RESUMEN
Dysfunctional breathing (DB) is a respiratory condition characterized by irregular breathing patterns that occur either in the absence of concurrent diseases or secondary to cardiopulmonary diseases. Although the primary symptom is often dyspnea or "air hunger", DB is also associated with nonrespiratory symptoms such as dizziness and palpitations. DB has been identified across all ages. Its prevalence among adults in primary care in the United Kingdom is approximately 9.5%. In addition, among individuals with asthma, a positive diagnosis of DB is found in a third of women and a fifth of men. Although DB has been investigated for decades, it remains poorly understood because of a paucity of high-quality clinical trials and validated outcome measures specific to this population. Accordingly, DB is often underdiagnosed or misdiagnosed, given the similarity of its associated symptoms (dyspnea, tachycardia, and dizziness) to those of other common cardiopulmonary diseases such as COPD and asthma. The high rates of misdiagnosis of DB suggest that health care professionals do not fully understand this condition and may therefore fail to provide patients with an appropriate treatment. Given the multifarious, psychophysiological nature of DB, a holistic, multidimensional assessment would seem the most appropriate way to enhance understanding and diagnostic accuracy. The present narrative review was developed as a means of summarizing the available evidence about DB, as well as improving understanding of the condition by researchers and practitioners.
Asunto(s)
Trastornos Respiratorios/fisiopatología , Tolerancia al Ejercicio/fisiología , Corazón/fisiopatología , Humanos , Hiperventilación/fisiopatología , Pulmón/fisiopatología , Trastornos Respiratorios/líquido cefalorraquídeo , Trastornos Respiratorios/psicología , Músculos Respiratorios/fisiopatologíaRESUMEN
ABSTRACT Dysfunctional breathing (DB) is a respiratory condition characterized by irregular breathing patterns that occur either in the absence of concurrent diseases or secondary to cardiopulmonary diseases. Although the primary symptom is often dyspnea or "air hunger", DB is also associated with nonrespiratory symptoms such as dizziness and palpitations. DB has been identified across all ages. Its prevalence among adults in primary care in the United Kingdom is approximately 9.5%. In addition, among individuals with asthma, a positive diagnosis of DB is found in a third of women and a fifth of men. Although DB has been investigated for decades, it remains poorly understood because of a paucity of high-quality clinical trials and validated outcome measures specific to this population. Accordingly, DB is often underdiagnosed or misdiagnosed, given the similarity of its associated symptoms (dyspnea, tachycardia, and dizziness) to those of other common cardiopulmonary diseases such as COPD and asthma. The high rates of misdiagnosis of DB suggest that health care professionals do not fully understand this condition and may therefore fail to provide patients with an appropriate treatment. Given the multifarious, psychophysiological nature of DB, a holistic, multidimensional assessment would seem the most appropriate way to enhance understanding and diagnostic accuracy. The present narrative review was developed as a means of summarizing the available evidence about DB, as well as improving understanding of the condition by researchers and practitioners.
RESUMO A disfunção respiratória (DR) é um quadro respiratório caracterizado por padrões respiratórios irregulares que ocorrem na ausência de doenças concomitantes ou secundariamente a doenças cardiopulmonares. Embora o principal sintoma seja frequentemente dispneia ou "fome por ar", a DR também está associada a sintomas não respiratórios, como vertigem e palpitações. A DR pode ser identificada em todas as idades. Sua prevalência entre adultos na atenção primária no Reino Unido é de aproximadamente 9,5%. Além disso, entre indivíduos com asma, um diagnóstico positivo de DR é encontrado em um terço das mulheres e um quinto dos homens. Embora a DR tenha sido investigada por décadas, ela permanece pouco compreendida devido a uma escassez de ensaios clínicos de alta qualidade e de variáveis de desfecho validadas especificamente para essa população. Assim, a DR é frequentemente subdiagnosticada ou diagnosticada incorretamente, devido à similaridade de seus sintomas associados (dispneia, taquicardia e vertigem) aos de outras doenças cardiopulmonares comuns, como DPOC e asma. As altas taxas de diagnóstico incorreto de DR sugerem que os profissionais de saúde não entendam completamente esse quadro e possam, portanto, não fornecer aos pacientes um tratamento adequado. Dada à natureza multifatorial e psicofisiológica da DR, uma avaliação holística e multidimensional parece ser a maneira mais apropriada de melhorar a compreensão e a precisão do diagnóstico. A presente revisão foi desenvolvida como um meio de resumir as evidências disponíveis sobre DB, bem como de melhorar a compreensão do quadro por pesquisadores e profissionais.
Asunto(s)
Humanos , Trastornos Respiratorios/fisiopatología , Trastornos Respiratorios/líquido cefalorraquídeo , Trastornos Respiratorios/psicología , Músculos Respiratorios/fisiopatología , Tolerancia al Ejercicio/fisiología , Corazón/fisiopatología , Hiperventilación/fisiopatología , Pulmón/fisiopatologíaRESUMEN
Objective To analyse how therapeutic play structured in a nursing care model contributes to the care of hospitalised children. Method This is a qualitative study based on convergent care research (CCR). Seven children participated in the study. Data were collected in September and October of 2014 by means of interviews with open-end questions and participant observation of therapeutic and dramatic play sessions and/or instructional play sessions based on the stages "Welcoming/Playing/Concluding" of the nursing model Care with Play. Data were analysed according to the analysis and interpretation stages of the CCR. Results The following three categories emerged: Meanings attributed by the child to hospitalisation and its influence on nursing care; Perception of the therapeutic procedures through therapeutic play, and Importance of the family in care. Final considerations It is concluded that the application of therapeutic play structured in the care model contributes to systematic and specialised nursing care.
Asunto(s)
Niño Hospitalizado/psicología , Modelos de Enfermería , Atención de Enfermería/métodos , Ludoterapia , Ansiedad/prevención & control , Brasil , Niño , Preescolar , Emociones , Femenino , Hospitales Públicos , Humanos , Infecciones/psicología , Infecciones/terapia , Masculino , Comunicación no Verbal , Relaciones Enfermero-Paciente , Trastornos Respiratorios/psicología , Trastornos Respiratorios/terapia , Estrés Psicológico/terapiaRESUMEN
RESUMO Objetivo Analisar como o Brinquedo Terapêutico estruturado em um Modelo de Cuidado de Enfermagem contribui no cuidado à criança hospitalizada. Método Trata-se de uma Pesquisa Convergente Assistencial (PCA), de abordagem qualitativa. Participaram do estudo sete crianças. A coleta de dados foi realizada entre setembro e outubro de 2014, por meio de entrevista aberta e de observação participante de sessões de BT dramático e/ou instrucional através das etapas “Acolhendo/Brincando/Finalizando” do Modelo de Cuidado de Enfermagem Cuidar Brincando. Os dados foram analisados de acordo com as fases de análise e interpretação da PCA. Resultados Três categorias: Significados atribuídos pela criança à hospitalização e sua influência no cuidado de enfermagem, Percepção quanto aos procedimentos terapêuticos por meio do brinquedo terapêutico e Importância da inserção da família no cuidado. Considerações finais Conclui-se que aplicar o BT estruturado em um Modelo de Cuidado pode contribuir para um cuidado de enfermagem sistematizado e especializado.
RESUMEN Objetivo Objetivo de analizar como Juego Terapéutico estructurado en un modelo de atención de enfermería ayuda en el cuidado de niños hospitalizados. Método Se trata de una investigación cualitativa del tipo convergente asistencial. Participaron del estudio siete niños. Los datos fueron recolectados entre septiembre y octubre de 2014, por medio de entrevistas abiertas y observación participante de sesiones de juguete terapéutico dramático y de instrucción por los pasos “Acogiendo/Jugando/Finalizando” del Modelo de Atención de Enfermería Cuidar Jugando”. Los datos se analizaron de acuerdo a las fases de análisis e interpretación. Resultados Tres categorías: Significados atribuidos por el niño a la hospitalización y su influencia en los cuidados de enfermería, Percepción acerca de los procedimientos terapéuticos a través del juego y La Importancia de la inserción de la familia en la atención terapéutica. Consideraciones finales La aplicación de la BT estructurada en un modelo de atención puede contribuir a un cuidado de enfermería especializada y sistematizadas.
ABSTRACT Objective To analyse how therapeutic play structured in a nursing care model contributes to the care of hospitalised children. Method This is a qualitative study based on convergent care research (CCR). Seven children participated in the study. Data were collected in September and October of 2014 by means of interviews with open-end questions and participant observation of therapeutic and dramatic play sessions and/or instructional play sessions based on the stages “Welcoming/Playing/Concluding” of the nursing model Care with Play. Data were analysed according to the analysis and interpretation stages of the CCR. Results The following three categories emerged: Meanings attributed by the child to hospitalisation and its influence on nursing care; Perception of the therapeutic procedures through therapeutic play, and Importance of the family in care. Final considerations It is concluded that the application of therapeutic play structured in the care model contributes to systematic and specialised nursing care.
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Ludoterapia , Niño Hospitalizado , Modelos de Enfermería , Atención de Enfermería/métodos , Ansiedad/prevención & control , Trastornos Respiratorios/psicología , Trastornos Respiratorios/terapia , Estrés Psicológico/terapia , Brasil , Emociones , Hospitales Públicos , Infecciones/psicología , Infecciones/terapia , Comunicación no Verbal , Relaciones Enfermero-PacienteRESUMEN
This systematic review assesses the current state of clinical and preclinical research on panic disorder (PD) in which the carbon dioxide (CO2) challenge was used as a trigger for panic attacks (PAs). A total of 95 articles published from 1984 to 2012 were selected for inclusion. Some hypotheses for PD evolved greatly due to the reproducibility of PAs in a controlled environment using the safe and noninvasive CO2 test. The 35% CO2 protocol was the method chosen by the majority of studies. Results of the test report specific sensitivity to hypercapnia in PD patients of the respiratory PD subtype. The CO2 challenge helped assess the antipanic effects of medication and non-pharmaceutical approaches such as physical exercise and cognitive behavioral therapy. The test was also used in studies about the genetic component of PD, in which twins and relatives of PD patients were analyzed.
Asunto(s)
Dióxido de Carbono , Trastorno de Pánico/inducido químicamente , Trastornos Respiratorios/inducido químicamente , Humanos , Trastorno de Pánico/psicología , Trastornos Respiratorios/psicología , Pruebas de Función Respiratoria , Sensibilidad y EspecificidadRESUMEN
This systematic review assesses the current state of clinical and preclinical research on panic disorder (PD) in which the carbon dioxide (CO2) challenge was used as a trigger for panic attacks (PAs). A total of 95 articles published from 1984 to 2012 were selected for inclusion. Some hypotheses for PD evolved greatly due to the reproducibility of PAs in a controlled environment using the safe and noninvasive CO2 test. The 35% CO2 protocol was the method chosen by the majority of studies. Results of the test report specific sensitivity to hypercapnia in PD patients of the respiratory PD subtype. The CO2 challenge helped assess the antipanic effects of medication and non-pharmaceutical approaches such as physical exercise and cognitive behavioral therapy. The test was also used in studies about the genetic component of PD, in which twins and relatives of PD patients were analyzed.
Asunto(s)
Humanos , Dióxido de Carbono , Trastorno de Pánico/inducido químicamente , Trastornos Respiratorios/inducido químicamente , Trastorno de Pánico/psicología , Trastornos Respiratorios/psicología , Pruebas de Función Respiratoria , Sensibilidad y EspecificidadRESUMEN
INTRODUCTION: Respiratory changes are associated with anxiety disorders, particularly panic disorder (PD). The stimulation of respiration in PD patients during panic attacks is well documented in the literature, and a number of abnormalities in respiration, such as enhanced CO2 sensitivity, have been detected in PD patients. Investigators hypothesized that there is a fundamental abnormality in the physiological mechanisms that control breathing in PD. METHODS: The authors searched for articles regarding the connection between the respiratory system and PD, more specifically papers on respiratory challenges, respiratory subtype, and current mechanistic concepts. CONCLUSIONS: Recent evidences support the presence of subclinical changes in respiration and other functions related to body homeostasis in PD patients. The fear network, comprising the hippocampus, medial prefrontal cortex, amygdala and its brainstem projections, may be abnormally sensitive in PD patients, and respiratory stimulants like CO2 may trigger panic attacks. Studies indicate that PD patients with dominant respiratory symptoms are particularly sensitive to respiratory tests compared to those who do not manifest dominant respiratory symptoms, representing a distinct subtype. The evidence of changes in several neurochemical systems might be the expression of the complex interaction among brain circuits.
Asunto(s)
Trastorno de Pánico/fisiopatología , Trastornos Respiratorios/fisiopatología , Dióxido de Carbono/efectos adversos , Dióxido de Carbono/fisiología , Humanos , Hiperventilación/psicología , Trastorno de Pánico/psicología , Trastornos Respiratorios/psicología , Pruebas de Función RespiratoriaRESUMEN
INTRODUCTION: Respiratory changes are associated with anxiety disorders, particularly panic disorder (PD). The stimulation of respiration in PD patients during panic attacks is well documented in the literature, and a number of abnormalities in respiration, such as enhanced CO2 sensitivity, have been detected in PD patients. Investigators hypothesized that there is a fundamental abnormality in the physiological mechanisms that control breathing in PD. METHODS: The authors searched for articles regarding the connection between the respiratory system and PD, more specifically papers on respiratory challenges, respiratory subtype, and current mechanistic concepts. CONCLUSIONS: Recent evidences support the presence of subclinical changes in respiration and other functions related to body homeostasis in PD patients. The fear network, comprising the hippocampus, medial prefrontal cortex, amygdala and its brainstem projections, may be abnormally sensitive in PD patients, and respiratory stimulants like CO2 may trigger panic attacks. Studies indicate that PD patients with dominant respiratory symptoms are particularly sensitive to respiratory tests compared to those who do not manifest dominant respiratory symptoms, representing a distinct subtype. The evidence of changes in several neurochemical systems might be the expression of the complex interaction among brain circuits.
INTRODUÇÃO: As anormalidades respiratórias estão associadas a transtornos de ansiedade, especialmente ao transtorno do pânico (TP). A estimulação respiratória em pacientes com TP durante os ataques de pânico está bem documentada na literatura, e vários problemas respiratórios como uma elevada sensibilidade ao CO2 foram detectados em pacientes com TP. Os pesquisadores levantam a hipótese de que existe um distúrbio fundamental nos mecanismos fisiológicos que controlam a respiração no TP. MÉTODOS: Os autores pesquisaram artigos sobre a conexão entre o sistema respiratório e TP, mais especificamente artigos sobre testes respiratórios, subtipo respiratório e conceitos mecanicistas atuais. CONCLUSÕES: Evidências recentes apoiam a existência de alterações subclínicas na respiração e em outras funções relacionadas à homeostase corporal em pacientes com TP. O circuito do medo, composto pelo hipocampo, córtex pré-frontal medial, amígdala e suas projeções para o tronco encefálico, pode estar anormalmente sensível em pacientes com TP, e os estimulantes respiratórios, como o CO2, podem desencadear ataques de pânico. Estudos indicam que os pacientes com TP que apresentam sintomas respiratórios dominantes são particularmente sensíveis a testes respiratórios, comparados àqueles que não manifestam sintomas respiratórios dominantes, representando um subtipo distinto. A constatação de anormalidades em vários sistemas neuroquímicos pode ser a expressão da interação complexa entre os circuitos cerebrais.
Asunto(s)
Humanos , Trastorno de Pánico/fisiopatología , Trastornos Respiratorios/fisiopatología , Dióxido de Carbono/efectos adversos , Dióxido de Carbono , Dióxido de Carbono/fisiología , Hiperventilación/psicología , Trastorno de Pánico/psicología , Trastornos Respiratorios/psicología , Pruebas de Función RespiratoriaRESUMEN
OBJECTIVE: Our objective is to summarize the new findings concerning the respiratory subtype (RS) of panic disorder (PD) since its first description. METHODS: Two searches were made in the Institute for Scientific Information Web of Science: with the keywords "panic disorder" and "respiratory symptoms," and all articles that cited Briggs and colleagues' 1993 article "Subtyping of Panic Disorder by Symptom Profile" (Br J Psychiatry 1993;163:201-9). Altogether, 133 articles were reviewed. RESULTS: We describe and discuss RS epidemiology, genetics, psychopathology, demographic features, clinical features, correlations with the respiratory system, traumatic suffocation history, provocative tests, and nocturnal panic. Compared to patients with the nonrespiratory subtype (non-RS), the RS patients had higher familial history of PD, lower comorbidity with depression, longer duration of illness, lower neuroticism scores, and higher scores in severity scales, such as the Panic and Agoraphobia Scale, Panic-Agoraphobia Spectrum scale and the Clinical Global Impression scale. Tests to induce panic attacks, such as those with CO(2), hyperventilation, and caffeine, produce panic attacks in a higher proportion of RS patients than non-RS patients. Differences in the subtypes' improvement with the pharmacologic treatment were found. There are also some controversial findings regarding the RS, including the age of onset of PD, and alcohol and tobacco use in RS patients. CONCLUSIONS: Some characteristics, such as the increased sensitivity to CO(2) and the higher familial history of PD, clearly distinguish the RS from the non-RS. Nevertheless, there are also controversial findings. More studies are needed to determine the validity of the RS subtype.
Asunto(s)
Asfixia/psicología , Trastorno de Pánico/diagnóstico , Trastorno de Pánico/psicología , Trastornos Respiratorios/psicología , Obstrucción de las Vías Aéreas/psicología , Cafeína , Dióxido de Carbono , Terapia Combinada , Disnea/psicología , Predisposición Genética a la Enfermedad/genética , Humanos , Hiperventilación/psicología , Ácido Láctico , Trastorno de Pánico/genética , Trastorno de Pánico/terapia , Determinación de la Personalidad , Psicopatología , Factores de RiesgoRESUMEN
AIM: to compare the scores of the WHOQOL quality of life domains with the clinical features of patients with respiratory and non-respiratory panic disorders (PD) treated at the UFRJ Panic and Respiration Laboratory. METHOD: cross sectional study. Thirty-two PD outpatients under treatment were consecutively selected and evaluated by the MINI v.4.4. They were divided into two different groups according to Briggs et al. classification of respiratory and non-respiratory PD subtypes. Twelve (37.5%) patients had the respiratory subtype (SR) and 20 (62.5%) the non-respiratory subtype (SN). RESULTS: the SN patients presented worse scores in the psychological domain of the WHOQOL. There were no differences between groups in gender, age, level of schooling, occupational status, marital status, smoking and comorbidities. There were no differences in the anxiety questionnaires and PD questionnaire (BAI, STAI-T, STAI-S, PAS) scores and in the age at the beginning of the disorder and the disorder's duration. CONCLUSION: non-respiratory subtype patients presented worse scores in the psychological domain of WHOQOL than the respiratory subtype group, when they had similar anxiety and PD scores.
Asunto(s)
Pánico/clasificación , Calidad de Vida , Trastornos Respiratorios/clasificación , Trastornos Respiratorios/psicología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos Respiratorios/complicacionesRESUMEN
Multiple respiratory abnormalities can be found in anxiety disorders, especially in panic disorder (PD). Individuals with PD experience unexpected panic attacks, characterized by anxiety and fear, resulting in a number of autonomic and respiratory symptoms. Respiratory stimulation is a common event during panic attacks. The respiratory abnormality most often reported in PD patients is increased CO2 sensitivity, which has given rise to the hypothesis of fundamental abnormalities in the physiological mechanisms that control breathing in PD. There is evidence that PD patients with dominant respiratory symptoms are more sensitive to respiratory tests than are those who do not manifest such symptoms, and that the former group constitutes a distinct subtype. Patients with PD tend to hyperventilate and to panic in response to respiratory stimulants such as CO2, triggering the activation of a hypersensitive fear network. Although respiratory physiology seems to remain normal in these subjects, recent evidence supports the idea that they present subclinical abnormalities in respiration and in other functions related to body homeostasis. The fear network, composed of the hippocampus, the medial prefrontal cortex, the amygdala and its brain stem projections, might be oversensitive in PD patients. This theory might explain why medication and cognitive-behavioral therapy are both clearly effective. Our aim was to review the relationship between respiration and PD, addressing the respiratory subtype of PD and the hyperventilation syndrome, with a focus on respiratory challenge tests, as well as on the current mechanistic concepts and the pharmacological implications of this relationship.
Asunto(s)
Trastorno de Pánico/complicaciones , Trastornos Respiratorios/etiología , Dióxido de Carbono/fisiología , Susceptibilidad a Enfermedades , Humanos , Hiperventilación/tratamiento farmacológico , Hiperventilación/etiología , Hiperventilación/psicología , Trastorno de Pánico/tratamiento farmacológico , Trastornos Respiratorios/tratamiento farmacológico , Trastornos Respiratorios/psicologíaRESUMEN
Multiple respiratory abnormalities can be found in anxiety disorders, especially in panic disorder (PD). Individuals with PD experience unexpected panic attacks, characterized by anxiety and fear, resulting in a number of autonomic and respiratory symptoms. Respiratory stimulation is a common event during panic attacks. The respiratory abnormality most often reported in PD patients is increased CO2 sensitivity, which has given rise to the hypothesis of fundamental abnormalities in the physiological mechanisms that control breathing in PD. There is evidence that PD patients with dominant respiratory symptoms are more sensitive to respiratory tests than are those who do not manifest such symptoms, and that the former group constitutes a distinct subtype. Patients with PD tend to hyperventilate and to panic in response to respiratory stimulants such as CO2, triggering the activation of a hypersensitive fear network. Although respiratory physiology seems to remain normal in these subjects, recent evidence supports the idea that they present subclinical abnormalities in respiration and in other functions related to body homeostasis. The fear network, composed of the hippocampus, the medial prefrontal cortex, the amygdala and its brain stem projections, might be oversensitive in PD patients. This theory might explain why medication and cognitive-behavioral therapy are both clearly effective. Our aim was to review the relationship between respiration and PD, addressing the respiratory subtype of PD and the hyperventilation syndrome, with a focus on respiratory challenge tests, as well as on the current mechanistic concepts and the pharmacological implications of this relationship.
Múltiplas anormalidades respiratórias podem ser encontradas em pacientes com transtornos de ansiedade, particularmente no transtorno de pânico (TP). Indivíduos com TP experimentam ataques de pânico inesperados, caracterizados por ansiedade, medo e diversos sintomas autonômicos e respiratórios. A estimulação respiratória é um fenômeno comum durante os ataques de pânico. A anormalidade respiratória mais citada em pacientes com TP é a sensibilidade aumentada para o CO2, que originou a hipótese de uma disfunção fundamental nos mecanismos fisiológicos de controle da respiração no TP. Há evidências de que pacientes com TP com sintomas respiratórios predominantes são mais sensíveis a testes respiratórios do que aqueles sem a manifestação de tais sintomas, representando um subtipo distinto. Pacientes com TP tendem a hiperventilar e a reagir com pânico como resposta a estimulantes respiratórios como o CO2, gerando uma ativação de um circuito de medo hipersensível. Apesar de a fisiologia respiratória desses pacientes permanecer normal, algumas evidências recentes apontam a presença de disfunções subclínicas na respiração e em outras funções relacionadas à homeostase corporal. O circuito do medo, composto pelo hipocampo, córtex pré-frontal medial, amígdala e projeções do tronco cerebral, pode estar hipersensível em pacientes com TP. Essa teoria pode explicar porque os medicamentos e a terapia cognitivocomportamental são claramente eficazes. Nosso objetivo foi revisar a relação entre respiração e TP, especialmente o subtipo respiratório de TP e a síndrome da hiperventilação, focalizando os testes respiratórios, bem como as hipóteses mecanísticas e as implicações farmacológicas dessa relação.
Asunto(s)
Humanos , Trastorno de Pánico/complicaciones , Trastornos Respiratorios/etiología , Dióxido de Carbono/fisiología , Susceptibilidad a Enfermedades , Hiperventilación/tratamiento farmacológico , Hiperventilación/etiología , Hiperventilación/psicología , Trastorno de Pánico/tratamiento farmacológico , Trastornos Respiratorios/tratamiento farmacológico , Trastornos Respiratorios/psicologíaRESUMEN
OBJECTIVE: Analyze the relations established between air pollution and health-disease-death in a sample of students in Mexico City. MATERIAL AND METHODS: Survey of 1274 students from 14 secondary schools in five areas in Mexico City was conducted between March and April of 2003. We used a multi-stage sampling, based in a basic geostatistical areas (AGEB). RESULTS: A total of 84.4% believed that Mexico City has a high, or very high air pollution; that valuation decreases as it approaches the most immediate place in which the students live. The health risks range from effects on respiratory health, 66.9%, to other effects on daily life, 2.2%. The predictors that air pollution is perceived as serious/very serious are: 1) that they associate it with the possibility of causing death (OR= 1.35, 95% CI=1.02-1.77), and 2) that they attend schools located in the La Merced zone, (OR= 2.23, 95% CI= 1.56-3.21). CONCLUSIONS: Determinants of perception, such as gender, zone where the school is located and the differences in air quality perceived in the city/area/schools, suggest that focalizing components must be involved in environmental policies, in order to make environmental programs more effective at the local level.
Asunto(s)
Contaminación del Aire , Conocimientos, Actitudes y Práctica en Salud , Psicología del Adolescente , Estudiantes/psicología , Adolescente , Contaminantes Atmosféricos/efectos adversos , Contaminación del Aire/efectos adversos , Actitud , Participación de la Comunidad , Conjuntivitis/etiología , Conjuntivitis/psicología , Cultura , Recolección de Datos , Femenino , Cefalea/etiología , Humanos , Masculino , México , Material Particulado/efectos adversos , Trastornos Respiratorios/etiología , Trastornos Respiratorios/psicología , Riesgo , Factores Socioeconómicos , Población UrbanaRESUMEN
OBJETIVO: Analizar las relaciones que se establecen entre contaminación del aire y salud-enfermedad-muerte en una muestra de estudiantes de la Ciudad de México. MATERIAL Y MÉTODOS: Se realizó una encuesta a 1 274 alumnos de secundaria de 14 escuelas en cinco zonas del Distrito Federal, entre marzo y abril de 2003. Muestreo polietápico de áreas geoestadísticas básicas (AGEB). RESULTADOS: El 84.4 por ciento considera alta o muy alta la contaminación del aire en la Ciudad de México, que disminuye al aproximarse al espacio más inmediato del alumno. Los riesgos a la salud van desde efectos en la salud respiratoria, 66.9 por ciento, a otras consecuencias en la vida diaria, 2.2 por ciento. Los predictores de percibir la contaminación como grave/muy grave son: a) que la asocien con la posibilidad de causar la muerte (RM= 1.35, IC 95 por ciento= 1.02-1.77), y b) asistencia a escuelas en la zona de La Merced (RM= 2.23, IC 95 por ciento= 1.56-3.21). CONCLUSIONES: Los determinantes de la percepción para esta población de adolescentes son: género, zona de ubicación de la escuela y las diferencias en la calidad del aire percibidas en la ciudad/colonia/plantel educativo. Lo anterior permite sugerir que en la política ambiental debe incorporarse el componente de la focalización, de tal manera que los programas ambientales sean más eficientes en el ámbito local.
OBJECTIVE: Analyze the relations established between air pollution and health-disease-death in a sample of students in Mexico City. MATERIAL AND METHODS: Survey of 1274 students from 14 secondary schools in five areas in Mexico City was conducted between March and April of 2003. We used a multi-stage sampling, based in a basic geostatistical areas (AGEB). RESULTS: A total of 84.4 percent believed that Mexico City has a high, or very high air pollution; that valuation decreases as it approaches the most immediate place in which the students live. The health risks range from effects on respiratory health, 66.9 percent, to other effects on daily life, 2.2 percent. The predictors that air pollution is perceived as serious/very serious are: 1) that they associate it with the possibility of causing death (OR= 1.35, 95 percent CI=1.02-1.77), and 2) that they attend schools located in the La Merced zone, (OR= 2.23, 95 percent CI= 1.56-3.21). CONCLUSIONS: Determinants of perception, such as gender, zone where the school is located and the differences in air quality perceived in the city/area/schools, suggest that focalizing components must be involved in environmental policies, in order to make environmental programs more effective at the local level.
Asunto(s)
Adolescente , Femenino , Humanos , Masculino , Psicología del Adolescente , Contaminación del Aire , Conocimientos, Actitudes y Práctica en Salud , Estudiantes/psicología , Contaminantes Atmosféricos/efectos adversos , Contaminación del Aire/efectos adversos , Actitud , Conjuntivitis/etiología , Conjuntivitis/psicología , Participación de la Comunidad , Cultura , Recolección de Datos , Cefalea/etiología , México , Material Particulado/efectos adversos , Trastornos Respiratorios/etiología , Trastornos Respiratorios/psicología , Riesgo , Factores Socioeconómicos , Población UrbanaRESUMEN
The aim of this study was to correlate the socio structural variables of the Simplified Index of Family Poverty with the self-perception of resources that conform social capital among patients with acute respiratory disease (ARD). We used a qualitative and quantitative methodology. The sample included 848 cases distributed in seven Rural Medicine Units of Mexico. We considered three pathways described by Kawachi where social capital might have an impact on individual health. The bivariate correlation and discriminant analysis showed that when there is evidence of poverty in the family, the statistically significant differences are mainly observed in self-perception. Moral support of sons and daughters is thereby increased when there is an ARD. We concluded that when there is a higher index of family poverty there is a decreased access to social resources when a family member is diagnosed with an ARD.
Asunto(s)
Pobreza , Trastornos Respiratorios , Autoimagen , Apoyo Social , Enfermedad Aguda , Estudios Transversales , Familia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos Respiratorios/epidemiología , Trastornos Respiratorios/psicología , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Clonidine, which inhibits locus coeruleus discharge, would seem for theoretical reasons to be a good antipanic drug. Panic disorder (PD) presents a heterogeneous cluster of symptoms and a classification based on subtypes has been suggested and the respiratory symptoms group appears as a distinct subtype. METHOD: We report three cases of respiratory PD patients who were successfully treated with clonidine. RESULTS: Patients obtained panic free status, reduced anxiety levels and better functioning after clonidine administration (0.30-0.45 mg/day) for 6 weeks. CONCLUSION: Clonidine can be effective in the treatment of respiratory PD. This drug might play a role in relieving symptoms of anxiety due to noradrenergic hyperactivity in these patients.
Asunto(s)
Agonistas alfa-Adrenérgicos/uso terapéutico , Clonidina/uso terapéutico , Trastorno de Pánico/tratamiento farmacológico , Trastornos Respiratorios/tratamiento farmacológico , Adulto , Femenino , Humanos , Trastorno de Pánico/psicología , Trastornos Respiratorios/psicologíaRESUMEN
The goal of the study was to describe with prospective methodology the therapeutic response to nortriptyline in the respiratory panic disorder (PD) subtype versus the non-respiratory subtype. A total of 118 PD outpatients (DSM-IV) were previously divided into respiratory (n=77) and non-respiratory (n=41) subtypes and then treated with nortriptyline for 1 year. Demographic and clinical features were compared in the two groups. Anxiety scales were administered before and during the treatment by raters who were blind to the subtype diagnosis. The principal instruments used to evaluate response were the Clinical Global Impression, the Sheehan Panic and Anticipatory Anxiety Scale, and the Panic Disorder Severity Scale. In the first 8 weeks of treatment (acute phase), the respiratory subtype had a significantly faster response on all the major scales. At the end of the study (week 52), there was no difference in the scale scores, and the reduction in panic attacks from baseline to end-point did not differ significantly between the two groups. In the respiratory subtype, the disorder had a later onset, was associated with a high familial history of mental disorder, and significantly more often required treatment with more than an occasional benzodiazepine. The non-respiratory subtype had significantly more previous depressive episodes. In conclusion, the respiratory PD subtype had a faster response to treatment with nortriptyline at 8 weeks than did the non-respiratory subtype, and an equivalent response after 1 year of treatment.
Asunto(s)
Antidepresivos Tricíclicos/uso terapéutico , Nortriptilina/uso terapéutico , Trastorno de Pánico/tratamiento farmacológico , Trastornos Respiratorios/tratamiento farmacológico , Enfermedad Aguda , Adulto , Antidepresivos Tricíclicos/efectos adversos , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Humanos , Cuidados a Largo Plazo , Masculino , Persona de Mediana Edad , Nortriptilina/efectos adversos , Trastorno de Pánico/diagnóstico , Trastorno de Pánico/psicología , Determinación de la Personalidad , Trastornos Respiratorios/diagnóstico , Trastornos Respiratorios/psicología , Resultado del TratamientoRESUMEN
During Phase II of the Cross-National Panic Study, descriptions of the patient's last severe panic attack were collected for 1168 patients. Statistical analysis indicated that patients could be divided into two groups, characterised by the presence or absence of prominent respiratory symptoms. The two groups did not differ on demographic variables or coexisting diagnoses, but they did differ on psychopathology on entry to the study and treatment outcome. The group with prominent respiratory symptoms suffered more spontaneous panic attacks and responded to imipramine, whereas the group without prominent respiratory symptoms suffered more situational panic attacks and responded more to alprazolam. It is important to distinguish spontaneous and situational panic attacks, to aid choice of treatment.