Utility and health-related quality of life measures in adult Colombian patients with solid tumours.

According to a 2020 report, the World Health Organization explained how, in 20 years, the prevalence of cancer cases will increase by 60% worldwide. In lower-middle-income countries, this figure will be 74.07%. Therefore, the authors propose a series of recommendations, such as how to address both traditional health indicators and the psychosocial environment, to improve the health system. The objective of this study is to demonstrate the impact of cancer on the quality of life (QoL) and health status of oncology patients in Colombia. An observational cross-sectional study using patient reported outcomes tools, such as European Organization for Research and Treatment of Cancer (EORTC) Quality of Life of Cancer Patients (QLQ-C30) and EuroQoL-5 dimensions questionnaire-3 levels (EQ5D-3L), was carried out. The information of 356 people was compiled. They were contacted by patient associations. The results were analysed using descriptive and inferential statistics, using ordinary least squares methodology. For the EORTC QLQ-C30, overall health status was 66.05 (95% confidence interval: 63.78-68.32), on the functional scales, emotional and social function were the two scales with the lowest ratings (71.57 and 71.77), without any representative differences. For the EQ5D-3L, the average utility was 0.70 (Standard deviation: 0.20); 50% of people had a utility between 0.63 and 0.82. The analysed population was most affected in the following areas: financial difficulties, insomnia, anxiety, depression and emotional functioning, establishing the need for future interventions and the creation of public policies that generate a better QoL for patients.

MMSE items that predict incident delirium and hypoactive subtype in older medical inpatients.

Because hypoactive delirium is especially under-recognized, we analyzed which Mini-Mental State Examination (MMSE) items predicted incident delirium and its hypoactive motor presentation. Over a 1-year period, older medical inpatients (n=291) were consecutively screened on admission with the Confusion Assessment Method-Spanish (CAM-S) to exclude prevalent delirium. Nondelirious patients were evaluated the same day with the MMSE, followed by daily ratings with the CAM-S. Those who became CAM-S positive were rated using the Delirium Rating Scale-Revised-98 to assess severity and motor subtype. Disorientation to time (OR 4.4, 95% CI 1.7-11.1) and place (OR 3.8, 95% CI 1.7-8.2) at admission were risk factors for delirium at follow-up and together correctly classified 88.3% of subjects as to delirium status. Disorientation to time and place, and visuoconstructional impairment were each associated with either hypoactive or mixed subtype (p<0.05 χ(2) test). Simple bedside evaluation of cognitive function in nondelirious patients revealed deficits that detected patients at risk for developing incident delirium at follow-up (especially hypoactive or mixed). We recommend patients with orientation deficits be monitored closely for emergence of delirium. A separate evaluation for possible dementia or other causes of cognitive impairment at admission should be considered too.

[Clinical Characteristics of 276 Patients Treated with Electroconvulsive Therapy at a University Clinic in Medellín, Colombia]. / Características clínicas de 276 pacientes tratados con terapia electroconvulsiva en una clínica universitaria de Medellín, Colombia.

OBJECTIVE: To describe the socio-demographic and clinical characteristics of patients undergoing Electroconvulsive Therapy with Anesthesia and Relaxation (ECTAR) for 10 years in a university clinic. METHODOLOGY: Review of 276 medical records of patients who had undergone ECTAR between 1997 and 2007 at the Clínica Universitaria Bolivariana de Medellín, Colombia. Data was collected through an instrument designed for that purpose and then was analyzed. RESULTS: During 10 years, more than 2000 ECT procedures were performed; most of the patients were female 67.4%, between 15 and 86 years old. The first indication was a major depressive episode without psychotic symptoms (56.5%) almost half of the patients had a minor and temporary complication, and no major complications or deaths were reported. Pre-oxygenation, intravenous anesthesia and muscular relaxation were used in all procedures. CONCLUSIONS: The ECT used in a third-level hospital with participation of a trained, interdisciplinary team (psychiatrist, anesthesiologist, nursing assistants) and the use of the modified technique (oxygenation, monitoring, general anesthesia, and relaxation is safe for certain psychiatric pathologies disorders that have not responded to medication or when medication is counter-indicated.

Sensibilidad en el Reconocimiento de Emociones Faciales Como Endofenotipo de Esquizofrenia / Sensitivity in the Recognition of Facial Emotions as an Endophenotype for Schizophrenia / Sensibilidade no Reconhecimento de Emoções Faciais Como Endofenótipo de Esquizofrenia

Los endofenotipos son rasgos presentes antes de la aparición de un trastorno y podrían ser útiles para identificar genes de susceptibilidad. Se determinó si personas con esquizofrenia y sus familiares de primer grado no afectados tenían un desempeño menor que los controles en la Tarea de Multitransformación de Expresión Emocional, que mide reconocimiento de emociones faciales. Las personas con esquizofrenia y sus familiares mostraron menor sensibilidad o requirieron más intensidad para identificar emociones que los controles. La exactitud para identificar emociones fue similar entre familiares y controles, pero menor en aquellos con esquizofrenia. Esto sugiere que la sensibilidad para el reconocimiento de emociones faciales es un endofenotipo de la esquizofrenia.

Endophentoypes are the traits present before the appearance of a disorder and could be useful to identify susceptibility genes. The purpose of this study was to determine whether persons suffering from schizophrenia and their immediate relatives performed less well than controls in the Emotional Expression Multi-transformation Task, which measures recognition of facial expressions. Persons with schizophrenia and their relatives showed less sensitivity than controls or required greater intensity to identify emotions than controls did. Accuracy in the identification of emotions was similar in relatives and controls, but lower in individuals with schizophrenia. This suggests that sensitivity in the recognition of facial emotions is an endophenotype for schizophrenia.

Os endofenótipos são traços presentes antes do surgimento de um transtorno e poderiam ser úteis para identificar genes de suscetibilidade. Determinou-se se pessoas com esquizofrenia e seus familiares de primeiro grau não afetados tinham um desempenho menor que os controles na Tarefa de Multitransformação de Expressão Emocional, que mede reconhecimento de emoções faciais. As pessoas com esquizofrenia e seus familiares mostraram menor sensibilidade ou requereram mais intensidade para identificar emoções que os controles. A exatidão para identificar emoções foi similar entre familiares e controles, mas menor naqueles com esquizofrenia. Isso sugere que a sensibilidade para o reconhecimento de emoções faciais é um endofenótipo da esquizofrenia.

Validación del “inventario de razones para vivir” (RFL) en sujetos con conducta suicida de Colombia / Validation of the Reasons for Living Inventory (Rfl) in subjects with suicidal behavior in Colombia

Objetivo: Evaluar la estructura factorial, la confiabilidad y la validez de contenido y constructo de una versión en español para Colombia del Inventario de Razones para Vivir (Rfl) en una muestra clínica de sujetos con intento de suicidio. Método: Se hicieron dos traducciones al español y dos traducciones en sentido inverso de cada uno de los ítems. Se examinó la validez del contenido y del constructo, la consistencia interna y la reproducibilidad prueba-reprueba. Resultados: La estructura factorial tiene seis dominios que explican el 63,5% de la varianza: “Creencia en la vida y capacidad de afrontamiento”, “Miedo a la muerte y a la desaprobación social”, “Responsabilidad con la familia”, “Preocupación por los hijos”, “Percepción de incapacidad para el suicidio” y “Objeciones morales”. La consistencia interna fue alta (Alfa de Cronbach=0,96), así como la reproducibilidad prueba-reprueba (CCI=0,89, IC95%: 0,78-0,94). Cuando se evaluó la validez del constructo encontramos diferencias significativas en las puntuaciones del Rflentre individuos con riesgo de suicidio alto y bajo, definido clínicamente. Conclusiones: La versión colombiana del Rflmuestra buenas propiedades psicométricas en una población clínica con comportamiento suicida.

Objective: To evaluate the factor structure, reliability, and construct and content validity of the Colombian Spanish version of the Reasons for Living Inventory (Rfl) in a clinical sample of subjects who attempted suicide. Method: Two translations into Spanish and two back-translations for each of the items were done. We assessed content and construct validity as well as internal consistency and test-retest reproducibility. Results: The factor structure has six domains which explain 63.5% of the variance: “survival and coping beliefs”, “fear of death and social disapproval”, “responsibility to family”, “child-related concerns”, “perception of incapacity for suicide” and “moral objections”. The internal consistency was high (Cronbach’s alpha=0.96), as was test-retest reproducibility (ICC=0.89, IC95%: 0.78-0.94). When assessing construct validity, we found significant differences between individuals with clinically defined high and low suicide risk in Rflscores. Conclusions: The Rflversion for Colombia shows good psychometric properties in clinical population with suicidal behavior.

Prevalencia de trastornos psiquiátricos en pacientes medicoquirúrgicos hospitalizados en la Clínica Universitaria Bolivariana de Medellín, Colombia / Prevalence of psychiatric disorders in medical-surgical hospitalized patients in the Clinica Universitaria Bolivariana from Medellín, Colombia

Objetivo: El grupo de psiquiatría de enlace se propuso determinar la frecuencia de trastornos psiquiátricos en los pacientes hospitalizados en los servicios de medicina interna, cirugía, ginecología y ortopedia de la Clínica Universitaria Bolivariana de Medellín. Metodología: Estudio descriptivo de 157 personas entrevistadas aleatoriamente en un período de 30 días. Se diseñó un formulario con preguntas que incluían aspectos sociodemográficos y clínicos que se aplicó a cada uno de los entrevistados. Se realizó el Mini-Examen Cognoscitivo (MEC 35) a todos los pacientes. Si el MEC 35 no encontraba alteración psiquiátrica se aplicaba la Escala de Ansiedad y Depresión Hospitalaria (EADH). A quienes tuvieron alteraciones en el MEC 35 o en la EADH, se les realizó una entrevista clínica para diagnosticar el trastorno psiquiátrico presente. Resultados: Del total de pacientes, 70 (44.5/100), se diagnosticaron con algún trastorno psiquiátrico. El más frecuente fue demencia en 19 (12.1/100), seguido por trastorno depresivo mayor, 16 (10.2/100). Conclusiones: Existe una frecuencia de 44.5/100 de trastornos psiquiátricos en los pacientes hospitalizados de la Clínica Universitaria Bolivariana, Medellín que no son diagnosticados por el personal médico no psiquiatra. Se sugiere realizar jornadas de actualización médica en psiquiatría para el personal médico y paramédico de la institución y crear líneas de investigación en psiquiatría de enlace en otros centros médicos de Medellín

Depresion y familia en pacientes con artritis reumatoide / Depression and family relationship of RA patients

Objetivos: Estudiar la prevalencia de depresión y las características de las relaciones familiares en pacientes con artritis reumatoide (AR). Métodos: Estudio transversal y descriptivo. La depresión fue evaluada mediante la escala de Zung. El estado de salud de los pacientes y las características familiares fueron evaluados por encuesta dirigida. Resultados: Se incluyeron 107 pacientes. Se ob-servó una alta tasa de depresión (58 por ciento), y una baja proporción de satisfacción con el entorno laboral (40 por ciento) y con la situación del país (7 por ciento). La relación con el núcleo familiar fue considerada buena en la mayoría de los casos, con una proporción importante de satisfacción (60 por ciento). Dentro del núcleo familiar, quienes más colaboran con el paciente son la pareja (53 por ciento) y los hijos (63 por ciento), quienes, a través de una actitud de escucha, logran que el paciente con AR se sienta apoyado. Conclusión: La depresión es frecuente en los pacientes con AR, a pesar de tener un buen entorno familiar, el cual parece actuar ejerciendo un efecto amortiguador en el impacto de la enfermedad sobre la calidad de vida