caso de homicidios y accidentes de tránsito, que en el de suicidios y otras muertes accidentales. CONCLUSIONES: En Bogotá, la mortalidad por causas violentas ha presentado una tendencia a la disminución. En el caso de suicidios y muertes accidentales diferentes de accidente de tránsito la frecuencia de muertes tiende a estabilizarse. Se plantea la realización de estudios que evalúen el papel de diferentes factores sobre esta dinámica de las muertes violentas.

Prevalencia y factores asociados a ideación suicida en estudiantes universitarios / Prevalence and factors associated with suicidal ideation among university students

Objetivos: Cuantificar la prevalencia de ideación suicida en una población de estudiantes universitarios, caracterizar grupos en relación con la ideación y las conductas suicidas y determinar las variables que se asocian con ideación suicida e intentos de suicidio. Metodología: Estudio observacional, analítico y transversal en el cual se seleccionó una muestra probabilística de la población de estudio, a la cual se aplicó un instrumento para la medición del riesgo de suicidio y de las variables asociadas. Resultados: La prevalencia de ideación suicida actual fue 3.6/100 y 18/100 en el último año. Tanto la ideación como el antecedente de intento de suicidio fueron más frecuentes en estudiantes de género femenino. El antecedente de violación, permanecer mas de ocho horas diarias solo y el género femenino, fueron los factores mas fuertemente relacionados con la ideación suicida. En esta población no se observó relación entre ideación suicida y exposición al suicidio de otros. Conclusión: La presencia de antecedente de violación, permanecer mas de ocho horas al día solo y pertenecer al género femenino, debe alertar al clínico sobre la posibilidad de ideación suicida, siendo recomendables la exploración y evaluación de la misma en los sujetos que presenten estos factores.