Concepción Fernández

Effects of diets and their role in weight control

Abstract This study examines the secondary effects of hypocaloric diets. The results show that the positive short-term effects with regards health are not maintained in the long term, as most people eventually return to their original weight. A description is given of how psychological reasons are more important than biological mechanisms when explaining this failure and stress is put on how carrying out successive hypocaloric diets can result in a subgroup of people becoming overweight or obese. Furthermore, an analysis is made of the relationship between diets, eating disorders and the “yo-yo effect”, which is in turn associated with a rise in morbimortality due to a wide range of causes. As an alternative to the indiscriminate use of hypocaloric diets, a strategy based on the modification of lifestyle is suggested in order to control weight and improve health.

Stress and contingency management in the treatment of irritable Bowel syndrome

Ninety patients with irritable bowel syndrome (IBS) who did not respond to medical treatment were randomly assigned to four treatment conditions - two experimental groups: stress management and contingency management; and two control groups: medical treatment and placebo. The subjects underwent 12 individual sessions which were specific for each condition. All the subjects completed symptom-monitoring diaries. Thirty-three dropped out during the assessment or treatment. The subjects who received training in contingency management experienced significant reductions in all the characteristic digestive symptoms: abdominal pain (p < 0.001), diarrhoea (p < 0.05), constipation (p < 0.05) and dyspepsia (p < 0.001). At the end of the treatment, 50 per cent of the patients remained asymptomatic and 37.5 per cent reduced their symptoms by at least 50 per cent. Among the patients assigned to the condition stress management, 33 per cent got rid of their symptomatology and the subjects showed significant reductions in the following digestive symptoms: abdominal pain (p < 0.05), diarrhoea (p < 0.05) and dyspepsia (p < 0.05). The changes in the placebo group are not representative. The subjects assigned to this condition showed a high dropout rate. Significant changes were not observed in symptomatology in the medical treatment group. The results are maintained after a year of follow-up. Possible predictive parameters of the progress of the patients are explored.

Characteristics and one-year follow-up of primary care patients with health anxiety

Health anxiety is frequent, both amongst the general population and in Primary Care (PC) clinical contexts in which prevalence of between 8% and 20% has been found. Hypochondriac disorders have less prevalence, although they have been calculated at between 3% and 6%. States of health anxiety are characterised by recurrent, highly emotive thoughts about the possibility of suffering or contracting a serious illness. The patient frequently shows characteristic behavioural patterns such as checking his/her body, seeking medical reassurance or behaviour aimed at avoiding external stimuli and thoughts/images related to the illness. Such behavioural patterns have also been regarded as important factors in perpetuating these problems. Hypochondriac worries, on the other hand, are associated with emotional disturbances and disorders, more frequent use of health services and affectation of quality of life. Clinical and research interest in health anxiety is a result of the high personal and health-care costs associated with it, given the prevalence of the problem in medical contexts. PRIMARY CARE AND COMMUNITY PSYCHIATRY VOL. 10, NO. 3, 2005, 89–101

Calidad de vida informada por pacientes oncológicos paliativos: Relaciones con el informe médico y estado emocional

Objetivo: analizar la utilidad clinica de los datos acerca de la calidad de vida (QL) informada por pacientes oncologicos en situacion paliativa. Sujetos y Metodo: 107 pacientes del Servicio de Oncologia del Hospital de Cabuenes de Gijon (Espana) cumplimentaron los cuestionarios QL-CA-AFex, HAD y Duke-UNC y un protocolo clinico. Los sujetos se asignaron aleatoriamente a distintos grupos de seguimiento (uno, dos, tres o seis meses). Se utilizaron coeficientes de correlacion para analizar la relacion entre la QL y la situacion clinica, estado emocional y apoyo social. Se empleo el ANOVA para estudiar las diferencias en la QL en funcion de las variables analizadas. Resultados: la QL no se deterioro con la progresion de la enfermedad. Los aspectos mas relacionados con la QL fueron los sintomas y, en segundo lugar, los aspectos psicologicos. Se comprobo la capacidad del QL-CA-AFex para discriminar entre grupos de pacientes realizados en funcion de diversas variables clinicas.

Seis actuaciones del profesional de enfermería para prevenir los falsos diagnósticos de hipertensión: La hipertensión de bata blanca y el efecto de bata blanca

La hipertension de bata blanca (HBB) puede considerarse como un falso diagnostico de hipertension que puede provocar tratamientos farmacologicos innecesarios, afectar a la calidad de vida de las personas e incrementar de un modo notable el gasto sanitario. Se calcula que la prevalencia de la HBB se situaria en torno a un 20% de los pacientes diagnosticados como hipertensos. Las investigaciones experimentales subrayan que la enfermera obtiene, en general, medidas mas fiables de la presion arterial (PA) que los medicos y que por ello puede desempenar un papel fundamental para prevenir estos falsos diagnosticos. En esta linea se subrayan seis actuaciones profesionales que contribuirian de manera decisiva para prevenir estos errores.