Scielo RSS <![CDATA[Salud mental]]> http://www.scielo.org.mx/rss.php?pid=0185-332520060004&lang=pt vol. 29 num. 4 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.mx/img/en/fbpelogp.gif http://www.scielo.org.mx <![CDATA[Tryptophan and serotonin in blood and platelets of depressed patients: Effect of an antidepressant treatment]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252006000400001&lng=pt&nrm=iso&tlng=pt Abstract: Platelets llave serotonin (5-HT) uptake and storage mechanisms similar to those from neurons. In addition, they represent nearly 99% of blood 5-HT concentration. For these characteristics, platelets are considered useful biomarkers of the serotonergic synaptic neurotransmission, particularly in psychiatric disturbances such as depression. However, most studies which have evaluated platelet 5-HT concentrations in depression have not shown similar findings. It has been suggested that changes in plasma tryptophan (TRP) concentrations might modify 5-HT concentration in the brain, as well as in platelets. Likewise, decreased plasma concentrations of TRP have been found in depressed patients, and the selective 5-HT reuptake inhibitors (SSRIs) induce changes in platelet 5-HT concentration. Considering the controversy surrounding platelet 5-HT concentrations in depressed patients, and the fact that blood 5-HT and TRP have not been studied in the Mexican population, we decided to study 5-HT and tryptophan concentrations in blood and platelets from depressed and control Mexican subjects to evaluate a possible correlation with the severity of depression. The effect of fluoxetine and citalopram treatment on blood and platelet 5-HT and TRP concentrations in depressed patients was also studied. Material and methods Depressed patients The patients of this study were carefully selected and evaluated. Scales based on semi-structured interviews were applied (MINI and SCID-II) by clinical investigators to reduce any possible bias in patient selection. The influence of the seasonal variability on the 5-HT or TRP blood concentrations was controlled by pairing depressed patients and healthy subjects according to age, gender and, in the case of women, menstrual cycle phase. Patients with a complete remission of depression symptoms (defined as a score not higher than 5 points in the Hamilton's scale, and lower than 7 points in Beck's scale) were asked for a blood sample to measure platelet and blood concentrations of 5-HT and TRP. The patients were weighted before the treatment and after their improvement. Control subjects The control group was integrated by 30 healthy subjects, 24 women and 6 men, with an average age of 32.3 ± 10.8 years. Participants were recruited from the overall Mexican population, interviewed by a psychiatrist, and evaluated with the structured interview MINI and the SCID-II, all these to discard any psychiatric diagnose. None of them had received any pharmacological treatment during the three weeks prior to the study. Control and depressed women were paired according to their menstrual cycle phase. All participants received a detailed explanation of the study, and those who voluntarily accepted the stipulations signed an informed consent document. Control and patient subjects were clinically examined and studied with routine laboratory tests (blood count, blood chemistry, urinalysis, and thyroid function test). Blood sample procedures 5-HT and TRP measurements in total blood preparation were carried out according to the method described by Anderson, and were quantified by high performance liquid chromatography (HPLC). Statistical analysis The differences were statistically determined through an analysis of variance (ANOVA), with the assistance of the SPSS 12.00 (Statistical Software by SPPS Inc.). Results Results from laboratory tests, such as blood count, blood chemistry, thyroid function (T3, T4 and TSH) and urinalysis were normal in depressed subjects, as well as in healthy volunteers. Platelet number, blood 5-HT concentration, platelet content of 5-HT, and blood tryptophan concentration showed no significant differences in depressed patients in comparison to control subjects. 5-HT values in blood and platelet were significantly lower than the initial concentrations in patients after antidepressant treatment. Discussion and conclusions Discrepancies between our study and those found in the literature can be explained with three different approaches: ethnical, physiological, and methodological, as is further discussed. The significant decrease produced by the antidepressant treatment in blood and platelet serotonin concentration may be a consequence of the action of SSRIs, due to a 5-HT diminished uptake by the platelet. Considering our results, we conclude that: Blood and platelet 5-HT concentrations were not different between depressed patients and healthy volunteers. Blood TRP concentrations were not different between depressed patients and healthy volunteers. SSRIs (fluoxetine or citalopram) used in the treatment of depressed patients induced a significant decrease in blood and platelet content of 5-HT, and had no effect in TRP concentrations. Based on these results, neither blood/platelet 5-HT nor blood tryptophan concentrations seem to be good biological markers of depressive patients status. However, 5-HT, but not tryp-tophan, might be a reference point for pharmacological treatment effect.<hr/>resumen está disponible en el texto completo <![CDATA[En torno al sentido del dolor]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252006000400009&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Abstract: Pain and suffering have always accompanied man. We find them in the most ancient myths and particularly in the Book of Genesis. Pain is apparently something innate in man and to a certain extent peculiar to him. This is clear when Yahweh tells the woman, "In sorrow thou shalt bring forth children" (Chapter 3, Vers. 16) and the man, "In the sweat of thy face shalt thou eat bread" (Chapter 3, Vers. 19) and not long before he had told him that from now on life would give him "thorns and thistles" (Chapter 3, Vers. 18). Now, how could man, who in Paradise lived in a state of full happiness, not know pain before his "fall", when he also had body, like the animals? Or is it perhaps a matter of different kinds of pain? One possibility of understanding this biblical assertion is to think that the mythical text refers to suffering and not to pain. We would share the latter with animals, while suffering would be peculiar to the human being. But it just happens that, as we will see later, the boundary between suffering and pain is very diffuse and there are pains that are neither the result of action of an external agent nor identifiable with suffering (due to something lost, for example). Alfred Prinz Auersperg, disciple and collaborator of Viktor von Weizsácker in the development of the Circle of the Form's Theory (Gestaltkreis), published in 1963 a book entitled "Pain and painfulness", where he clearly distinguishes two types of pain, sensation-pain and feeling-pain. The former is more localized, abrupt in its presentation and passes without leaving traces. Examples of this kind of pain are those caused by a stabs or burns. The latter is more diffuse and comes about gradually. It is the case of migraine, of the irritable bowel syndrome, of lower back pain, etc. This second type of pain is common in psychic diseases, particularly in depression. In its masked forms, the enti-re syndrome revolves round the painful experience, with the alteration of patient's mood and vital rhythms trapped in a sort of semi-darkness. Moving up from the most somatic, now we should ask ourselves about the role of pain as suffering in depression. Here we see a sort of paradox, because the facies of the depressive patient represents in a way the maximum expression of suffering, but at the same time one often hears these patients complaining about a freezing of emotions, an inability to feel and thus to suffer and so, some come to believe they are incapable of loving their children, their spouses or their lovers. The difficulty we experience when trying to apprehend vital feelings is really that of separating our-selves from them, because they are continuously determining what we are thus our way of looking at the world. In pain, be it exteroceptive or interoceptive, it is the body that hurts. In suffering, on the other hand, what hurts is the meaning of what occurs to me. The two forms have at least two features in common: one is their pathic nature, that is, that they are outside forces that happen to us, they do not derive from our will like movement and action. The second feature is that both isolate, interrupt our commitment relationship with the world. Pain, because it causes a lose of body transparence and suffering, because the reason for it completely absorbs our attention. Count the former as a previous explanation to the question about the possible sense of pain and/or of suffering. We will try to give an answer to this question from two different perspectives: one historical and another hermeneutic. The latter consists of resorting to the later works of Rainer Maria Rilke, a poet who in his work has illuminated many contexts, but one in a masterful way: suffering and pain. For the ancient Semites pain was a consequence of sin, fault committed either by ourselves, by our ancestors or by our first parents (original sin). In New Testament pain occupies a central place in the life and death of Jesus Christ. By His sacrifice the human race has been redeemed and reconciled with God. The message of the cross eventually becomes a message of resurrection and of life. In consequence, for the Christian pain cannot but belong to the very essence of life. This conception was valid during the first nineteen centuries of Christian-Western civilization. Starting from the second half of the 19 Century, five discoveries will shake up the very foundation of this conception of the world: a) anxiety, described by Kierkegaard, b) evolution, Darwin's theory, c) power of economic forces described by Marx, d) the absurd, put forward by Nietzsche, and e) the unconscious, studied by Freud. Rapidly appeared secularization, the "death of God" and the oblivion of His Providence; then totalitarianisms, with the consequences known by all and now we are in the midst of postmodernity, with rampant technological development, the destruction of the environment, genetic manipulation and a false sense of freedom, where everything seems to be allowed, up to the point of living surrounded by the most extreme forms of obscenity. The author appeals then to the later poetry of Rilke to answer the question of the possible sense of pain. The author tries to make a hermeneutical analysis of some poems, that is to say, an interpretation as unprejudiced as possible, in the sense of allowing the text to speak for itself. Thus, for example, in Sonnet XIX from the First Part of the Sonnets to Orpheus, the poet says: "Pain is beyond our grasp, / love hasn't been learned, / and whatever eliminates / us in death is still secret. / Only the Song above the land / blesses and celebrates." According to Heidegger, this poem reveals to us the "co-belonging" of pain, of love and of death, an idea of which modern man remains oblivious. But we still have the song, there where the word and the music meet, a song that sanctifies and celebrates life and that will allow us to illuminate that "abyss of the being" where pain, love and death cobelong. In the second sonnet chosen, Number VIII of the first part, the poet says: "Only in the sphere of praise may Lamentation walk, / water-spirit of the weeping spring / who watches closely over our cascading / so it will be clear even on the rock / that supports the gates and altars". In these verses the nymph watches to ensure that the spring of our tears (of suffering) -which in turn constitute our "sediment", that is, our essence- is purified when passing or colliding with the same rock on which our temples are built. Later on he will assert that suffering and celebration, like thankful prayer to the gods, always go together. Toward the end of the sonnet this pain embodied in that being called the Lamentation by the poet is transformed into the true intermediary between men and gods. In the Ninth Elegy suffering appears as one of the highest values, together with love: "Ah, but what can we take across / into the realm? Not the power to see we've learned / so slowly here, and nothing thafs happened here. / Nothing. And so, the pain; above all, the hard / work of living; the long experience of love - / those purely unspeakable things." Seldom has pain been so exalted. It is much more important than everything seen, heard or experienced, more than everything done and consummated throughout life. And the only thing that is at the level as pain is "the long experience of love". The idea of the transcendence of pain appears again in the Tenth Elegy, that represents the culmination of the cycle and whose subject is precisely the transit from this world to the next: "And then how dear / you'll be to me, you nights of anguish. / Sisters of despair, why didn't I kneel lower / to receive you, surrender myself more loosely / into your flowing hair. We waste our sufferings...". And further on the poet shows us that pain constitutes the ultímate sense of human existence: "... But they' re nothing more / than our winter trees, our dark evergreen, one / of the seasons in our secret years - not just a season, / but a place, a settlement, a camp, soil, a home". <![CDATA[Dependencia de los sistemas de memoria al ciclo luz-oscuridad en la expresión de estrategias adaptativas. Primera parte]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252006000400018&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Abstract: The ability to abstract, store and recover information from the environment in order to generate new strategies to solve problems is one of the most important qualities of the human brain. We mean by strategy, the sophisticated way to solve a problem. A strategy represents in essence the refinement of a given behavior to solve a problem. A strategy could be generalized to solve different problems. The generation of strategies is subjected to the correct functioning of the brain, meaning, alertness, attention, memory among others brain processes in good stand. In this work we focus on the role of memory in the generation of strategies. In this context, we focus on the literature concerning to memory systems, to show that different memory systems process and store different kinds of information. Therefore, the generation of a given strategy would require the participation of one system instead of other, or at least, one system would be commanding over the others. A memory system is defined as neural network consisting on a central structure communicated through afferences and efferences with others. The ones conveying information to this central structure would provide information from the internal or external environment to be interpreted and stored; while the ones that receive information from the central structure would execute its commands. Curiously, the role of central structure can be played by one structure "A" that in other conditions was under the control of a structure "B". In this condition, "B" is under the control of "A". In this review we sought to describe the anatomic and physiologic basis of the memory systems and their participation in the expression of strategies for the solution of specific problems. In this first part, we review the literature concerning to the hippocampus and striatum. Our endeavor was to make a synthesis of the main components of the functional neuroanatomy of memory and of its specific participation in the generation and expression of strategies, and also of the influence of the light-dark cycle on the strategies resulting from the interaction of these structures. In this review we focus mainly on the basic description of memory systems and on the data obtained from intact rats and of others with lesions and subject to electrophysiological experiments. Many studies reviewed on this first part confront subjects to situations where different solutions can be performed; basically this studies are conducted on mazes were the subject can use different kinds of information for spatial orientation. Depending on the nature of the information available or selected by the subject, investigators may infer the kind of strategy the subject is using to solve the problem. From this background, concepts such as stimulus-stimulus strategy and stimulus-response strategy have been generated. The first one consists of making associations between neutral stimuli, to make a conceptual map that guides the subject toward his/her objective. It has been related with the hippocampus function and it has been classically related to the processing, interpretation, and storage of contexts and events as well as to spatial navigation. We center our attention on studies carried out in mazes, showing that lesions or temporal inactivation of the hippocampus disturb the capacity of orientation by using spatial cues. We also review studies where the expression of spatial strategies is correlated with preferential activation of hippocampus detected with different techniques such as immuno-histochemistry and mycrodialisis in vivo. The stimulus-response strategy, on the other hand, consists on making associations between a particular stimulus and the immediate consequence of its presence. This kind of strategy has been related with the striatum, particularly with its dorsolateral region. For this section we discuss studies where lesions or inactivation of the dorsolateral striatum were performed, on rats submitted to tasks where the solution could be achieved by using stimu-lus-stimulus or stimulus-response strategy. In subjects with striatal dysfunction the ability to perform using a stimulus-response strategy was disrupted but not the ability to use a stimulus-stimu-lus strategy. In addition, we revise studies where the expression of the stimulus-response strategy is correlated with a preferential activation of the striatum over hippocampus. We additionally discuss the interaction hippocampus-striatum to solve a spatial task. We make special emphasis in describing the hippocampal and the striatal systems as independent systems that process and store different kinds of information; therefore, they seem to alternate their activity depending on the demand of the environment. This means that if a stimulus-stimulus strategy is required, the hippocampus will govern the response of the subject, increasing its activity that will be over the activity of the striatum. The opposite will occur if a stimulus-response strategy is required. Studies in humans and rats have been performed to understand the interaction between hippocampus and striatum with similar results. Apparently hippocampus appears more active during the first stages of learning, leading behavior and being expressed as stimulus-stimulus strategy. Later, in learning, the hippocampus decreases in activity and the striatum increases, thus becoming the leader structure. This later activation of stria-tum has been related with the phase of learning when the task is mastered and is starting to become a habit. Finally, we devoted special interest to describe the influence of the light dark cycle over these systems and over the goal-oriented behavior. And as we will see on the second part of this review, the functioning of these structures may be regulated by the light-dark cycle. We will review the influence of the presence or absence of light on neurotransmitters release. We will give evidence indicating that the neurochemical modulation depends greatly on the influence of the light-dark cycle and that it results obviously in a different activity of these structures and hence the behavior. In conclusion, when a subject is confronted with a specific problem, he/she can find the solution by using different strategies. At present, we can not say which are the mechanisms responsible for the selection of a particular strategy at a given mo-ment, but we can say that the expression of any strategy depends on the activity of structures such as the hippocampus and the striatum. In theory each structure represents a memory system or a fundamental part of a memory system. The interaction of the different memory systems, produce a scenario were each system provides, processes, and stores different information about the environment, and this information is useful to generate and exhibit a given strategy. On the second part of this review we will focus on the func-tioning and participation of the amygdala and prefrontal cortex, and the influence of the environment on the memory systems. <![CDATA[<strong>Sincronización luminosa. Modelos y alteraciones de la sincronización luminosa. Segunda parte</strong>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252006000400025&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Abstract: The ability to abstract, store and recover information from the environment in order to generate new strategies to solve problems is one of the most important qualities of the human brain. We mean by strategy, the sophisticated way to solve a problem. A strategy represents in essence the refinement of a given behavior to solve a problem. A strategy could be generalized to solve different problems. The generation of strategies is subjected to the correct functioning of the brain, meaning, alertness, attention, memory among others brain processes in good stand. In this work we focus on the role of memory in the generation of strategies. In this context, we focus on the literature concerning to memory systems, to show that different memory systems process and store different kinds of information. Therefore, the generation of a given strategy would require the participation of one system instead of other, or at least, one system would be commanding over the others. A memory system is defined as neural network consisting on a central structure communicated through afferences and efferences with others. The ones conveying information to this central structure would provide information from the internal or external environment to be interpreted and stored; while the ones that receive information from the central structure would execute its commands. Curiously, the role of central structure can be played by one structure "A" that in other conditions was under the control of a structure "B". In this condition, "B" is under the control of "A". In this review we sought to describe the anatomic and physiologic basis of the memory systems and their participation in the expression of strategies for the solution of specific problems. In this first part, we review the literature concerning to the hippocampus and striatum. Our endeavor was to make a synthesis of the main components of the functional neuroanatomy of memory and of its specific participation in the generation and expression of strategies, and also of the influence of the light-dark cycle on the strategies resulting from the interaction of these structures. In this review we focus mainly on the basic description of memory systems and on the data obtained from intact rats and of others with lesions and subject to electrophysiological experiments. Many studies reviewed on this first part confront subjects to situations where different solutions can be performed; basically this studies are conducted on mazes were the subject can use different kinds of information for spatial orientation. Depending on the nature of the information available or selected by the subject, investigators may infer the kind of strategy the subject is using to solve the problem. From this background, concepts such as stimulus-stimulus strategy and stimulus-response strategy have been generated. The first one consists of making associations between neutral stimuli, to make a conceptual map that guides the subject toward his/her objective. It has been related with the hippocampus function and it has been classically related to the processing, interpretation, and storage of contexts and events as well as to spatial navigation. We center our attention on studies carried out in mazes, showing that lesions or temporal inactivation of the hippocampus disturb the capacity of orientation by using spatial cues. We also review studies where the expression of spatial strategies is correlated with preferential activation of hippocampus detected with different techniques such as immuno-histochemistry and mycrodialisis in vivo. The stimulus-response strategy, on the other hand, consists on making associations between a particular stimulus and the immediate consequence of its presence. This kind of strategy has been related with the striatum, particularly with its dorsolateral region. For this section we discuss studies where lesions or inactivation of the dorsolateral striatum were performed, on rats submitted to tasks where the solution could be achieved by using stimu-lus-stimulus or stimulus-response strategy. In subjects with striatal dysfunction the ability to perform using a stimulus-response strategy was disrupted but not the ability to use a stimulus-stimu-lus strategy. In addition, we revise studies where the expression of the stimulus-response strategy is correlated with a preferential activation of the striatum over hippocampus. We additionally discuss the interaction hippocampus-striatum to solve a spatial task. We make special emphasis in describing the hippocampal and the striatal systems as independent systems that process and store different kinds of information; therefore, they seem to alternate their activity depending on the demand of the environment. This means that if a stimulus-stimulus strategy is required, the hippocampus will govern the response of the subject, increasing its activity that will be over the activity of the striatum. The opposite will occur if a stimulus-response strategy is required. Studies in humans and rats have been performed to understand the interaction between hippocampus and striatum with similar results. Apparently hippocampus appears more active during the first stages of learning, leading behavior and being expressed as stimulus-stimulus strategy. Later, in learning, the hippocampus decreases in activity and the striatum increases, thus becoming the leader structure. This later activation of stria-tum has been related with the phase of learning when the task is mastered and is starting to become a habit. Finally, we devoted special interest to describe the influence of the light dark cycle over these systems and over the goal-oriented behavior. And as we will see on the second part of this review, the functioning of these structures may be regulated by the light-dark cycle. We will review the influence of the presence or absence of light on neurotransmitters release. We will give evidence indicating that the neurochemical modulation depends greatly on the influence of the light-dark cycle and that it results obviously in a different activity of these structures and hence the behavior. In conclusion, when a subject is confronted with a specific problem, he/she can find the solution by using different strategies. At present, we can not say which are the mechanisms responsible for the selection of a particular strategy at a given mo-ment, but we can say that the expression of any strategy depends on the activity of structures such as the hippocampus and the striatum. In theory each structure represents a memory system or a fundamental part of a memory system. The interaction of the different memory systems, produce a scenario were each system provides, processes, and stores different information about the environment, and this information is useful to generate and exhibit a given strategy. On the second part of this review we will focus on the func-tioning and participation of the amygdala and prefrontal cortex, and the influence of the environment on the memory systems. <![CDATA[Principios generales sobre la psicofarmacoterapia en niños y adolescentes. Una revisión.]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252006000400030&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Abstract: The work of Charles Bradley done in 1937, which reports the effects of Benzedrine in 30 pediatric patients that had behaviour problems, is a classic document considered by many as the beginning of child psychopharmacotherapy. In spite of a coordinated effort made by the National Institute of Mental Health in the United States carried out by a panel, called "Conferences on Infantile Research in Psychopharmacology", for many years this practice kept being inarticulate. Psychopharmacotherapy in adults with psychiatric diseases has had a different development. During the decade of 1950 substances such as chlorpromazine and tricycle antidepressives started to be used in clinical practice and between 1980 and 1990 new products were developed for treating schizophrenia, depression and mania. Even if there is no such as the "ideal drug", the new psychopharmacological developments have allowed patients to have a better quality of life. In pediatric population the difficulty to conduct controlled clinical tests has been a constant; for this reason the practice of child psychopharmacotherapy keeps facing challenges; also, in the United States several very strict norms have been dictated in order to endorse the security and efficacy of a product for infantile use. Other problems faced today in clinical practice are the excesive use of medications for minors prescribed by people without enough practice and academic information, and also the deficient therapeutic results provoked by wrong prescriptions. But the worst of all are the false promises made to relatives and patients, on the usage of products or substances that have not been tested by a rigorous scientific scrutiny, specially concerning diffused clinical problems such as the Attention Deficit Hyperac-tivity Disorder (ADHD) or Autism. These facts, most of all, determine the rejection and fear for medications and become an adverse variable that we must face continuously. The main objective of this work is to make a review about the general principles that are suggested for a good psychopharmaco-therapy on children and teen-agers, a practice that must always be part of a planned multimode treatment that follows an adequate paidopsychiatric evaluation. A right diagnose will always be important for the appropriate selection of the medication. The development of taxonomies such as those described in the Mental Disorders Statistics and Diagnostic Manual of the American Psychiatric Association or by the International Classification of Diseases of the World Health Organization, have allowed the existence of an order in the ela-boration of paidopsychiatric diagnosis, that even if being mainly descriptive, allow to make a more structured clinical work. The parameters for the psychiatric evaluation of children and teen-agers recommended by the American Academy of Child and Adolescent Psychiatry (AACAP) in 1997 is an example of the importance that proves the attention on minors, its objective is to give a guide without pretending to make it a golden standard. The selection of a medication must be based on two premises: a diagnose of the disorder itself, and on the other hand, the recognition of target symptoms. Considering this interrelation will allow a more acceptable evaluation on the risks and benefits of a phar-macological prescription for children and teenagers. Thus pediatric psychopharmacotherapy must be based on the correlation between the actions and effects of drugs and the biochemical and evolving aspects of the disorder, but it will also be necessary that the professional be aware of the changes that inevitably will take place in the dynamic of absorption, distribution and elimination of the medications according to the stage of the biological child's development. When someone deals with very small children, it is almost impossible for the child psychiatrist to get direct information as it is for children to understand the information that the expert would pretend to give them. This constrains to consider the cognitive and verbal realities proper of each stage of the development, so the direct evaluation of the small patient must be complemented with reports of a multi-informers system. It will be fundamental to consider also that small children have little differentiated emotions and that it must not be ignored that for them concepts such as time and space are difficult to understand. Clinical exploration through recreational activities will be a primordial tool in the daily work with children. It will also be recommendable that the plan of the treatment be organized jointly with the parents of the minor in order to inform them completely about the goals and objectives of the prescription of a drug; the participation of the small patient must be included too. It must not be forgotten that the pharmacological treatment is part of a more integral attention program in which other experts must participate, such as pedagogues, clinical psychologists or language therapists, a fact that will be more common than irregular. The therapeutic adherence is a variable that must be constantly checked. If it is carried out irregularly or the wrong dose of the recommended drug is taken, the presence of symptoms as a result of the abrupt interruption of the medication could be confused with the adverse collateral effects, which would make worse the clinical condition. Pediatric patients must have a complete medical history complemented by a physical and neurological evaluation, which must be included in the registry of vital constants as well as size and weight of the minor; other registers could be more convenient if they are considered to be needed. The support on laboratory surveys plays an important roll and at the present time the recommendation for making an electro-cardiography evaluation previous to the administration of some drugs is more accepted; in this sense it is undoubtedly important to consider the recommendations proposed by the American Association of Cardiology for monitoring the cardiovascular function of children and teen-agers who receive medications after prolonged periods of time. Polypharmacy is a common practice; due to this fact, the interaction between drug/ drug must be carefully valued. The child psychiatric evaluation must be made with the support of structured or semistructured interviews for the clinical diagnosis and with evaluation scales for measuring the severity of the specific symptoms or global clinical conditions. The strategy for choosing a plan of pharmacological treatment for the pediatric patient must be made individually; in this sense, the development of algorithms for the administration of medications on children and teenagers has been the result of many efforts in order to make prescriptions more rational and neat. The revision of controlled clinical tests on the efficacy and security of these agents in the pediatric population is fundamental for the election of a prescription. The responsibility of the professional that prescribes a medication devolves on structuring a plan of formal treatment and an individualized monitoring according to the stages of the treatment (beginning, maintenance and interruption ). As it is expected, the expert must reach the maximum therapeutic benefit in a child or an adolescent with the minimum of collateral effects, evaluating always the risk and the benefits. Some authors recommend the prescription of drugs on children and teen-agers only for short periods of time as the nondesirable effects in long terms are not quite well known. There are no specific times for stopping the administration of a drug. However, it is recommended that during the stages of the treatment, clinical changes in minors be watched and registered rigorously, in order to be able to reduce or stop the dose in the appropriate moment, even in cases of clinical conditions such as schizophrenia, depression or development generalized disorders. The main objective of this clinical work will be that the quality of life of the minor becomes optimum. <![CDATA[Aptitud clínica de los médicos familiares en la identificación de la disfunción familiar en unidades de medicina familiar de Guadalajara, México]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252006000400040&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Abstract: Introduction Families function as dynamic systems, where the different members stimulate each other to achieve common objectives. Family development is thus conceived as a chain of changes, in form and function, which follow evolution stages. The balance of positive and negative forces inside the family is translated into an evolution, and so the ability to respond to internal or external changes is vital to avoid discrepancies or clashes between the tasks and roles of the different family members. In this sense, family physicians must be able to identify any potential dysfunction or difficulty inside the family, and to facilitate the compatibility of tasks in order to reestablish the continuity and good functioning of the family. The family physicians' clinical aptitude is made up of a series of abilities intended to identify any signs and symptoms of dys-function. They must also be skilled in using auxiliary resources for the diagnosis and treatment of all these. Such an aptitude is measured by a structured and validated instrument. Material and methods This is an observational, prospective and comparative research of a 450 family physicians sample from 23 first level family health care medical clinics from the National Social Security Institute (Instituto Mexicano del Seguro Social: IMSS). All family physicians working at the clinics were included, excepting those who were at the time on vacation, worked the night shift, attended the ER, were absent or refused to participate. Clinical aptitude for family dysfunction was measured in three areas: 1. Identification of risk factors for family dysfunction; 2. Diagnosis with an integral point of view and 3. Proposal, identification and guidance, which describes a physician's ability to judge decisions taken on case reports and to propose alternative actions. Other variables taken into account were sex, age, specialty, years of experience, shift, clinic and type of contract. Instruments. The instrument was designed to integrate theory and practice. It was conformed by real case reports, which were condensed, divided in sections, and followed by a series of ques-tions with three possible answers: «true», «false» or «I don't know». In total, there were 187 questions, 94 of which were true and 93, false. Correct answers accounted for one point, while incorrect ones rested one point; «I don't know» answers had no effect on the results. There were 42 lines to explore risk factors; 24 to explore the use of diagnostic resources; 19 to explore the use of therapeutic resources; 36 to evaluate a physician's knowledge of family sociology; 42 to assess family psychology, and 24 designed to evaluate proposal abilities. It was all validated and standardized with a group of post-graduate medical residents in Family Medicine from Mexico City. The Richardson K index was 0.90. Clinical aptitude was measured using an ordinal scale, where a random level «1» was defined by &lt;60 points; a low «2» level by 60-99 points; an intermediate «3» level by 100-139 points, and a high «4» level by &gt;140 points. A descriptive and inferential statistical analysis was used with median, percentage, Mann-Whitney's and Kruskal-Wallis' tests. All this was then processed with the EPI INFO-6 and SPSS Plus software packages. Ethical considerations. This is a risk-free research, as established in the Health Research section of the Mexican Health Law. Ne-vertheless, a signed acceptance form was required from all participants. Results Table 1 shows the general characteristics of the study sample. In turn, table 2 presents clinical aptitude to identify family dysfunction, sorted by clinic. Clinics B and D had, respectively, a median of 105 and 102, with similar ranges. There were no statistically significant differences among the subindexes of each clinic. The diagnosis median was higher than that for guidance. Table 3 reveals a high level of clinical aptitude in 3% of the physicians, an intermediate level in 25%, a low level in 58%, and a random-defined level in 14%. There were no significant differences when clinical aptitude was correlated with sex, shift, type of contract, specialty and years of experience. Discussion. The main objective of a family dysfunction diagnosis is to reestablish the normal flow of a family's vital cycle with the support of a specialized physician. It has been reported that clinical aptitude measurement is useful to discriminate and establish the aptitude level of experiment and non-experiment physi-cians with the aim of creating educational opportunities. A slight advantage, with no significant difference, was appreciated in physicians who attended patients in their offices, which suggests they are in a better position to gain a higher level of trust from their patients. This is due to the fact that they attend a regular set group of patients assigned to their offices. Since the education of family physicians is aimed at offering an integral care to families, family dysfunction recognition is essential. Results also suggest a non-significant advantage from family physicians with curricular education (not all family physicians working at the IMSS have a degree in Family Medicine). Experienced physicians (10 to 19 years on the job) showed another non-significant advantage, which pointed to the value of clinical practice. This is a powerful reason to promote continuous educational programs for family physicians. Family physicians who worked the morning shift showed a non-statistical advantage over their afternoon shift counterparts. This could be explained by the fact that educational and other institutional activities are more likely to take place in the morning. The educational model of family physicians should promote the physicians' involvement in understanding how to become active elements in gathering their own knowledge. Such a model should promote physicians' initiatives for the development of an experience based on constructive critic. The current health care model is mainly focused on a biological interpretation of the health-disease process. However, this is only a partial approach which prevents the implementation of an integral clinical practice. From our research, we expect changes in institutional health care orientation and a reframing of the curricula of general and family physicians'. Although the acquisition of clinical aptitude requires the physicians' experience and involvement in developing their own knowledge, our results do not reflect this ideal condition. This is due to the low percentage of clinical aptitude, which correlates with an evident inability for research and interpretation. Half of the physicians were capable of elaborating diagnostic hypothesis and two thirds of them showed a adequate use of diagnostic resources, such as clinical tests, functional family diagnostic instruments and a guide to conform an integral family workup. All these should be useful educational tools to establish the social functions diagnosis of a family's members, together with their formal and informal roles and their importance in the healthdisease process. Guidance requires the ability to judge decisions taken by other professionals and make suggestions for alternative actions in case reports. This latter skill includes the use of therapeutic resources for only less than half of the physicians know how to properly use these resources. The use of instruments to measure aptitude, competency and work performance is a growing practice in continuous education and human resources formation. Even though these instruments are capable of discriminating high clinical aptitude, they cannot be used to account for this non-significant advantage, because educational activities are conceived as the consumption of infor mation and not as the acquisition of it from each one's experience. Overall, 58% of the family physicians showed a low level of clinical aptitude. Such a result reflects a poor ability to integrate daily experience. <![CDATA[La adicción ¿vicio o enfermedad? Imágenes y uso de servicios de salud en adolescentes usuarios y sus padres]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252006000400047&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Abstract: Introduction Through time, the concept underlying drug consumption has been a matter of much controversy in the health sciences field. Here, it has been referred to using different definitions, but society seems to perceive it mostly as a vice, associated to socially unacceptable behavior. The addiction-vice notion implies a moral concept which goes beyond health issues and induces affective reactions that seem to hinder the use of health care services. In contrast, when addiction is considered as a disease and the inability to control consumption is acknowledged, it all seems to lead to an intervention meant to solve the problem. Does the temí "addiction" -as used by drug users to refer either to a disease or vice- have any influence on stopping or promoting the use of health care services? And if so: Which are the cognitive processes supporting the images of addiction-vice and addiction-disease? Reports from different studies agree on the fact that adolescents and their parents only look for the help of health care services when they feel frustrated because they find themselves unable to control the drug use and feel at risk because of certain beliefs, attitudes or intentions. The study of images comes from the socalled "French social psychology", where Moscovici proposed using the concept of images to define a more complex and logical structure than that of attitudes and/or evaluation results. He considers images as an inner representation of an external reality, as constructions similar to visual experiences: a sort of mental sensations or impressions of objects and persons. According to him, images persist because they are lodged in the memory where they reinforce the sense of both a continuity of the environment and individual and collective experiences. From this theoretical perspective, the following were the aims of this study: to describe addiction-related images built both by adolescent users of illegal drugs, who were undergoing treatment at the time, and their parents. Method Based on the theory of social representation, a qualitative study was devised. The sample was composed by fifteen 13 to 19 year-old adolescents, who were users of multiple illegal drugs and were undergoing treatment in the Centros de Integración Juvenil in Guadalajara, Jalisco, Mexico, in 2002, together with their respective accompanying parents. The data were compiled using in-depth recorded interviews. The interpretations consisted of thematic encoding, classification and interpretative analyses. Ethical steps were taken in order to protect the participants' identity and to obtain their informed consent. Results In the accounts of both the adolescents and their parents, addiction was consistently referred to as a vice. Here, the voluntary use pathway put forward by the subjects' stood out; so, a voluntary decision would also be required to stop using drugs. In addition, parents perceived addiction as something wrong. Only when drug users started having drug consumption-related difficulties, was this redefined as a problem that they could not solve by their own means. It is worth mentioning here that adolescents did try to avoid the influence of friends and the environment when using drugs. Parents thought willpower alone would suffice to stop their offspring from using drugs. This was so because parents were not sensitive enough to the influence of tolerance and abstinence regarding the problem. Consequently, there were reasoning processes that redefined addiction as a problem needing the help of specialists. This cognitive re-definition turned the image of addiction-vice into that of addiction-disease. On the one hand, to look for help in the health care services under the stigma of the vice image meant to be openly recognized as a dissolute person and to be thus socially excluded. On the other, having a disease implied the possibility of solving the mistake of drug-taking and thus being rehabilitated and reinserted into a productive life. Nevertheless, in the addiction-disorder image, drug consumption-related problems still prevailed, such as the inability to control using drugs, together with family, school and work problems. Redefining addiction as a disease did not seem to be stable or permanent in their minds for there were still traces of the vice image. This finding suggests the disease image acted as a sort of link between addiction-vice and the access to treatment when trying to stop the use by their own means failed. Instead of rejecting the vice image, it seems that the subjects' appropriation of the disorder image represented by health care services in order to look for a specialized treatment was used as an important expectation. This was the case even when in their minds the use of drugs was a vice influenced by willpower and environment. Drugs and addiction-vice and addiction-disease are not antagonistic images in social reasoning, but are a part of a continuum where they coexist. Discussion Our findings show that the adolescents interviewed had in their minds an image of addiction-vice as a pathway to drug use. It was also an image where drug use-related problems appeared, and thus they defined addiction as a disease without completely disassociating it from the notion of vice. Although these findings agree partially with those reported on this matter, there is a more elaborated and useful construction giving the problem a continuance in society, and to which Moscovici referred to as "image". An image has three characteristics accounting for its stability, consistency and continuance in social groups: 1. marginal elements, such as beliefs, cognitions, and judgements, which act as safeguards to protect; 2. the key element of the image, which is in this case addiction as vice, and 3. the social function accomplished by the image. We believe that the latter is the most important characteristic, a feature which was also emphasized by Moscovici. According to the common sense of the adolescents and parents under study, the function of the addiction-vice image was to reject a behavior considered deviant from accepted social norms. On the other hand, we detected that the addiction-disease image was not stable in the social mind, because this was not an image made up by the population under study, but one that they had appropriated and where health services were included. It is a construction circulating outside these particular social actors, and which is appropriated to carry out the purpose of gaining access to treatment. The images composing the voluntary use pathway seem to be antagonistic and mutually excluding, and they seem to coexist in the mind's continuum when addiction is redefined as a problem deserving help. Consequently, using drugs can be at times viewed either as a vice or disease, or vicedisease, depending on the purpose it fulfills in a given situation. Only common sense can accept such exclusions and alternations, because the reasoning underlying it does not need any verifications regarding its validity. From this viewpoint, addiction represents a big challenge for health services because of the several elements it involves. Results from this study point out to the reasoning used to examine the ideas of both the adolescents and their parents and to explain decisions regarding drug use. The degree of knowledge about the way these individuals think, communicate and take decisions will enable health services professionals to develop more efficient interventions. To a certain extent, we believe the reasoning behind the vice image is accurate enough because, although the use pathway was voluntary, willpower is also important to stop consumption and look for help in the health care services. Finally, we think that it would be appropriate to study these images in populations from other regions in order to evaluate if the same or similar images prevail or not. Further research of these images would help to develop longitudinal studies which would also evaluate, on the one hand, the images through the therapeutic process and, on the other, their link with the effectiveness of any given treatment. <![CDATA[Síntomas depresivos en el embarazo y factores asociados, en pacientes de tres instituciones de salud de la ciudad de México]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252006000400055&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Abstract: Background Depression is a frequent condition in pregnancy, at least as frequent as it is among non-pregnant women. Studies on its prevalence show rates from 2% to 21% of major depression and 8% to 31% of depressive symptomatology. In Mexico, a prevalence of 22% has been estimated on the basis of a self-report scale. Risk factors for depression in pregnancy include previous history of depression, parental separation during childhood, single mother-hood, not wishing to be pregnant, lack of social support and low educational attainment. Objective Due to the consequences of depression on pregnancy and to the scarce studies available in Mexico, the aim of this study was to examine the presence of depression in pregnant women as well as the risk factors associated with the latter. Material and methods Three hundred pregnant women receiving ante-natal care were interviewed in the waiting rooms of three institutions (one third level hospital, a health center and a clinic specializing in women). The instrument included a scale of depression (CES-D) and the following risk factors: previous depression symptoms, parental separation before the age of 11, possible depression and problem-atic alcohol consumption in expectant motliers parents, unplanned pregnancy and lack of social support. Results A total of 30.7% of the interviewees showed significant depressive symptomatology (CES-D &gt; 16). Fifty-nine percent mentioned having suffered from depressive symptomatology in the past. Some degree of disability in the past month was reported by 19% of those that mentioned depression symptoms. The mean number of days they stopped performing their everyday activities was 11.21 (SD = 10.68) with a range of 1 to 30 days. Seven women (21.2%) stated that they could not engage in their activities because of their depression every single day of the past month. As for suicidal ideation at any time in their lives, the following symptoms were displayed: half said that they had thought a great deal about death, a quarter said that they had wanted to die, nearly a fifth had intended to take their own life and 7.7% had injured themselves in order to take their own lives. During the previous month, the frequency of these behaviors had considerably declined, almost to zero, and only "thinking frequently about death" was common (18%). The variables associated with depression symptoms (CES-D) were: previous symptoms of depression (t = -4-40, p &gt; 0.000), separation from the father before the age of 11 (t = -2.68; p &gt; 0.008), possible depression in mother (t = -3.24, p &gt; 0.001), possible depression in father (t = -2.41, p &gt; 0.016), problematic alcohol consumption in father (t= -2.23, p &gt; 0.040), unplanned pregnancy (t=-2.43, p&gt;0-015), lack of emotional social support (t = 2.87, p &gt; 0.005) and lack of practical social support (t = 2.94, p &gt; 0.005). The evaluation of a risk model of these factors on depressive symptomatology through logistic regression (with the step-by-step method) showed that the following variables were significant: possible depression in the mother (of the expec-tant mother) which increases the risk of displaying depression in pregnancy 0.8 times, previous depressive symptomatology, which increases it 1.08 times, lack of practical social support, which increases it 1.71 times and not having a partner, which increases it 1.51 times. Discussion and conclusions The results, as regards mental health, showed that depressive symptoms occured in nearly a third of pregnant women; this percentage is higher than the 22% found in Mexico in previous studies. Although this symptomatology does not necessarily meet the criteria for major depression, it has been considered to be of sufficient clinical importance, as it has been associated with disability, psychiatric and physical co-morbidity; demand for treat-ment for and risk of future depression and in this case, with post-partum depression. A fifth of the subjects displayed more serious symptomatology in terms of disability, as the women mentioned not being able to engage in their everyday activities, working or studying. The mean number of days in which they were unable to carry out their activities was eleven during the previous month. This data suggests that this population with greater pathology should be detected and referred for specialized mental care by antenatal care services. Suicidal ideation during the previous month decreased considerably, in comparison with that reported at any time in theit lives, which agrees with reports that state that self-damaging behaviors and suicide attempts tend to be very low during pregnancy. As for pathological antecedents, 59% considered that they had suffered from depressive symptomatology in the past, in addition to having experienced suicidal ideation to varying degrees. It is significant that nearly 8% had previously attempted suicide. Both, previous depressive symptomatology and suicidal ideation in the past, were associated with current depression symptoms in the expectant mother, as has been reported in other countries. Unplanned pregnancy was also related to depression (CES-D). As literature suggests, not wishing to be pregnant is related to this disorder and although not planning a pregnancy is not synonymous with not wishing for it, according to these data, lack of planning also increases depressive symptoms. Among childhood situations, parental separation or loss of the father before the age of 11 was a significant variable as regards symptomatology in pregnancy; this was similar to what other authors have reported. Separation from the mother was not related to these symptoms, contrary to what other studies have reported in both pregnant and non-pregnant women. Adversity in childhood in the form of parents' mental pathology or substance use has been associated with depression among the general population. The results obtained here show a significant relationship between problematic alcohol consumption in the father and possible depression in the mother or father -as perceived by the interviewee herself- and depression symptoms in the expectant mother. During pregnancy and above all, post-partum, women have a real need to receive both emotional and practical support. This study, like others showed that the lack of this support increased the risk of depression. The construction of a model with some of these variables showed that being a single or divorced mother, having had a mother who may have been depressed, having displayed depressive symptoms in the past and the lack of practical support increased the risk of depressive symptomatology. By way of a conclusion, one can say that although there are similarities between depression in pregnancy and at other moments in women's lives, its presence during this period is particu-larly important due to the new demands the woman has to cope with and the adverse effects it has on the development of pregnancy, and the high risk of experiencing depression during the post-partum. Designing intervention programs for expectant mothers could have an enormous effect on improving the mental health of mothers and their babies, a reason why it is important to take into account the risk factors described in this study. <![CDATA[Características organizacionales, estrés y consumo de alcohol en trabajadores de una empresa textil mexicana]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252006000400063&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Abstract: There are different factors within work environment that could créate both wellbeing and distress in workers. The climate perception employees have, as well as their evaluation of some, could have positive and negative consequences at personal and organizational levels. Work stress is another element that has meaningful repercussions on the health of people and on the quality of their performance; it has been related to alcohol and psychoactive substances abuse, besides of an increase in different social and work problems. The main objective of this paper is to determine the relationship between organizational factors (such as work stress, organization climate, and work satisfaction) and alcohol use, and the occurrence of industrial problems and accidents in Mexican workers in a textile organization. Method In order to interfere as less as possible with the production process, this study was carried out at the facilities of the organization, during work hours and during weekends. Thus, only employees who attended to work these days were interviewed. The sample included 277 workers who basically performed as operative staff. No more organization characteristics are described on behalf of an agreement, and of the anonymity of the answers given by the subjects. All the interviewees were men, their ages fluctuated between 16 and 65 years, 85% of them had attained junior high school, and 72% were married or living with a partner. A self rated questionnaire was used, along with the AUDIT (alcohol use disorder identification test) alcohol test, a work stress scale, another scale for organization climate, one more for work satisfaction, and some general questions. All the scales had good internal consistency. The procedure consisted in gathering 20 workers in a well-ventilated and illuminated room. The interviewer, who was previously trained, read the instructions aloud, emphasizing anonymity and confidentiality of any information the workers give, and stating that no one from the company would have access to the data. Analyses were performed with statistical software SPSS 11.5. EQS 6.0 was used to test the structural equation model with the relationship between organizational factors, alcohol use and negative consequences at work. Results Organizational climate. Most of the workers (92%) perceived a good level of communication with the work group, 87.2% mentioned to receive help from the boss when they have to do an activity they are not familiar with, 78% said they have enough support to solve the problems related to work. There were differences between the workers according to education level; the ones with the higher level perceived a more adverse climate. There were differences also between shifts (morning, evening, and mixed); the workers from the first one perceived a less favorable climate. Work satisfaction. Most of the workers think of their job as something useful (95%), 93% said they liked it, and 88.3% mentioned their families are satisfied. There are statistical differences be-tween satisfaction and education levels; subjects who had only basic education were more satisfied than those with a higher level. The stress sources are related to the effort implied in the struggle to move forward (87.6%), to have too much work to do (60.5%), and to the possibility of an accident when subjects are careless (51.6%). The total scale scores indicated that 14.2% of the workers had high levels of work stress. Alcohol use: 61.7% of the workers consumed alcohol during the previous year. According to the AUDIT (using eight or more as a cutoff score) 25.8% were classified as cases for alcohol related problems; 26.5% of the subjects had risk consumption, and 5.3% were consuming in a dangerous way because of the frequency and the amount they drink. Work problems: 24.1% of the subjects mentioned they have invested more time than usual in some activity related to work, 21% have been told off because of their performance, 18% felt they could not achieve quality outcomes. The incidents that workers mentioned were: hand injuries (17.5%), finger injuries (15.7%), being close to suffer an accident (13.5%), and suffering damage or injuries when working (10%). A structural equation model allowed to observe that organizational factors, climate, satisfaction, and work stress are meaningful predictors of work accidents and problems. Of all the variables included in this analysis, work stress also was the one that best predicted alcohol use at the work place. A direct effect of the individual level of alcohol use and of the use at the work place on problems and accidents, was observed. This effect was not initially considered in the model of individual consumption, neither were the frequency, the amount consumed, nor the excessive use; it was necessary to add this direct path to adjust the model so they were observed as important elements. Discussion Interviewees perceived communication as an important climate issue, mainly when established with the work group. Another element mentioned as important was perceived, that is support from the boss or supervisor to solve problems. Education level has a relevant role in the way workers live their work climate; those with a lower level experience it as more favorable. This could be the consequence of higher work expectations related to a higher education level. There are differences among shifts; workers from the first shift experienced a more favorable climate. The model included climate as a meaningful element for the presence of consequences at work place; this had a direct effect over the existence of problems and the occurrence of accidents, it was opposite to the results observed in other studios were there was not a direct relationship. Work satisfaction has to do with job usefulness, the joy for the task done, and family satisfaction with the position. The education at level affects perception of work climate. This evaluation of the worker climate has been identified as a significant factor for the reduction of negative effects at work. It is necessary to mention that employees with a higher stress level are the married ones, which may be caused by the responsibilities implied in being a family supplier. This concurs with the result of a study on burnout, which found that being married is a risk factor to develop high stress. Work stress was the most predictive component of accidents and problems at the work place, which had a direct relation (0.50). It also directly predicted alcohol use at the work place (0.22), and had a negative statistical difference with climate (-.29). Thus, it is important to consider that when workers perceive a better climate, stress level goes down, and it is necessary to consider this organizational factor to improve work conditions besides employees' physical and mental health. According to the model tested in this study, alcohol use has a direct and meaningful effect on performance and on the frequency of problems and accidents, inside and outside the organization. It is important to consider that prevention in work places must be done globally, taking into account organizational factors such as climate, stress, and worker satisfaction. It also should include educative and practical elements that allow reducing excessive alcohol use and its negative consequences (poor performance, bad interpersonal relationships, and bad outcome quality) at work, besides reducing also industrial accidents. The most frequent work problems were as follows: to invest more time than necessary in an activity, to be told-off because of mistakes, and to have problems with the boss or supervisor. These events have an impact on productivity and represent money loss for the company. The most frequent accidents were as follows: hand injuries, which are related to heavy machinery operation, basic in the production process of this industry. This reflects the need to consider the physical aspects of the place where activities are performed, as well as the psychosocial factors affecting individuals, all of which will result in benefit of any organization.