Adicciones y depresión en la salud del hombre

Los problemas de salud mental son uno de los más prevalentes de la salud del hombre el día de hoy y dada la baja tasa de consulta de los hombres por estos y otros cuadros, se hace necesario un enfoque preventivo de estas patologías a través de un diagnóstico precoz y la aplicación de intervenciones mínimas, así como mejorar el tamizage con uso de escalas de apoyo al diagnóstico. Se analizan la epidemiología y clínica de depresión mayor y los trastornos por uso de sustancias (alcohol, cocaína y nicotina) enfatizando aspectos clínicos que permitan una intervención precoz con herramientas como la “entrevista motivacional” y “prevención de recaídas” para consejería y tratamiento más eficiente. El objetivo de este artículo es el conocer, implemen-tar en la consulta habitual del médico, con las enfermeras y otros profesionales de salud las técnicas mencionadas para mejorar el diagnóstico, retención en tratamiento y el trabajo psicoterapéutico básico para estos casos

El ABCD de la cesación de fumar: de la evidencia a la práctica clínica en medicina preventiva

En el presente artículo se revisan aspectos epidemiológicos sobre el tabaquismo, mostrándolo como la enfermedad o causa de muerte más evitable en el mundo al día de hoy. Dada esta situación se plantea la importancia de la intervención médica en medicina preventiva, mostrando su efectividad por sobre otras aproximaciones alternativas. Se analizan las razones y limitaciones por las que los médicos no aplican estrategias de intervención antitabaco, incluyendo el hecho de que un porcentaje importante de los médicos fuma. Asimismo, se muestran las dificultades que pueden enfrentar los médicos al hacer una intervención, a la vez que se explican en detalle las intervenciones de las 5 A's y el ABCD de dejar de fumar, resaltando que todo fumador es un paciente objetivo y que todo médico puede tratar fumadores. Un punto importante que destaca este artículo es la comorbilidad psiquiátrica de los fumadores particularmente con depresión; y entrega herramientas como la entrevista de Goldberg 12 (GHQ) para ser utilizado como screening o tamizage y así mejorar el sistema de triage y derivación cuando corresponde. Un último punto no menos importante es tocar el tema del fumar pasivo por el humo de terceras personas, se entregan datos acerca de su importancia y cómo intervenir con los pacientes

Prevalencia del uso de alcohol y de otros diagnósticos relacionados al beber problema en servicios de urgencia de Santiago de Chile

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Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline