Liliana Mondragón

Consumo de bebidas alcohólicas en pacientes de los servicios de urgencias de la ciudad de Pachuca, Hidalgo

OBJECTIVE: Prevalence of alcohol consumption and abuse among patients with medical emergencies, accidents and violence, attending an emergency room in one of three public health hospitals in Pachuca, Hidalgo, was studied. MATERIAL AND METHODS: Patients answered a questionnaire and their blood alcohol was measured on their first visit to the emergency room. The questionnaire gathered socio-demographic data, patterns of alcohol consumption and included scales for heavy and dependent drinkers, such as the CAGE and the alcohol use disorders identification test (AUDIT). Injured and non-injured patients were compared with the chi 2 statistics. RESULTS: A total of 1,511 patients were evaluated. Alcohol consumption was higher in those attending for accidents or violence than in medical patients. Positive blood alcohol levels were found in 17.7% of injured patients and 15.8% reported alcohol consumption 6 hours prior to the accident. According to the CAGE, 9.2% of the patients were alcohol-dependent, and 10.9% were heavy drinkers according to the AUDIT. CONCLUSIONS: Alcohol consumption, especially among emergency room patients attending for accidents or injuries is high. Preventive measures are indispensable to diminish social and individual costs of alcohol abuse in this population.

Suicide attempts in a sample of patients from a General Hospital

BACKGROUND Suicide in Mexico has risen steadily in recent years, increasing by 156% in the last two decades. The study of suicide precursors, such as suicide attempts, has also become an important public health topic. The aim of this study is to establish the prevalence of suicide attempts in a general hospital setting and its association with alcohol, depression, and other factors. METHODS A cross-sectional survey of a sample of patients was carried out in all three service units (inpatient, outpatient, and the emergency room) of a general hospital in Mexico City. All patients were randomly selected to participate regardless of the reason for initial hospital admission. Each patient was administered a series of psychological and demographic scales including the Beck Depression Inventory, the Beck Hopelessness Inventory, the General Health Questionnaire, a suicide assessment scale, a scale for alcohol consumption, and several measurements of alcohol-related problems. RESULTS The final sample was made up of 1,094 patients of both genders (68% women), aged 18-65 years. A lifetime prevalence of suicide attempts of 6.1% (95% confidence interval [CI] of 4.7-7.7%) was found. Multiple logistic regression was used to obtain estimations of the association between lifetime suicide attempt and other factors. Marital status, age, depressed mood, hopelessness, Goldbergs 30-item version of the General Health Questionnaire, and high levels of alcohol consumption were all associated with the suicide attempt. CONCLUSIONS Prevalence of lifetime suicide attempts was mainly related to being young, divorced, or widowed, and to feeling depressed, hopeless, and under undesirable psychological distress.

Characteristics of Mexican women admitted to emergency care units: alcohol consumption and related problems

OBJECTIVE This article describes the demographic characteristics and psychological differences in a sample of female heavy and non-heavy drinkers who attended three emergency services of the Mexican city of Pachuca, Hidalgo. MATERIAL AND METHODS A sample of patients seen at emergency services (ES) patients over the age of 18 was selected using ES admission forms. Twenty-five-minute, face-to-face interviews were conducted by a group of trained interviewers. Patients answered various questionnaires and scales to measure alcohol consumption and to provide information on variables that have proved to be related to female drinking. RESULTS Thirty-six women (5.2%) out of 717 of the total number of women were found to be heavy drinkers according to the TWEAK scale. This group of women had 2.3 times the risk of becoming depressed, 2.87 times the risk of taking other drugs, 1.95 times the likelihood of having been sexually abused and 1.57 times the risk of displaying suicidal ideation. CONCLUSIONS Data from this small analysis confirm international findings that problem drinking among females throughout the life cycle is linked to depression. As regards the screening instruments employed, it is necessary to conduct more in-depth research to enrich their contents and increase their reliability and validity when used among female populations. In this study, the TWEAK proved to be extremely useful for studies in emergency services.

Disyuntivas en las Concepciones sobre Autonomía y Beneficencia que Afectan la Terapéutica del Intento Suicida

The aim of this study is to know the conflicts between beneficence and autonomy principles present in physician-patientrelationship during therapy of suicidal attempt.Research was carried out in two psychiatry hospitals of the city of Mexico. The sample included three subjects with suicidal attempt,older than 18 years, attended as outpatients for an injure self inflicted last year, and three psychiatrists treating these patients.Information was obtained by individual interviews with previous informed consent. An argumentative discourse analysis was carriedout to find meaning given by participants to bioethics principles and possible conflicts between them.Conflicts between beneficence and autonomy were related to the benefit of treatment, respect to patients values and beliefs, amongothers. This study present relevant ethical considerations in the clinical scenery, by offering to the psychiatrist a bioethical analysiswhich allows him/her to act according with beneficence while respecting the autonomy of the patient in cases of suicidal attemptand, in this way, to give them better attention.El objetivo del trabajo es conocer las disyuntivas entre los principios de beneficencia y autonomía, que se presentan en la relación médico-paciente, durante la terapéutica del intento de suicidio.La investigación se realizó en dos hospitales psiquiátricos de la Ciudad de México. La muestra incluyó a tres sujetos con intento de suicidio, mayores de 18 años, que eran atendidos en consulta externa a causa de una lesión autoinfligida en el último año, y a tres psiquiatras que trataban a estos pacientes. La información se obtuvo previo consentimiento informado en entrevistas individuales. Se llevó a cabo un análisis de discurso argumentado para encontrar los significados que los participantes otorgaron a los principios bioéticos y las posibles disyuntivas entre éstos.Las discordancias entre la beneficencia y la autonomía estuvieron relacionadas con el beneficio del tratamiento, el respeto por los valores y las creencias de los pacientes, entre otros. Este trabajo presenta consideraciones éticas relevantes en el escenario clínico, al ofrecer al psiquiatra un análisis bioético que le permita actuar de acuerdo con la beneficencia y respetando la autonomía del paciente frente a casos de intento de suicidio y, de esta forma procurar una mejor atención para ellos.

Ethnography in an emergency room: evaluating patients with alcohol consumption

OBJECTIVE To present an ethnographic description of the treatment of patients with excessive alcohol consumption in an emergency room, how they are evaluated by doctors, and the various contextual aspects surrounding this condition. MATERIAL AND METHODS The ethnographic work was carried out over a period of two months, with researchers working 24 hours a day, seven days a week from January 9 to March 15, 2002 in the emergency room (ER) at General Hospital, Mexico City. RESULTS Patients that had consumed alcohol and were admitted to the ER had to wait longer than others to be treated for their intoxication to wear off and for their sometimes aggressive attitude to become calm. The rejection of the alcoholized patients was expressed through scolding to persuade alcohol-dependent patients or those that abused alcohol to reduce their consumption. CONCLUSION The theoretical and methodological approach of the ethnographic observation enables reflection on the social and cultural mechanisms related to this health problem.

DISJUNÇÕES NAS CONCEPÇÕES SOBRE AUTONOMIA E BENEFICÊNCIA QUE AFETAM A TERAPÊUTICA DO INTENTO SUICIDA

The aim of this study is to know the conflicts between beneficence and autonomy principles present in physician-patientrelationship during therapy of suicidal attempt.Research was carried out in two psychiatry hospitals of the city of Mexico. The sample included three subjects with suicidal attempt,older than 18 years, attended as outpatients for an injure self inflicted last year, and three psychiatrists treating these patients.Information was obtained by individual interviews with previous informed consent. An argumentative discourse analysis was carriedout to find meaning given by participants to bioethics principles and possible conflicts between them.Conflicts between beneficence and autonomy were related to the benefit of treatment, respect to patients values and beliefs, amongothers. This study present relevant ethical considerations in the clinical scenery, by offering to the psychiatrist a bioethical analysiswhich allows him/her to act according with beneficence while respecting the autonomy of the patient in cases of suicidal attemptand, in this way, to give them better attention.El objetivo del trabajo es conocer las disyuntivas entre los principios de beneficencia y autonomía, que se presentan en la relación médico-paciente, durante la terapéutica del intento de suicidio.La investigación se realizó en dos hospitales psiquiátricos de la Ciudad de México. La muestra incluyó a tres sujetos con intento de suicidio, mayores de 18 años, que eran atendidos en consulta externa a causa de una lesión autoinfligida en el último año, y a tres psiquiatras que trataban a estos pacientes. La información se obtuvo previo consentimiento informado en entrevistas individuales. Se llevó a cabo un análisis de discurso argumentado para encontrar los significados que los participantes otorgaron a los principios bioéticos y las posibles disyuntivas entre éstos.Las discordancias entre la beneficencia y la autonomía estuvieron relacionadas con el beneficio del tratamiento, el respeto por los valores y las creencias de los pacientes, entre otros. Este trabajo presenta consideraciones éticas relevantes en el escenario clínico, al ofrecer al psiquiatra un análisis bioético que le permita actuar de acuerdo con la beneficencia y respetando la autonomía del paciente frente a casos de intento de suicidio y, de esta forma procurar una mejor atención para ellos.

Conflicts Between Autonomy and Beneficence Conceptions which Affect the Therapeutics of Suicidal Attempt

The aim of this study is to know the conflicts between beneficence and autonomy principles present in physician-patientrelationship during therapy of suicidal attempt.Research was carried out in two psychiatry hospitals of the city of Mexico. The sample included three subjects with suicidal attempt,older than 18 years, attended as outpatients for an injure self inflicted last year, and three psychiatrists treating these patients.Information was obtained by individual interviews with previous informed consent. An argumentative discourse analysis was carriedout to find meaning given by participants to bioethics principles and possible conflicts between them.Conflicts between beneficence and autonomy were related to the benefit of treatment, respect to patients values and beliefs, amongothers. This study present relevant ethical considerations in the clinical scenery, by offering to the psychiatrist a bioethical analysiswhich allows him/her to act according with beneficence while respecting the autonomy of the patient in cases of suicidal attemptand, in this way, to give them better attention.El objetivo del trabajo es conocer las disyuntivas entre los principios de beneficencia y autonomía, que se presentan en la relación médico-paciente, durante la terapéutica del intento de suicidio.La investigación se realizó en dos hospitales psiquiátricos de la Ciudad de México. La muestra incluyó a tres sujetos con intento de suicidio, mayores de 18 años, que eran atendidos en consulta externa a causa de una lesión autoinfligida en el último año, y a tres psiquiatras que trataban a estos pacientes. La información se obtuvo previo consentimiento informado en entrevistas individuales. Se llevó a cabo un análisis de discurso argumentado para encontrar los significados que los participantes otorgaron a los principios bioéticos y las posibles disyuntivas entre éstos.Las discordancias entre la beneficencia y la autonomía estuvieron relacionadas con el beneficio del tratamiento, el respeto por los valores y las creencias de los pacientes, entre otros. Este trabajo presenta consideraciones éticas relevantes en el escenario clínico, al ofrecer al psiquiatra un análisis bioético que le permita actuar de acuerdo con la beneficencia y respetando la autonomía del paciente frente a casos de intento de suicidio y, de esta forma procurar una mejor atención para ellos.