Scielo RSS <![CDATA[Salud mental]]> http://www.scielo.org.mx/rss.php?pid=0185-332520080001&lang=pt vol. 31 num. 1 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.mx/img/en/fbpelogp.gif http://www.scielo.org.mx <![CDATA[<b>Thirtieth Anniversary of the journal SALUD MENTAL</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252008000100001&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Editorial productivity impact of the National Institute of Psychiatry Ramón de la Fuente, between the years 1995-2005, according to the Institute of Science Information Web of Science</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252008000100002&lng=pt&nrm=iso&tlng=pt The immediate expression of the scientific activity is very well reflected through the serial journals, due to the fact that they are the main means of information that scientists have chosen to communicate to their peers and society as a whole the advances and recent contributions of research that is being done. Thus explaining in this manner the reason why bibliometric studies are of great utility to highlight the evolution of the scientific research, also, this allows scientists, institutions and, editors of scientific journals to be aware of a series of indicators to analyze science productivity from different angles. In this study, the editorial productivity of the National Institute of Psychiatry Ramon de la Fuente (NIPRF), and its journal Salud Mental included in two indexes of the ISI Web of Science: 1) The Social Science Citation Index (SSCI), 2) The Science Citation Index (SCI) and The Journal Citation Reports (JCR), by Thompson Scientific, between the years 1995 - 2006. The objective of the study is to make public the editorial productivity of the institution, research staff and their journal Salud Mental, according to the mentioned information sources. These databases were selected for this study because of the prestige that Thompson Scientific has not only in the scientific community, but also, in the information media, due to its rigorous methods to select the journals in order to maintain updated journal titles that are included in their indexes. This study shows the productivity of different countries of the world in the SSCI in the period analyzed to place Mexico in the international context. Then, it is shown all the productivity of Mexico in the SSCI by author, subject, institution, publication, type of document and language, with the purpose of knowing the position of productivity of the NIPRF in the national context. After this, all the productivity of the NIPRF contained in the SCI is presented with the total productivity of the institute in both indexes. Afterwards, a chart is shown of the productivity of the authors belonging to the institute that appear in both indexes, showing the number of articles as single authors and as first authors, as well as identifying the type of documents published. The study follows with a series of data of the productivity of three Mexican journals indexed in the SSCI related to subjects such as psychology and psychiatry, they are: Salud Pública de Mexico, Salud Mental and, Revista Mexicana de Psicologia, with the purpose of identifying the institutions journal Salud Mental in the national and international context. The impact factor of the three Mexican journals was obtained from the Journal Citation Reports Edition. All the productivity of the three journals was analyzed by author, institution, type of document and language. The Mexican scientific productivity in social sciences, according to the SSCI, is very low compared with the other countries that were analyzed; in the case of Latin America, only Brazil exceeds Mexico in editorial production in this subject. According to the SSCI, the recurrent subjects in the editorial production in the social sciences are related with subjects such as psychology and psychiatry and the authors that stand out in this study are from the NIPRF. It is worth pointing out the fact that most of the editorial production of Mexico in this field according to the SSCI is generated in public institutions, first of all, the National Autonomous University of Mexico followed by the National Institute of Psychiatry Ramon de la Fuente.<hr/>La expresión inmediata de la actividad científica se refleja en publicaciones periódicas, toda vez que es el medio de información que los científicos han elegido para comunicar a sus colegas y a la sociedad en general los avances y aportaciones recientes de sus investigaciones. En este sentido los estudios bibliométricos son de gran utilidad para conocer la evolución de la investigación científica. Además permite a los investigadores, a las instituciones y a los editores de revistas conocer una serie de indicadores para analizar la productividad científica desde distintos ángulos. En este trabajo se presenta un estudio sobre la productividad bibliográfica del Instituto Nacional de Psiquiatría Ramón de la Fuente (INPRF) y de su revista Salud Mental contenida en dos índices del ISI Web of Science: 1. Social Science Citation Index (SSCI), 2. Science Citation Index (SCI) y en el Journal Citation Reports (JCR) de Thompson Scientific, entre 1995 y 2006. Todo esto con el objetivo de dar a conocer la productividad de la institución, de sus autores y de su revista: Salud Mental, de acuerdo con estos índices. Se eligieron estas bases para realizar el estudio en virtud del prestigio que en el medio de la información tiene la empresa Thompson Scientific, debido al rigor con que selecciona y mantiene los títulos de revistas que incluye en sus índices. Se presentan los registros de distintos países del mundo en el SSCI del periodo analizado para ubicar a México en el contexto internacional. Luego se presentan todos los registros de México en el SSCI por autor, tema, institución, publicación, tipo de documento e idioma, con el fin de ubicar la productividad del INPRF en el contexto nacional. Después se presentan todos los registros del INPRF en el SCI con el total de registros del instituto en ambos índices. Posteriormente se presenta un cuadro con la productividad de los autores del INPRF con mayor número de publicaciones registradas en los dos índices, que expone el número de trabajos que cada uno tiene como autor único y como primer autor, así como el tipo de documento de cada registro. A continuación se presentan todos los registros de las Revistas Mexicanas indizadas en el SSCI relacionados con temas de Psicología y Psiquiatría: Salud Pública de México, Salud Mental y Revista Mexicana de Psicología, con el propósito de ubicar a la revista del INPRF en el contexto nacional e internacional. Se obtuvo en el JCR Social Sciences Edition el factor de impacto de las tres revistas. Se analizaron todos sus registros por autor, institución, tipo de documento e idioma. La producción de México en ciencias sociales, de acuerdo con el SSCI, es muy baja en relación con el resto de países analizados, sin embargo, en el caso de América Latina, solamente Brasil le supera en producción editorial en esta materia. De acuerdo con el SSCI los temas más recurrentes en la producción editorial en ciencias sociales, se relacionan con temas de psicología y psiquiatría y los autores que más sobresalen son del INPRF. Destaca el hecho de que la mayor parte de la producción editorial de México en este terreno, de acuerdo con el SSCI, se genera en instituciones públicas y en este sentido destacan sobre todo la UNAM y el INPRF. <![CDATA[<b>Attention Deficit Hyperactivity Disorder and Pediatric Bipolar Disorder, comorbidity or overlap?</b>: <b>A Review. Part One</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252008000100003&lng=pt&nrm=iso&tlng=pt Attention deficit/hyperactivity disorder (ADHD) can present itself with a wide variety of comorbid psychiatric entities and can easily be misdiagnosed with disorders such as the pediatric bipolar disorder (PedBP), making early detection and treatment difficult. The main objective of this review is to evaluate the relationship between PedBP and ADHD. Several studies have addressed this association, establishing a high rate of comorbidity, from 57% to 93%. The risk of developing PedBP in ADHD population has also been studied, documenting a ten-fold increase risk in both genders compared with age-matched healthy controls. Pediatric bipolar disorder is still a diagnostic entity which is hard to recognize and differentiate from other disorders, even with the current international diagnostic criteria. Individuals with ADHD with a current depressive episode, suicide attempts and/or substance abuse and that carry a family load (mainly parents) for bipolar disorder are at increased risk of actually having this disorder. Several researchers have compared clinical symptoms expressed in children with ADHD and PedBP. They have found that children with PedBP exhibit higher frequency of elated mood, increased energy, thought disorder, flight of ideas, increased speed in speech and irritability than those with ADHD. Other authors report higher rates of thought disorders, anxiety, depression, aggression and delinquent behavior amongst children with PedBP than those with ADHD. It has also been reported that children with PedBP compared to those with ADHD present higher rates of euphoria, grandiosity, racing thoughts and decreased need for sleep. Yet another study found that euphoria and increased energy distinguished youths with PedBP from those with other psychiatric disorders, and found that with the group of depressed patients exhibit higher rates of suicidal thoughts and behavior than other diagnostic groups. Some cues to diagnose and differentiate PedBP and ADHD have been proposed: ADHD symptoms appearing suddenly or later in life, loss of therapeutic response to stimulants in a previous responder, intermittent symptoms, emergence of elated mood and decreased need for sleep, severe mood shifting, hallucinations or thought disorders, family history of bipolar disorder and lack of response to adequate treatment. Three of the seven criteria for bipolar disorder are shared with ADHD (distractibility, increased goal directed activity and talkativeness), making the clinical distinction between ADHD and early onset PedBP a difficult task. In fact, most children diagnosed with PedBP present symptoms and behavior compatible with a simultaneous ADHD. The role of ADHD as a prodromic, phenocopy, comorbid condition and/or as a misdiagnosis for PedBP can be further clarified by: 1. case follow-up to determine if comorbid diagnosis can predict the course or determine a prognosis factor; and 2. family genetic studies which are convenient for the evaluation of complex comorbid conditions. Some studies have suggested that this comorbid syndrome may possess a specific genotype, as well a particular course, a pattern of treatment response and may represent a distinctive clinical condition. High comorbidity BPD, both in adult and child and adolescent populations, runs a similar pattern to that of other important diagnostic categories in child and adolescent psychiatry. From a clinical perspective, these findings support the notion of avoiding hierarchical diagnoses. Furthermore, it questions the vision of categorical entities as it is proposed in the current diagnostic classification (ICD and DSM). Currently, when we talk about ADHD, we cannot separate it from other disruptive behavior disorders, such as conduct disorder (CD) and oppositional-defiant disorder (ODD). Epidemiological studies show that 40% to 70% of children with ADHD have CD or ODD, and some of them also present comorbid internalizing disorders. There is a clear possibility of a diagnostic confussion between PedBP and disruptive behavior disorders. Certain behavioral signals can indicate whether a child has a PedBP and/or a ODD or CD. The role sequential or concurrent comorbidity plays on neuropsychological profiles or neuroanatomy of bipolar disorder and ADHD remains unclear. Independent reports indicate an overlap of the neural circuits implicated on both disorders. Apparently, there is an overlap of impairments in ADHD children with and without PedBP involving motor inhibitory control, sustained attention, verbal learning, working memory, planning, and visual and motor skills. In addittion, to making both the early detection and diagnosis more difficult, comorbidity between ADHD and PedBP in the clinical setting complicates pharmacological and psychotherapeutic treatment. Pharmacologically, some studies have suggested that stimulant use may be safe and effective in children with manic symptoms and ADHD. Other reports argue against their use, hence these findings are not conclusive. An alternative for the pharmacological management of the ADHD/PedBP comorbidity is the use of atomoxetine, although there are no randomized, double blind or clinical controlled trials to support its use. It has been reported that BP and ADHD comorbidity may predict a lack of response to lithium pharmacotherapy in adolescents. Few studies have the addressed response to divalproex with this comorbidity. Data also suggest a lack of response in manic phases to usual pharmacotherapy in bipolar patients with a history of ADHD. These data stress the importance of the detection of comorbid ADHD (active or in remission) for prognostic and therapeutic planning. Furthermore, it is necessary to research on novel treatment modalities to specifically address the comorbid condition. In our country, efforts have been made to address the ADHD-PedBP comorbidity. One example is the treatment algorithm for ADHD and PedBP proposed by the Second Expert Consensus on the management of Attention Deficit/Hyperactivity disorder, an effort made towards adapting the available evidence and treatment options for our population. The algorithm establishes that at STAGE 0 the crucial aspect is early detection. Bipolar disorder should be addressed first and it ought to be done by a specialist. Some important points in STAGE 1 are: 1. first treatment option should be a stimulant (in Mexico, immediate and controlled release methylphenidate ) plus a mood stabilizer; 2. in the case of a lack of response to two different stimulants, atomoxetine or bupropion should be considered; 3. as a last option, atypical antipsychotics like risperidone, olanzapine, quetiapine and aripiprazole are proposed. It also mentions the ever frequent need for combined therapy and dynamic modifications in treatment sequences. Conclusions ADHD and PedBP disorder are highly comorbid. The similarities between the clinical features of these entities often make diagnosis a challenge for clinicians and carries several treatment considerations. In accordance to international research and national efforts to establish treatment options, stimulants may be considered a first line option for ADHD/BP comorbidity with the addition of a mood stabilizer. Although in general stimulants may be benefitial to many patients with both ADHD and B P, a group of patients may not tolerate their use, mainly due to side effects or mood destabilization. To offer a better treatment option for these patients it is crucial to continue in the search for other therapeutic modalities in order to improve residual symptoms in attention and cognition, even when the affective symptoms have resided.<hr/>El trastorno por déficit de atención con hiperactividad (TDAH) es comórbido con una variedad de trastornos psiquiátricos, y se puede confundir con algunas entidades diagnósticas como el trastorno bipolar pediátrico o de inicio temprano (TBPinf), lo que impide ofrecer un tratamiento oportuno y adecuado. Como objetivo principal de este artículo evaluaremos la relación existente entre el TBPinf y el TDAH. Existen múltiples estudios que han hablado de esta relación, y se ha encontrado que los niños y los adolescentes con trastorno bipolar tienen una alta comorbilidad con el TDAH, con índices que van de 57 a 93%. Los estudios de TDAH también han documentado que el riesgo de desarrollar un trastorno bipolar se incrementa 10 veces en sujetos de ambos sexos con TDAH al compararse con controles sin TDAH de la misma edad y sexo. Varios investigadores han comparado los síntomas observados en niños con TDAH y en niños con TBP, y se han propuesto algunas claves para diferenciar el TBPinf del TDAH. Actualmente, cuando hablamos del TDAH, no podemos desligarlo del resto de los trastornos de la conducta disruptiva, es decir, del trastorno de conducta y del trastorno oposicionista desafiante. Ciertos signos conductuales mencionados aquí pueden ayudar a determinar si un niño presenta un trastorno Bipolar y/o un trastorno oposicionista desafiante o un trastorno de conducta. El papel de la comorbilidad secuencial o concurrente entre la neuropsicología o neuroanatomía del trastorno bipolar y el TDAH aún no está clara. Reportes independientes indican un traslape en los circuitos neurales implicados en la fisiopatología del TBP y el TDAH. La comorbilidad del TBPinf y el TDAH en la práctica clínica complica, además del diagnóstico y la detección oportuna, su manejo tanto farmacológico como psicoterapéutico. En el aspecto farmacológico, algunos estudios han sugerido que los estimulantes pueden ser seguros y efectivos en niños con síntomas maniacos y TDAH, y existen otras alternativas que comienzan a considerarse. Existen datos que indican que en presencia de una historia de TDAH existe una disminución en la respuesta al tratamiento farmacológico en pacientes con TBP en fase maniaca. Evidencia como esta subraya la importancia que tiene para fines pronósticos y de planeación investigar la presencia de un TDAH activo o en remisión. En nuestro país se han realizado esfuerzos como el Algoritmo de Tratamiento para el TDAH en comorbilidad con el trastorno bipolar propuesto durante el Segundo Consenso de Expertos para el manejo del Trastorno por Déficit de Atención con Hiperactividad, preocupados por adaptar para nuestra población los tratamientos actualmente existentes y propuestos para esta comorbilidad. Conclusiones El TDAH y el TBPinf son altamente comórbidos. Las semejanzas entre las características clínicas de estas entidades provocan con frecuencia que el diagnóstico se vuelva un reto para el clínico, e implica varias consideraciones en el tratamiento. En sintonía con las investigaciones internacionales, y los esfuerzos nacionales e internacionales por establecer un tratamiento, los estimulantes pueden ser considerados como una primera opción para el manejo de estos pacientes (TDAH/TBP), siempre y cuando se añadan a un estabilizador del estado de ánimo. Aunque los estimulantes pueden ser generalmente benéficos para muchos pacientes con TBP y TDAH, otros no pueden tolerarlos debido a los efectos secundarios o la desestabilización del estado de ánimo. Para ofrecer un mejor tratamiento a estos pacientes, es imperativo seguir buscando otras opciones de tratamiento que mejoren los síntomas residuales de atención y de cognición, incluso después de que se hayan controlado los síntomas afectivos. <![CDATA[<b>Suicidal phenomenon in adolescents and school context</b>: <b>link between self-management and health services</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252008000100004&lng=pt&nrm=iso&tlng=pt Deliberately Self-Inflicted Injuries (DSII) can include different behaviors with lethal consequences. Suicide threat, suicide attempt and suicide itself can be grouped within these conducts. Though suicide in school contexts is more frequent in women, it has been observed that DSII has similar frequencies in both genders according to age, recurrence, motives, methods, and lethality. Official sources provide an epidemiological overview of the suicide phenomenon and concur in pointing out that: a) adolescent and young population has the highest suicide attempt and suicide prevalences; b) men commit more suicide than women but these attempt it more than men; and c) there are some areas in Mexico where suicide prevalences are higher. There is a lot of information about the suicide problem, but there are still some questions unanswered. For example, what are the most subtle characteristics of the different adolescent and young populations affected by the phenomenon? Do the context and the type of population represent a specific peculiarity? How does suicide behave in juvenile offenders? How does it behave in people who live and work in the streets? And how does it behave in groups of migrant and indigenous people? From the present situation of the suicide phenomenon in the school context, emerges the importance of intervention strategies for preventing its occurrence. Thus, one of the proposals under development underlines the need for creating self-management and binding mechanisms within schools. Self-management implies an ascending transformation process, which seeks that the individuals of certain group or community identify their own needs and change their perception of such needs to ignite the development of the inherent potentials in their community. The suicidal problem is growing in school population, that is why it is important to treat it adequately from prevention, having in mind the characteristics of socio-educational institutions. These institutions have particular resources and needs that shape them and could make them ideal setting for prevention and mental health promotion among adolescents. Since the suicide phenomenon has a multifactorial nature, complex and dynamic, an interdisciplinary approach seems to be one the most adequate options to work. This assumption represents a starting point to promote self-management actions that facilitate links between schools and mental health services. Nevertheless, within educational institutions coexist a series of complex circumstances that, at the same time, found and affect the possibility to begin self-management. For example, the academic and bureaucratic demands have an impact on keeping the links with health services or diminish the role of the school as a potential facilitator. Another element opposing the development of self-management strategies in schools is the context where facilities are located. Many schools are in areas where drug traffic is usual, where weapon trading is evident, and where informal commerce and insecurity are normal. Thus, if self-management process is to be initiated, the proposal should be founded on a well-defined basis, which should address these elements: 1. A clear definition of the situations to be attended. 2. Specific strategies to achieve goals, to create interest, and to motivate the school staff. 3. To acknowledge real chances to fulfill perceived needs and the possible obstacles. 4. To consider all the people involved in achieving objectives, their roles, and the commitments they would attend. 5. To work constantly and consistently to ignite self-management. 6. To make use of every convenient option available. 7. To conduct meetings to establish specific needs, to remark objectives, to communicate achievements, and to structure or re-structure plans.<hr/>Dentro de las Lesiones Autoinfligidas Deliberadamente (LAD) hay una serie variada de conductas que pueden tener consecuencias fatales; entre ellas se incluyen comportamientos autodestructivos como el gesto suicida, el intento o tentativa de suicidio y el suicidio consumado. Las fuentes oficiales muestran un panorama epidemiológico de la problemática suicida y coinciden en señalar que la población de adolescentes y jóvenes tiene la mayor prevalencia de tentativas de suicidio y suicidio consumado; los varones se suicidan más y la tasa de intentos es más alta en las mujeres, y hay zonas geográficas del país con prevalencias mayores. A partir del estado actual del fenómeno en el contexto escolar, es importante desarrollar estrategias de intervención para prevenir su ocurrencia. En este sentido, una de las propuestas es la generación de mecanismos de autogestión y vinculación en el ámbito de las escuelas. La autogestión implica un proceso de transformación ascendente en que los individuos de un grupo identifican sus necesidades y cambian su percepción de las mismas para conseguir generar un desarrollo del potencial de su comunidad. La problemática suicida es multifactorial, compleja y dinámica, por lo que la interdisciplinariedad pareciera una opción de trabajo adecuada. Entonces, se parte de este supuesto para promover acciones autogestivas que faciliten la vinculación entre las escuelas y los servicios de salud mental. Para que se inicie el proceso autogestivo, la propuesta debiera sustentarse en una base bien definida, la cual tendría que tomar en consideración los siguientes elementos: 1. Definir claramente las situaciones que se busca atender. 2. Establecer rutas críticas para conseguir objetivos y contar con el interés y la disposición del personal escolar. 3. Distinguir las posibilidades reales para responder a las necesidades percibidas y los obstáculos que se puedan presentar. 4. Considerar a todas las personas involucradas en el logro de objetivos, su papel y los compromisos a los que responderían, así como la capacitación constante para el desarrollo, fortalecimiento y aplicación de habilidades profesionales requeridas y adecuadas. 5. Trabajar de manera constante y consistente para iniciar la autogestión. 6. Recurrir a de todas las opciones pertinentes de las que se disponga. 7. Realizar reuniones en que se resalte la importancia de plantear necesidades claras, se reiteren los objetivos, se comuniquen los logros y se elaboren planes. <![CDATA[<b>Neuroimmunomodulation pathways</b>: <b>Part two</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252008000100005&lng=pt&nrm=iso&tlng=pt Deliberately Self-Inflicted Injuries (DSII) can include different behaviors with lethal consequences. Suicide threat, suicide attempt and suicide itself can be grouped within these conducts. Though suicide in school contexts is more frequent in women, it has been observed that DSII has similar frequencies in both genders according to age, recurrence, motives, methods, and lethality. Official sources provide an epidemiological overview of the suicide phenomenon and concur in pointing out that: a) adolescent and young population has the highest suicide attempt and suicide prevalences; b) men commit more suicide than women but these attempt it more than men; and c) there are some areas in Mexico where suicide prevalences are higher. There is a lot of information about the suicide problem, but there are still some questions unanswered. For example, what are the most subtle characteristics of the different adolescent and young populations affected by the phenomenon? Do the context and the type of population represent a specific peculiarity? How does suicide behave in juvenile offenders? How does it behave in people who live and work in the streets? And how does it behave in groups of migrant and indigenous people? From the present situation of the suicide phenomenon in the school context, emerges the importance of intervention strategies for preventing its occurrence. Thus, one of the proposals under development underlines the need for creating self-management and binding mechanisms within schools. Self-management implies an ascending transformation process, which seeks that the individuals of certain group or community identify their own needs and change their perception of such needs to ignite the development of the inherent potentials in their community. The suicidal problem is growing in school population, that is why it is important to treat it adequately from prevention, having in mind the characteristics of socio-educational institutions. These institutions have particular resources and needs that shape them and could make them ideal setting for prevention and mental health promotion among adolescents. Since the suicide phenomenon has a multifactorial nature, complex and dynamic, an interdisciplinary approach seems to be one the most adequate options to work. This assumption represents a starting point to promote self-management actions that facilitate links between schools and mental health services. Nevertheless, within educational institutions coexist a series of complex circumstances that, at the same time, found and affect the possibility to begin self-management. For example, the academic and bureaucratic demands have an impact on keeping the links with health services or diminish the role of the school as a potential facilitator. Another element opposing the development of self-management strategies in schools is the context where facilities are located. Many schools are in areas where drug traffic is usual, where weapon trading is evident, and where informal commerce and insecurity are normal. Thus, if self-management process is to be initiated, the proposal should be founded on a well-defined basis, which should address these elements: 1. A clear definition of the situations to be attended. 2. Specific strategies to achieve goals, to create interest, and to motivate the school staff. 3. To acknowledge real chances to fulfill perceived needs and the possible obstacles. 4. To consider all the people involved in achieving objectives, their roles, and the commitments they would attend. 5. To work constantly and consistently to ignite self-management. 6. To make use of every convenient option available. 7. To conduct meetings to establish specific needs, to remark objectives, to communicate achievements, and to structure or re-structure plans.<hr/>Dentro de las Lesiones Autoinfligidas Deliberadamente (LAD) hay una serie variada de conductas que pueden tener consecuencias fatales; entre ellas se incluyen comportamientos autodestructivos como el gesto suicida, el intento o tentativa de suicidio y el suicidio consumado. Las fuentes oficiales muestran un panorama epidemiológico de la problemática suicida y coinciden en señalar que la población de adolescentes y jóvenes tiene la mayor prevalencia de tentativas de suicidio y suicidio consumado; los varones se suicidan más y la tasa de intentos es más alta en las mujeres, y hay zonas geográficas del país con prevalencias mayores. A partir del estado actual del fenómeno en el contexto escolar, es importante desarrollar estrategias de intervención para prevenir su ocurrencia. En este sentido, una de las propuestas es la generación de mecanismos de autogestión y vinculación en el ámbito de las escuelas. La autogestión implica un proceso de transformación ascendente en que los individuos de un grupo identifican sus necesidades y cambian su percepción de las mismas para conseguir generar un desarrollo del potencial de su comunidad. La problemática suicida es multifactorial, compleja y dinámica, por lo que la interdisciplinariedad pareciera una opción de trabajo adecuada. Entonces, se parte de este supuesto para promover acciones autogestivas que faciliten la vinculación entre las escuelas y los servicios de salud mental. Para que se inicie el proceso autogestivo, la propuesta debiera sustentarse en una base bien definida, la cual tendría que tomar en consideración los siguientes elementos: 1. Definir claramente las situaciones que se busca atender. 2. Establecer rutas críticas para conseguir objetivos y contar con el interés y la disposición del personal escolar. 3. Distinguir las posibilidades reales para responder a las necesidades percibidas y los obstáculos que se puedan presentar. 4. Considerar a todas las personas involucradas en el logro de objetivos, su papel y los compromisos a los que responderían, así como la capacitación constante para el desarrollo, fortalecimiento y aplicación de habilidades profesionales requeridas y adecuadas. 5. Trabajar de manera constante y consistente para iniciar la autogestión. 6. Recurrir a de todas las opciones pertinentes de las que se disponga. 7. Realizar reuniones en que se resalte la importancia de plantear necesidades claras, se reiteren los objetivos, se comuniquen los logros y se elaboren planes. <![CDATA[<b>Difficulties in assessing and measuring autism</b>: <b>A discussion</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252008000100006&lng=pt&nrm=iso&tlng=pt The detection of autism is very important because the lack of recognition of this disorder has elevated costs for the families, health care and education providers. Diagnosis is made frequently four or five years after parents notice the first signs. The reasons for this delay are many, but a common one is the lack of recognition of key symptoms that can lead to a more complex diagnosis assessment. Another reason is that screening and diagnostic instruments are not well known by primary caregivers in health and education systems, as these professionals are the first to hear parents' concerns. Moreover the instruments are not well known because the cost of acquiring them and receiving formal training is very high. The need to make comparable assumptions of this complex disorder makes it important to use the same instruments as other countries. Growing efforts for an early recognition have been made in recent years because early intervention programs benefit children with autism. In the last decade, important advances in the design of diagnostic and screening instruments have been made. These tools have primarily been used for clinical, epidemiological or research uses. In some countries their use has become routine in schools, leading to better detection and increasing prevalence rates of autism. Misdiagnosis is not uncommon in autism. Almost 60% of children with Asperger disorder first receive an erroneous diagnosis of attention deficit disorder, oppositionistic or bipolar disorder. Autism presents with a bizarre clinical picture during the years in which many thought it was untestable. Gradual characterization of behaviors and studying different aspects of the symptomatology had led to a better comprehension and descriptions. Most authors have incorporated this knowledge to design reliable instruments. The most common behaviors explored are: protodeclarative pointing, joint attention, repetitive/ stereotyped movements and absence of characteristic symbolic play. This target behavior can be explored through the diverse rating scales and interviews. The instruments are very diverse and varing form. There are rating scales for parents to record their children symptoms and observation schedules to be completed by a clinician or trained professional for that purpose. The best approach is to combine modalities to include as much information as possible. CHAT (Checklist for Autism in Toddlers) is a brief screening instrument intended to detect autism in toddlers. The first part consists of nine questions for parents to complete, while the second part is an observation schedule with five brief age-appropriate interactions with the children. This instrument is an important antecedent of more sophisticated and expanded play observation schedules. Checklist for Autism in Toddlers Modified (CHAT M) is a modified version which consists of an expansion of the parent questionnaire by eliminating the observational section. The Childhood Autism Rating Scale (CARS) is another instrument which assesses the severity of autism. This instrument is rated by clinicians or by trained observers. CARS was designed before DSM IV criteria were published so it does not contain an algorithm to distinguish between different developmental problems. In spite of this limitation, it is the most used rating scale for autism diagnosis. The Child Behavior Checklist (CBCL/1.5-5) is a broad band rating scale which evaluates psychopathology of children between 18 months and five years old. It has a DSM oriented subscale to evaluate developmental problems such as autism or Asperger disorder. It also contains a withdrawn subscale which has proven to be useful as demonstrated by some studies done with the CBCL/4-18. This instrument also allows assessing other associated problems common in autistic children such as attention problems, depression and anxiety. The Language Developmental Survey (LDS) associated to this rating scale, gives the opportunity to screen vocabulary for the identification of language delays, which are common in children with pervasive developmental disorders. It was necessary to have more structured instruments to diagnose autism and not only for screening purposes, so in 1989 the first diagnostic interview was published. The instrument has gone through an extensive review and creative process which has led to the most important tools for diagnosing autism in adults and children. The Autism Diagnostic Interview (ADI) was published in 1989 and correlated to the ICD-10 definition of autism. The original ADI was intended primarily for research purposes, providing behavioral assessment for subjects with a chronological age of at least five years and a mental age of at least two years. The ADI explores three key domains defining autism: (1) reciprocal social interaction, (2) communication and language, and (3) repetitive, stereotyped behaviors. The Autism Diagnostic Interview Revised ADI-R is a semi/ standardizer interview shorter than the ADI, which has been developed for clinical use. It is more appropriate for younger children than the ADI. The ADI-R takes from 2 to 3 hours to administer and can be used with children as young as two years of age (with a mental age greater than 18 months). It explores information about the child functioning in the present and the past. It contains an algorithm based on DSM criteria for autistic disorder, and allows for distinguishing between autistic disorder and non autistic disorder. Pre Linguistic Autism Diagnostic Observation Schedule (ADOS-PL) is a modified version of the ADOS used to diagnose young children (under the age of six years) who are not yet using phrase speech. It is a semi-structured assessment of play, interaction, and social communication and takes about 30 minutes for a trained clinician to administer. The Autism Diagnostic Observation Schedule-Generic (ADOS-G) is a standardized play observation schedule. Through structured play materials and activities promoted by the examiner, social interactions are rated for common autistic features like joint attention, protodeclarative pointing, quality of reciprocal social interaction and symbolic play. Different modules are available from one to four, with specified criteria to match the participants' developmental and language level. It contains an algorithm related to the DSM IV domains of an Autistic Disorder or PDD-NOS. The ADI, ADI/R, ADOS PL, and ADOS G are considered the gold standards for autism diagnosis. There are important reliable instruments for diagnosing autism but extensive training is needed to obtain useful diagnostic information. Since these instruments are very recent, they have not been validated in some countries and neither their cultural bias has been investigated. It is not enough to assess autistic symptoms only for diagnostic purposes; patients need further evaluation to determine their psychosocial functioning, cognitive abilities, and language delay or deviations. The information from these assessments is very important for planning well designed interventions. Even though there is a growing interest in perfecting these modern instruments, diagnosis cannot rely exclusively on them. They are important tools to facilitate the diagnosis, but broader assessment should be pursued. It is important to validate and culturally adapt these instruments so different countries can utilize the same tools and research results can be comparable. In the future more rating scales, observation schedules and diagnostic interviews will be developed for assessing Asperger disorder, to be used in genetic studies, for assessing broad band syndromes. Better cognitive measures will be necessary to evaluate psychosocial impact. But this growing specialization will increase costs so it is important to develop briefer and more cost-effective methods to evaluate persons with autism. The availability of these tools will guarantee early diagnosis and treatment not only for research purposes but for identification in the community.<hr/>La detección del autismo en México es muy importante ya que la falta de reconocimiento de este trastorno tiene costos muy elevados para las familias y los prestadores de servicios de salud y educación. Muy a menudo el diagnóstico de autismo se realiza cuatro o cinco años después de que los padres observan los primeros síntomas. Las razones para este reconocimiento tardío son diversas; pero una de las principales es la falta de identificación de síntomas clave que obliguen a una evaluación diagnóstica en forma. Otro motivo es que en nuestro país son poco conocidos los instrumentos de tamizaje y diagnóstico por parte de los profesionistas primarios como maestros y médicos familiares, quienes son los primeros en escuchar las quejas y preocupaciones de los padres. Aun en contextos más especializados, estas herramientas son poco conocidas pues su adquisición y aplicación es un proceso complejo y costoso que a menudo debe realizar el profesionista por su cuenta. A pesar de estos inconvenientes, en años recientes se han realizado grandes esfuerzos para el reconocimiento del autismo puesto que hay evidencias de que las intervenciones tempranas mejoran el pronóstico en estos niños. En la última década se han realizado avances muy importantes en el diseño de instrumentos de diagnóstico y tamizaje, a los que se han utilizado con propósitos de investigación clínica y epidemiológica. En algunos países su uso se ha vuelto una rutina en las escuelas y se ha logrado una mayor detección de autismo por lo que se han elevado las tasas de prevalencia. Los instrumentos son muy diversos, pueden ser listas de autoinforme dirigidos a los padres para que registren los síntomas de los niños, o cédulas de observación para ser completadas por el clínico o el personal entrenado para tal propósito. Lo mejor es el uso mixto de instrumentos para obtener la mayor cantidad de información posible como es el caso del CHAT que incluye una sección de interrogatorio y otra sección de observación con actividades que el niño debe desarrollar. Este instrumento es precursor de actividades sencillas y creativas con un componente lúdico, diseñadas con el propósito de evaluar al niño preescolar. Hoy este es un importante antecedente de otros instrumentos más elaborados. El cuestionario para el autismo en niños preescolares modificado CHAT M es una versión modificada del el cuestionario para el autismo en niños preescolares (CHAT) que consiste en una expansión de la sección de interrogatorio para el padre, con un formato de autoinforme que parte de la eliminación de la sección de observación. Otros instrumentos miden la gravedad del autismo como la Escala de Evaluación de Autismo Infantil (CARS), dirigida al clínico que evalúa la intensidad del autismo. La lista de síntomas del niño de 1.5-5 (CBCL/1.5-5) es un instrumento de banda ancha que evalúa la psicopatología general en niños con edad entre 18 meses y cinco años; contiene una subescala de problemas del desarrollo que sirve como tamizaje para evaluar el autismo y el trastorno por Asperger con base en los criterios del DSM. Se han diseñado y se han perfeccionando paulatinamente varias entrevistas de diagnóstico. La entrevista de diagnóstico de autismo (ADI), la entrevista de diagnostico para el autismo revisada (ADI-R), la cédula prelingüística genérica de observación para el autismo (ADOS PL), y la cédula de observación genérica para el autismo (ADOS G) son escalas consideradas standard de oro para el diagnóstico del autismo. Conforme se han mejorado las propiedades psicométricas, de los instrumentos, éstos también se han ajustado para cubrir las necesidades de evaluación de los pacientes autistas con un amplio rango de edad, destreza verbal y cognitiva. Como resultado, podemos contar con instrumentos confiables y adecuados para una población con necesidades muy diversas; estas herramientas nos han demostrado que un constructo tan complejo y amplio como el autismo se puede medir. En este artículo se presenta una breve revisión de la evolución histórica de la clasificación acorde a los criterios del DSM y a la descripción de los principales instrumentos de diagnóstico, y los datos de su validez y confiabilidad. <![CDATA[<b>What is sexual coercion? Meaning, tactics and interpretation in young university students in Mexico City</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252008000100007&lng=pt&nrm=iso&tlng=pt Sexual coercion in the context of flirting or courtship is a form of sexual violence that has rarely been explored in Mexico, with studies mainly being undertaken in the United States and some European countries. This may be due to the fact that it includes the use of certain practices that have traditionally not been regarded as violent and, on the contrary, been viewed as <<normal>> within intimate heterosexual relations. Like other forms of sexual violence, the definition of social coercion involves conceptual and methodological problems, since the term has been used interchangeably with other forms of sexual violence. Generally speaking, violence on dates or during courtship and sexual aggression tend to refer to a domineering behavior in sexual behavior in which physical aggression is used. At the same time, sexual coercion comprises a continuum of practices ranging from subtle psychological pressure and the use of language to the utilization of physical aggression to secure a sexual encounter. This form of violence may trigger major problems in the areas of mental, sexual, and reproductive health. For the purposes of this study, sexual coercion is defined as any type of physical or emotional pressure used by a person to impose acts of a sexual nature on another person within the context of a mutually agreed on heterosexual encounter to go out together, get to know each other or engage in a romantic or erotic relationship or in a more formal relationship such as courtship. This type of sexual violence occurs in Latin American countries where couple relationships continue to be regulated by certain cultural traditions that may prevent the problem from being detected. These norms, which are often stereotyped, create <<sexual scripts>>, in other words, structural blocks of information processing that combine concepts, categories and relationships based on the social experience that indicate how heterosexual relationships <<should>> be conducted. These scripts and their particular expression are strongly influenced by cultural attitudes and beliefs for men and women. In view of this context, it is hardly surprising that men and women engage in coercion in different ways to secure a sexual encounter. These different forms of coercion have been conceptualized as <<tactics>>, whether direct or indirect. Given the need to know how sexual coercion is defined, how it is exercised and whether coercive behavior is in fact identified, this study seeks to determine the meaning of sexual coercion, the tactics used by both sexes and the way in which young university students interpret the same coercive event. Method One way of dealing with the significance of a phenomenon, as well as its interpretation, is through the qualitative approach; for the purposes of this study, focus groups were used. Participants A total of 27 students comprised four focus groups, two comprising women, two comprising men. Three of these groups consisted of seven participants and one of six. The age range was 18 to 25. Data gathering techniques In order to obtain the information, thematic guidelines were drawn up to explore the meaning and interpretation students give sexual coercion as well as the type of tactics they recognize as being used by men and women. Procedure The study was carried out at two universities, after inviting participants to attend a focus group. At each public and private university, two groups (one of men, one of women) were formed. Analytical strategy For the analysis of the focus groups, audio-recorded interviews were transcribed. For each of the study, the entire transcription was read out for the first level of analysis. This was followed by segmentation, the extraction of fragments or paragraphs, sentences, phrases of words regarded as significant. Results As far as the significance of sexual coercion is concerned, it is striking that both men and women associate the term with extreme force, divided into three main categories: physical force, rape and violence against women. To a lesser extent, the term is identified with family violence and a continuum of sexual violence ranging from subtle to extremely severe. In order to obtain the meanings attributed to a situation of sexual coercion in courtship, participants discussed the two characters in a cartoon in order to reveal the aspects that could be regarded as accepted, permitted, questioned or rejected as means of obtaining a sexual relationship. The group discussion revealed two different points of view: men's and women's. In the analysis of the female character in the story, the men described her as a <<victim>> while the women regarded her as being responsible for what had happened. As for the male character in the story, the men perceived him as someone who was tactless and abusive, whereas the women labeled him as <<sick>>. The analysis of the tactics of sexual coercion used by men and women to obtain a sexual relationship revealed that indirect tactics are most commonly used by men and women. Conclusions It is important to note that although there are very few studies on sexual coercion in Latin American countries except in Argentina, Peru and Mexico, they must be undertaken, since failure to do so would mean neglecting a significant part of young people's sexual, reproductive, social and mental health. The following conclusions may be drawn from the results of this study: a) Most of the subjects interviewed are unclear as to the meaning of the term <<sexual coercion>>; b) Both the men and women in this study blame women for their victimization. This is particularly evident from the discussion of the cartoon on sexual coercion; c) Sexual coercion is a more common problem in women, although it has been said that men can be victims of sexual coercion as well. This finding opens up a significant line of research on how men perceive this type of violence, and d) Although both the male and female students in this study mentioned that men and women used indirect tactics more frequently to secure a sexual encounter, it is important to note that these are different, since men use subtle tactics with threats whereas women do not. This study showed that women are more likely to suffer some type of sexual coercion and that men use indirect tactics with threats. Although the subjects that participated in this study mentioned certain types of tactics used by women to obtain a sexual relationship, this result must be treated with caution, since further study is required on this issue. This exploratory study on the phenomenon shows the need for prevention strategies to enable men and women to identify an event in which they perceive they are being pressed in to having a sexual encounter. This is why it is important for sex education programs to include a gender perspective and to emphasize the notion of people's rights in order to eradicate inequalities of power and thereby eliminate any type of violence.<hr/>La coerción sexual, en el contexto de situaciones de "ligue" o en el noviazgo, es una forma de violencia sexual poco investigada en México. Posiblemente esto responda a que incluye el uso de ciertas prácticas que tradicionalmente no han sido reconocidas como violentas y que, muy por el contrario, se han visto como <<normales>> en las relaciones heterosexuales íntimas. Para los fines de este trabajo, la coerción sexual se define como cualquier tipo de presión física o emocional utilizada por una persona para imponer a otra actos de orden sexual en el contexto de un encuentro heterosexual de mutuo acuerdo para salir juntas. El presente trabajo tiene como objetivo conocer el significado de coerción sexual, las tácticas utilizadas por ambos sexos y la manera en que interpretan un mismo suceso coercitivo distintos jóvenes universitarios. Método Para los fines de este estudio, se utilizaron grupos focales. Participaron un total de 27 estudiantes que conformaron cuatro grupos focales: dos de mujeres y dos de hombres. Para obtener la información, se elaboró una guía temática que abordaba el significado e interpretación que otorgan los estudiantes a la coerción sexual, así como el tipo de tácticas que reconocen son utilizadas por hombres y mujeres. Procedimiento El estudio se llevó a cabo en las instalaciones de las Universidades participantes, previa convocatoria para asistir al grupo focal. Para el análisis de los grupos focales se transcribieron las entrevistas audiograbadas. Se realizó una segmentación que es la extracción de fragmentos o párrafos, oraciones, frases o palabras consideradas significativas. Resultados En cuanto al significado de la coerción sexual, destaca que hombres y mujeres asocian el concepto con el uso de una fuerza extrema. Para dar una idea de los significados atribuidos a una situación de coerción sexual en el noviazgo, se discutieron los dos personajes de una viñeta con el fin de dar cuenta de los aspectos que pueden considerarse aceptados, permitidos, cuestionados o rechazados como medios para obtener una relación sexual. Tras analizar las tácticas de coerción sexual utilizadas por hombres y mujeres para obtener una relación sexual, se encontró que las tácticas indirectas son las más utilizadas por ambos. Conclusiones De los resultados de este estudio se puede concluir lo siguiente: a) La gran mayoría de los sujetos entrevistados no tiene claro el significado del concepto <<coerción sexual>>. b) Tanto los hombres como las mujeres de este estudio culpan a las segundas de su victimización, situación que se ve muy clara en la viñeta sobre coerción sexual, c) Se pudo constatar que la coerción sexual es un problema que padecen con más frecuencia las mujeres, aunque se menciona que los hombres también pueden ser víctimas de coerción sexual. Este hallazgo abre una importante línea de investigación sobre cómo perciben los hombres este tipo de violencia. d) Por último, aunque todos los estudiantes participantes en este estudio mencionan que las tácticas indirectas son las que utilizan con más frecuencia los hombres y las mujeres para obtener un encuentro sexual, es importante señalar que hay diferencias ya que los primero recurren a una táctica sutil con amenaza y las mujeres no. Este estudio exploratorio sobre el fenómeno permite formular las estrategias de prevención necesarias para que hombres y mujeres sean capaces de identificar un evento en que perciban que se les presiona para tener un encuentro sexual. Por lo cual es importante que los programas de educación sexual contemplen una perspectiva de género y que además enfaticen sobre la noción de derechos de las personas para erradicar las desigualdades de poder y así eliminar cualquier tipo de violencia. <![CDATA[<b>Psychomotor development at six months predicts mental development at 20 months in healthy children</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252008000100008&lng=pt&nrm=iso&tlng=pt Introduction The study of the possible protector factors and the risk factors can favour or harm women during pregnancy, and so, the infant during the pre- and post-natal periods, has today become a necessary and a high priority objective of world health. In agreement with this proposal, carrying out follow-up programs to prevent, detect and treat consequences in infant development is one of the objectives of Early Care (EC). The follow-up is the way to verify whether the development of the child is occurring within the guidelines of normalcy, or if there is a suspicion that he may be suffering from delays. In order to do this in an appropriate way, one of the necessary conditions is to have access to the tables and instruments that include up-to-date parameters of the course of overall development in the normal population. If the detection and follow-up of risk populations is a key task in the context of early attention, so are the longitudinal studies that use the normal population as the focus of their study. Currently, in various countries in the European Union, important follow-up studies are being carried out of a multi-disciplinary nature (EARNEST Project, NUHEAL Project, and Spanish INMA Network), with the purpose of evaluating the development of the child in general and, specifically, his mental development. These studies take into account, among others, a series of parameters that contemplate the eating habits of the mother, exposure to environmental contaminants, styles of care and the physical, mental and social follow-up of the development of the children up to ages that include adolescence. One of the factors associated with mental development is psychomotricity. The psychomotor development refers to the acquisition of skills observed in the child in a continuous way throughout childhood, and it is associated, on the one hand, with the maturing of the Central Nervous System (proliferation of the dendrites, synaptogenesis and the myelinazation of the axons) from the first months of life up to the age of two. This maturation process has a pre-established order and a clear and predictable sequence: the progress is in a cephalocaudal sense and from proximal to distal. On the other hand, the psychomotor development is also associated with the learning done by the baby and the child in their interactions with themselves and their surroundings, with the affective links they establish based on the affect and stability of the care received and the perception of everything around them (people, images, sounds, movement…). These conditions are determinants in the emotional development, communicative functions, adaptive behaviours and attitude toward learning. It has been proposed that the psychomotor development precedes the mental development and forms the base on which it is established. And although it must be kept in mind that there are degrees of individual variation in normal psychomotor development, depending on the interaction between genetic and environmental factors, it can be said that full term babies who are born healthy follow a pattern of development or skills acquisition. This pattern is clear, and basic milestones have been defined that are easy to measure and that make it possible to know when a child is progressing satisfactorily. In these children, the rhythm of psychomotor development in the first two years of life is quite rapid. At six to seven months, they can sit and crawl; at eight to nine months, they stand up; and at 10 to 12 months, they walk with help. Through their movements and manipulations, they are exploring, imitating, learning and understanding. It is important to observe and rigorously follow the way the psychomotor development is occurring and being established in children because it may provide us with early indications of possible consequences in some parameters of their mental development. Another factor that is related to the mental development, in addition to the psychomotor development, is the somatic growth or development of the child. Numerous studies show how the weight, length and cephalic perimeter are predictors of disorders in development in the case of a risk, high-risk and/or clinical population with established problems and diverse associated pathologies. Therefore, these measures of growth constitute essential parameters to keep in mind for an early intervention in the deviations and disorders in development. In this study, it has been proposed the need to verify whether this relationship of prediction between somatic growth and psychomotor and mental development also occurs in populations of healthy children. The main objective of this study was to describe the evolution of the neurodevelopment in healthy children from the sixth to the 20th month of life. We now present the results of a part of the follow-up from the NUHEAL Project. Material and method The sample studied was composed of 66 (32 boys/34 girls) full-term, healthy infants, with a weight at birth appropriate for their gestational age, born at the San Cecilio Clinical University Hospital in Granada. All of their mothers were participants in the NUHEAL project, and they did not received docosahexaenoic acid and eicosapentaenoic acid supplements. To evaluate the neurodevelopment of the infants, the Bayley Scales of Infant Development (BSID) were used at six months (6.22±0.29) (n:66) and at 20 months (19.56±1.17) (n:56). The evaluation was performed by a psychologist who had been trained for this. The BSID evaluates three aspects of development: motor development, mental development and the behaviour of the child. It provides an index of mental development (MDI) and an index of psychomotor development (PDI). In addition, an evaluation of the somatic or anthropometric development was also performed by an expert paediatrician, taking into account the following variables: weight, height, cephalic and thoracic perimeter at birth, at six months of age and at 20 months. The local Ethical Committee of the University Clinical Hospital "San Cecilio" of Granada approved the study protocol. After a careful explanation of the study details, written informed consent was obtained from all participating women. Results The preliminary data obtained in this study showed that the psychomotor development of the children was greater than the mental development, at both six and 20 months of age, with the mean from the Psychomotor Development Index (PDI) being (107.95±11.70 vs 125.39±10.51) at six and 20 months, respectively, and the mean from the Mental Development Index (MDI) being (97.73±9.14 vs. 119.64±12.41) at six and 20 months of age. The results showed that the MDI at 20 months was greater in those children who had a greater PDI at six months, (F(1. 52)= 4.27; p<0.044). No statistically significant relationships were found between the anthropometric data at six months and the EBDI development indices (MDI and PDI) at 20 months of age.<hr/>Introducción El estudio de los posibles factores tanto protectores como de riesgo que puedan favorecer o dañar a la mujer durante el embarazo y, por tanto, al niño en el período prenatal y postnatal, se ha convertido hoy en una necesidad y en un objetivo prioritario de salud mundial. Uno de los objetivos de la Atención Temprana es la realización de programas de seguimiento para prevenir, detectar y tratar secuelas en el desarrollo infantil. El seguimiento es el modo de comprobar si el desarrollo se está produciendo dentro de unas pautas de normalidad. Si la detección y el seguimiento de poblaciones de riesgo son unas tareas claves en la atención temprana, no lo son menos la realización de estudios longitudinales que toman a la población normal como objeto de estudio. Actualmente, en diversos países de la Comunidad Europea se están llevando a cabo importantes estudios aleatorizados con seguimiento longitudinal (proyectos NUHEAL, EARNEST, Red de Excelencia INMA) para evaluar el desarrollo global de los niños sanos y el desarrollo mental, en particular. Dentro de los factores asociados al desarrollo mental se encuentran el desarrollo psicomotor y el desarrollo somático. Numerosos estudios muestran que el peso, la talla y el perímetro cefálico son predictores de trastornos del desarrollo cuando se trata de una población de alto riesgo o con alguna patología. El objetivo principal de este estudio es describir la evolución del neurodesarrollo en niños sanos desde el sexto al vigésimo mes de vida. En este artículo se presentan parte de los resultados del Proyecto Europeo NUHEAL. Material y método Se estudiaron 66 bebés sanos (32 niños / 34 niñas), nacidos a término, con peso al nacimiento apropiado para la edad gestacional, que fueron reclutados en el Hospital Clínico Universitario "San Cecilio" en Granada y cuyas madres eran participantes del proyecto NUHEAL pero que no recibieron suplementación de ácido docosahexaenoico y ácido eicosapentanoico. Se les realizó evaluación del neurodesarrollo a los seis (n:66) y 20 (n:56) meses de edad utilizando las Escalas Bayley de Desarrollo Infantil (EBDI). Estas escalas proporcionan un índice de desarrollo mental (IDM) y un índice de desarrollo psicomotor (IDP). Igualmente se realizó evaluación del desarrollo somático, mediante el estudio antropométrico de las siguientes variables: Peso, talla, perímetro cefálico y torácico al nacimiento, a los seis y 20 meses de edad. El protocolo del presente estudio fue aprobado por el Comité Ético local del Hospital Clínico Universitario <<San Cecilio>> de Granada. Resultados Los datos mostraron que la población estudiada tenía mayor desarrollo psicomotor que mental tanto a los seis como a los 20 meses de edad, siendo la media del Indice de Desarrollo Psicomotor (IDP) (107.95±11.70 vs 125.39±10.51) a los seis y 20 meses respectivamente, y la media del Índice de Desarrollo Mental (IDM) (97.73±9.14 vs 119.64±12.41) para los seis y 20 meses de edad. Los resultados también muestran que el IDM a los 20 meses es mayor en aquellos niños que tenían un IDP mayor a los seis meses (F (1.52)= 4.27; p<0.044). No se encontraron relaciones estadísticamente significativas entre las variables somatométricas a los seis meses y el IDM e IDP a los 20 meses de edad. Discusión Los resultados de este estudio indican que los niños incluidos en este trabajo de investigación se encuentran dentro de la normalidad. Los niños mostraron un buen desarrollo mental y psicomotor en ambas edades, aunque el desarrollo psicomotor era superior al mental tanto a los 6 como a los 20 meses. El IDP a los seis meses resultó ser un buen predictor del IDM a los 20 meses. Estos resultados corroboran los datos publicados por diversos autores que afirman que el desarrollo psicomotor precede al desarrollo mental, siendo el desarrollo psicomotor un factor protector y una base esencial para el establecimiento de las funciones mentales superiores. Respecto a los datos obtenidos de que ninguna variable somatométrica a los seis meses resultó predictora del desarrollo psicomotor y mental posterior a los 20 meses, probablemente sea debido a que los niños incluidos en este estudio eran niños sanos; si bien esta relación sí parece cumplirse cuando se trata de niños con antecedentes patológicos o en poblaciones de niños de alto riesgo. <![CDATA[<b>Organizational and functional profile of the nuclear psychosomatic family with one asthmatic son</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252008000100009&lng=pt&nrm=iso&tlng=pt Introduction Asthma is a current problem worldwide. By one hand the prevalence of the disease has been increasing in México during the last decades; on the other hand there is a considerable number of patients in whose the disease can not be controlled. The analysis of familiar function is a convenient weapon to approach in a more integrated manner such problem. In this systematic focus, the family becomes the protagonist in the symptoms of the indicated patient. It is within the family where the study proposes to find characteristics that instigate the development of the psychosomatic disease. The psychosomatic family basically suffers problems with boundaries. As with most family problems, the psychosomatic illness pertains to this dynamic group of families where the family roles are intermixed. The desire for a unified family creates a difficult home environment for individual spaces. This difficulty interpreted by Minuchin (1990) as the absence of psychological distance and defined it as the moment where one, or various family members begin to function as a family subsystem to which they do not pertain. According to Onnis (1990), there are four main characteristics of the psychosomatic family: Agglutination This refers to the reciprocal over-involvement of the family members. Each member is prone to intrusive actions, thoughts, feelings and communication with the other members. Reciprocal over-protection The members of the family demonstrate a high grade of diligence and reciprocal interest, encouraging and supplying answers that are of a protective type. As a result, the illness of the patient has a protective function towards the family. Rigidity This is the principal characteristic of the psychosomatic family. The family is resistant to change, and show itself as a unified and harmonious one, where the only problem is the illness of the patient. Outside relationships are scarce and the family remains stuck in the attempt to maintain it's own homeostasis. Avoidance of conflict There is a very low capacity for tolerating conflicts by the family and applies all possible methods to avoid it, which in the end the family only manages to hide the problem. In such a pattern, the patient plays a central and vital role by interfering every time the tension between the parents raises to a threat and the appearance of a symptom blocks the conflict by attracting the attention of the family members towards him/herself. The present study was done to characterize the organizational and functional profile of the nuclear family with one asthmatic child. Methods This is a descriptive semi-quantitative, non-experimental study to understand the family behavior and function of twenty nuclear families with one asthmatic child. The family function was evaluated in nine different areas with Emma Espejel Acco's the Scale of Family Function. This instrument was chosen because they could attain the desired objective and they were standardized for the Mexican population with a sensibility of 0.91 to discriminate between dysfunctional and functional families. Emma Espejel Acco's Scale of Family Function include the following areas: support, affect, disruptive conduct, communication, resources, authority, supervision, negative affect and control and final evaluation of each areas were reported in four categories: functional, fairly functional, poor functional and dysfunctional, attending Espejel Acco's recommendations. The study population was taken from a pool containing 102 psychosomatics families, whose participated in a previous study to characterize clinical patterns of asthma in children, also their relation with social and environmental factors leaded by Rodríguez-Orozco at the University of San Nicolás de Hidalgo, Morelia, México. Those nuclear families with an asthmatic children, within the ages six and twelve years, were included. There were only twenty families that fit the nuclear typology also, requirements for the study and those twenty were the ones included in this study; 95% was considered statistically significant and Pearson's Correlation was applied to study the relations between explored areas of the Scale of Family Function. The written consent was previously received for participant families and this study was run during 2005 at the University of San Nicolás de Hidalgo, Morelia, México. Results The 80% of the families were poorly functional in the area of affect. The communication was poorly functional in 60% of the families, in the area of resources 50 % of the families were fairly functional. Attending authority (75%), supervision(95%) and control (50%) of the families were fairly functional. 70 % of the families were fairly functional in support, and 65% were fairly functional when disruptive conducts were analized. In the area of negative affect almost 50% of the families were fairly functional. Within the obtained results, there was a positive correlation with a significance P <0.05 between the following areas authority and disruptive conduct r= .545 between the areas of authority and communication r=.518, and between disruptive conduct and resources r=.524 Discussion The principal characteristics found in the studied nuclear psychosomatic families with one son with asthma were agglutination, overprotection, rigidity and avoidance of conflict according to the four main characteristics referred in psychosomatic families. The familiar dinamics was really complex, even when all areas of the familiar function are compromised there is a predominance of poor efficacy to demonstrate affect and to communicate their feelings; it is associated with persistence of negative feelings which can not be treat adecuately due to a limited number of resources to solve conflicts. There was a positive correlation between authority and communication; authority and disruptive conduct and disruptive conduct and resources. This means that when authority resides in a parental subsystem, feelings are good expressed within the family; the emerging situations such as addictions and innapropiate social behaviour are well-discussed, despite of the major part of this innapropiate conducts remain unsolved because the family can not recognize the instruments to solve this problems. Conclusions The nuclear psychosomatics families with an asthmatic son, are rigid ones, and all areas of familiar functioning according. Espejel's Scale are affected, in agreement to other authors rigidity, as the crucial characteristics accompanied of avoidance of conflict, reciprocal-overprotection and agglutination. All evaluated areas of family function were affected in nuclear psychosomatic families with an asthmatic son. That is the way to stop the psychosomatic system. The psychological assistance is necessary to integrate to the medical treatment.<hr/>Introducción El asma es un problema de salud mundial, su incidencia continúa aumentando en nuestro medio y para su control en muchos casos no resulta suficiente el tratamiento farmacológico; por ello una perspectiva más integradora para su atención debe incluir el manejo de las circunstancias que detonan las crisis y las apuntan hacia la cronicidad de la enfermedad en la familia, la escuela y el trabajo. Bajo este enfoque sistemático, en la familia se encuentran las características que instigan el desarrollo de la enfermedad psicosomática y deviene en protagonista de los síntomas que el paciente exhibe. La familia psicosomática sufre básicamente problemas con las fronteras y los papeles que sus miembros tienden a entremezclar en una complicada madeja; en consecuencia, los deseos de unidad familiar están ligados a las dificultades para mantener los espacios individuales. Según Onnis (1990), existen cuatro características principales que caracterizan a la familia psicosomática: la aglutinación, la hiperprotección recíproca, la rigidez y la evitación de conflicto. La aglutinación se refiere al hecho de que los miembros de la familia se sobreinvolucran recíprocamente; cada uno mantiene tendencias intrusivas en los pensamientos, acciones, sentimientos y comunicaciones de los demás; los límites generacionales e interindividuales son frágiles, y se confunden papeles y funciones. La hiperprotección recíproca se establece cuando miembros de una familia muestran entre sí un alto grado de solicitud e interés recíproco; se estimulan y aportan respuestas de protección, en especial cuando el paciente asume el comportamiento sintomático todos se movilizan para protegerlo. La rigidez es una de las características más importantes del entorno psicosomático, una familia rígida es resistente al cambio aunque con frecuencia se presente unida y armónica, con escasas relaciones externas por lo que, aparentemente, el problema único es la enfermedad del paciente. La evitación del conflicto es otro de los rasgos típicos de la familia psicosomática, se aplican varios mecanismos para evitar el conflicto y ocultar el problema. Existe en la familia un bajo umbral de tolerancia al conflicto, por lo que es frecuente encontrar un niño en quien la aparición del síntoma consigue el bloque de las tensiones entre los padres y atrae hacia él la atención de la familia. Métodos La presente investigación se realizó en la ciudad de Morelia, Michoacán, durante el año de 2005; es una investigación de tipo cuantitativo, no experimental, transversal y descriptiva; se estudiaron 20 familias nucleares con un hijo asmático con edades entre seis y 12 años; el objetivo del estudio fue caracterizar el funcionamiento y la organización de la familia por su relación con la detonación y persistencia de los síntomas asmáticos en el miembro de la familia que experimenta la enfermedad. Para obtener las mediciones se aceptó un rango con 95% de confiabilidad y se usó la Correlación de Pearson para estimar la relación entre las áreas de función familiar evaluadas. Para estimar el funcionamiento de la familia se usó la Escala de Funcionamiento Familiar de Emma Espejel que permite evaluar nueve áreas: apoyo, recursos, afecto, conducta disruptiva, afecto negativo, comunicación, autoridad, supervisión y control, ésta última está validada para la población mexicana y puede discriminar familias funcionales de familias disfuncionales con una sensibilidad de 0.91. Resultados De las familias estudiadas 80% se mostraron poco funcionales en el área de afecto; 60% fueron poco funcionales en la comunicación; y 50% moderadamente funcionales en recursos. En las áreas de supervisión, autoridad y control fueron moderadamente funcionales 95%, 75% y 50% respectivamente. Fueron moderadamente funcionales en el area de apoyo, 70%. El 65% de las familias fueron moderadamente funcionales en el área que explora conductas disruptivas. En el área afecto negativo 50% de las familias fueron moderadamente funcionales. Las correlaciones positivas que más llamaron la atención entre las áreas de función familiar estudiadas fueron: entre autoridad y conducta disruptiva, r=.545, P<0.05; entre autoridad y comunicación, r=.518, P<0.05, y entre conducta disruptiva y recursos r=.524, P<0.05. Discusión El perfil organizativo-funcional encontrado en estas familias correspondió con las principales características reportadas por otros autores en las familias psicosomáticas: rigidez, sobreprotección, evitación de conflicto y aglutinación. Esta dinámica causa poca eficacia en cuanto a la demostración del afecto y para sustentar la comunicación, lo anterior se traduce en una permanencia de sentimientos negativos que repercute en la pobre utilización de recursos para salir adelante y, en ocasiones, se desconoce la existencia de éstos. La existencia de correlaciones positivas entre autoridad y comunicación, entre autoridad y conducta disruptiva y entre conducta disruptiva y recursos, significa que cuando la autoridad radica en el sistema parental los sentimientos son mejor expresados por la familia, se favorece el intercambio de puntos de vista y las situaciones emergentes como las adicciones y los comportamientos inapropiados son mejor discutidos. De igual forma los problemas en el comportamiento de la familia y las conductas inadecuadas tienden a no quedar resueltos debido a la limitación en el reconocimiento y manejo de las herramientas adecuadas para salir adelante. <![CDATA[<b>Gustave Flaubert and his double</b>: <b>the hemisphere dialectic in artistic creation</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252008000100010&lng=pt&nrm=iso&tlng=pt Introduction Asthma is a current problem worldwide. By one hand the prevalence of the disease has been increasing in México during the last decades; on the other hand there is a considerable number of patients in whose the disease can not be controlled. The analysis of familiar function is a convenient weapon to approach in a more integrated manner such problem. In this systematic focus, the family becomes the protagonist in the symptoms of the indicated patient. It is within the family where the study proposes to find characteristics that instigate the development of the psychosomatic disease. The psychosomatic family basically suffers problems with boundaries. As with most family problems, the psychosomatic illness pertains to this dynamic group of families where the family roles are intermixed. The desire for a unified family creates a difficult home environment for individual spaces. This difficulty interpreted by Minuchin (1990) as the absence of psychological distance and defined it as the moment where one, or various family members begin to function as a family subsystem to which they do not pertain. According to Onnis (1990), there are four main characteristics of the psychosomatic family: Agglutination This refers to the reciprocal over-involvement of the family members. Each member is prone to intrusive actions, thoughts, feelings and communication with the other members. Reciprocal over-protection The members of the family demonstrate a high grade of diligence and reciprocal interest, encouraging and supplying answers that are of a protective type. As a result, the illness of the patient has a protective function towards the family. Rigidity This is the principal characteristic of the psychosomatic family. The family is resistant to change, and show itself as a unified and harmonious one, where the only problem is the illness of the patient. Outside relationships are scarce and the family remains stuck in the attempt to maintain it's own homeostasis. Avoidance of conflict There is a very low capacity for tolerating conflicts by the family and applies all possible methods to avoid it, which in the end the family only manages to hide the problem. In such a pattern, the patient plays a central and vital role by interfering every time the tension between the parents raises to a threat and the appearance of a symptom blocks the conflict by attracting the attention of the family members towards him/herself. The present study was done to characterize the organizational and functional profile of the nuclear family with one asthmatic child. Methods This is a descriptive semi-quantitative, non-experimental study to understand the family behavior and function of twenty nuclear families with one asthmatic child. The family function was evaluated in nine different areas with Emma Espejel Acco's the Scale of Family Function. This instrument was chosen because they could attain the desired objective and they were standardized for the Mexican population with a sensibility of 0.91 to discriminate between dysfunctional and functional families. Emma Espejel Acco's Scale of Family Function include the following areas: support, affect, disruptive conduct, communication, resources, authority, supervision, negative affect and control and final evaluation of each areas were reported in four categories: functional, fairly functional, poor functional and dysfunctional, attending Espejel Acco's recommendations. The study population was taken from a pool containing 102 psychosomatics families, whose participated in a previous study to characterize clinical patterns of asthma in children, also their relation with social and environmental factors leaded by Rodríguez-Orozco at the University of San Nicolás de Hidalgo, Morelia, México. Those nuclear families with an asthmatic children, within the ages six and twelve years, were included. There were only twenty families that fit the nuclear typology also, requirements for the study and those twenty were the ones included in this study; 95% was considered statistically significant and Pearson's Correlation was applied to study the relations between explored areas of the Scale of Family Function. The written consent was previously received for participant families and this study was run during 2005 at the University of San Nicolás de Hidalgo, Morelia, México. Results The 80% of the families were poorly functional in the area of affect. The communication was poorly functional in 60% of the families, in the area of resources 50 % of the families were fairly functional. Attending authority (75%), supervision(95%) and control (50%) of the families were fairly functional. 70 % of the families were fairly functional in support, and 65% were fairly functional when disruptive conducts were analized. In the area of negative affect almost 50% of the families were fairly functional. Within the obtained results, there was a positive correlation with a significance P <0.05 between the following areas authority and disruptive conduct r= .545 between the areas of authority and communication r=.518, and between disruptive conduct and resources r=.524 Discussion The principal characteristics found in the studied nuclear psychosomatic families with one son with asthma were agglutination, overprotection, rigidity and avoidance of conflict according to the four main characteristics referred in psychosomatic families. The familiar dinamics was really complex, even when all areas of the familiar function are compromised there is a predominance of poor efficacy to demonstrate affect and to communicate their feelings; it is associated with persistence of negative feelings which can not be treat adecuately due to a limited number of resources to solve conflicts. There was a positive correlation between authority and communication; authority and disruptive conduct and disruptive conduct and resources. This means that when authority resides in a parental subsystem, feelings are good expressed within the family; the emerging situations such as addictions and innapropiate social behaviour are well-discussed, despite of the major part of this innapropiate conducts remain unsolved because the family can not recognize the instruments to solve this problems. Conclusions The nuclear psychosomatics families with an asthmatic son, are rigid ones, and all areas of familiar functioning according. Espejel's Scale are affected, in agreement to other authors rigidity, as the crucial characteristics accompanied of avoidance of conflict, reciprocal-overprotection and agglutination. All evaluated areas of family function were affected in nuclear psychosomatic families with an asthmatic son. That is the way to stop the psychosomatic system. The psychological assistance is necessary to integrate to the medical treatment.<hr/>Introducción El asma es un problema de salud mundial, su incidencia continúa aumentando en nuestro medio y para su control en muchos casos no resulta suficiente el tratamiento farmacológico; por ello una perspectiva más integradora para su atención debe incluir el manejo de las circunstancias que detonan las crisis y las apuntan hacia la cronicidad de la enfermedad en la familia, la escuela y el trabajo. Bajo este enfoque sistemático, en la familia se encuentran las características que instigan el desarrollo de la enfermedad psicosomática y deviene en protagonista de los síntomas que el paciente exhibe. La familia psicosomática sufre básicamente problemas con las fronteras y los papeles que sus miembros tienden a entremezclar en una complicada madeja; en consecuencia, los deseos de unidad familiar están ligados a las dificultades para mantener los espacios individuales. Según Onnis (1990), existen cuatro características principales que caracterizan a la familia psicosomática: la aglutinación, la hiperprotección recíproca, la rigidez y la evitación de conflicto. La aglutinación se refiere al hecho de que los miembros de la familia se sobreinvolucran recíprocamente; cada uno mantiene tendencias intrusivas en los pensamientos, acciones, sentimientos y comunicaciones de los demás; los límites generacionales e interindividuales son frágiles, y se confunden papeles y funciones. La hiperprotección recíproca se establece cuando miembros de una familia muestran entre sí un alto grado de solicitud e interés recíproco; se estimulan y aportan respuestas de protección, en especial cuando el paciente asume el comportamiento sintomático todos se movilizan para protegerlo. La rigidez es una de las características más importantes del entorno psicosomático, una familia rígida es resistente al cambio aunque con frecuencia se presente unida y armónica, con escasas relaciones externas por lo que, aparentemente, el problema único es la enfermedad del paciente. La evitación del conflicto es otro de los rasgos típicos de la familia psicosomática, se aplican varios mecanismos para evitar el conflicto y ocultar el problema. Existe en la familia un bajo umbral de tolerancia al conflicto, por lo que es frecuente encontrar un niño en quien la aparición del síntoma consigue el bloque de las tensiones entre los padres y atrae hacia él la atención de la familia. Métodos La presente investigación se realizó en la ciudad de Morelia, Michoacán, durante el año de 2005; es una investigación de tipo cuantitativo, no experimental, transversal y descriptiva; se estudiaron 20 familias nucleares con un hijo asmático con edades entre seis y 12 años; el objetivo del estudio fue caracterizar el funcionamiento y la organización de la familia por su relación con la detonación y persistencia de los síntomas asmáticos en el miembro de la familia que experimenta la enfermedad. Para obtener las mediciones se aceptó un rango con 95% de confiabilidad y se usó la Correlación de Pearson para estimar la relación entre las áreas de función familiar evaluadas. Para estimar el funcionamiento de la familia se usó la Escala de Funcionamiento Familiar de Emma Espejel que permite evaluar nueve áreas: apoyo, recursos, afecto, conducta disruptiva, afecto negativo, comunicación, autoridad, supervisión y control, ésta última está validada para la población mexicana y puede discriminar familias funcionales de familias disfuncionales con una sensibilidad de 0.91. Resultados De las familias estudiadas 80% se mostraron poco funcionales en el área de afecto; 60% fueron poco funcionales en la comunicación; y 50% moderadamente funcionales en recursos. En las áreas de supervisión, autoridad y control fueron moderadamente funcionales 95%, 75% y 50% respectivamente. Fueron moderadamente funcionales en el area de apoyo, 70%. El 65% de las familias fueron moderadamente funcionales en el área que explora conductas disruptivas. En el área afecto negativo 50% de las familias fueron moderadamente funcionales. Las correlaciones positivas que más llamaron la atención entre las áreas de función familiar estudiadas fueron: entre autoridad y conducta disruptiva, r=.545, P<0.05; entre autoridad y comunicación, r=.518, P<0.05, y entre conducta disruptiva y recursos r=.524, P<0.05. Discusión El perfil organizativo-funcional encontrado en estas familias correspondió con las principales características reportadas por otros autores en las familias psicosomáticas: rigidez, sobreprotección, evitación de conflicto y aglutinación. Esta dinámica causa poca eficacia en cuanto a la demostración del afecto y para sustentar la comunicación, lo anterior se traduce en una permanencia de sentimientos negativos que repercute en la pobre utilización de recursos para salir adelante y, en ocasiones, se desconoce la existencia de éstos. La existencia de correlaciones positivas entre autoridad y comunicación, entre autoridad y conducta disruptiva y entre conducta disruptiva y recursos, significa que cuando la autoridad radica en el sistema parental los sentimientos son mejor expresados por la familia, se favorece el intercambio de puntos de vista y las situaciones emergentes como las adicciones y los comportamientos inapropiados son mejor discutidos. De igual forma los problemas en el comportamiento de la familia y las conductas inadecuadas tienden a no quedar resueltos debido a la limitación en el reconocimiento y manejo de las herramientas adecuadas para salir adelante. <![CDATA[<b>La Mente</b><b> en el Mundo: en memoria de Paul Bach y Rita</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252008000100011&lng=pt&nrm=iso&tlng=pt Introduction Asthma is a current problem worldwide. By one hand the prevalence of the disease has been increasing in México during the last decades; on the other hand there is a considerable number of patients in whose the disease can not be controlled. The analysis of familiar function is a convenient weapon to approach in a more integrated manner such problem. In this systematic focus, the family becomes the protagonist in the symptoms of the indicated patient. It is within the family where the study proposes to find characteristics that instigate the development of the psychosomatic disease. The psychosomatic family basically suffers problems with boundaries. As with most family problems, the psychosomatic illness pertains to this dynamic group of families where the family roles are intermixed. The desire for a unified family creates a difficult home environment for individual spaces. This difficulty interpreted by Minuchin (1990) as the absence of psychological distance and defined it as the moment where one, or various family members begin to function as a family subsystem to which they do not pertain. According to Onnis (1990), there are four main characteristics of the psychosomatic family: Agglutination This refers to the reciprocal over-involvement of the family members. Each member is prone to intrusive actions, thoughts, feelings and communication with the other members. Reciprocal over-protection The members of the family demonstrate a high grade of diligence and reciprocal interest, encouraging and supplying answers that are of a protective type. As a result, the illness of the patient has a protective function towards the family. Rigidity This is the principal characteristic of the psychosomatic family. The family is resistant to change, and show itself as a unified and harmonious one, where the only problem is the illness of the patient. Outside relationships are scarce and the family remains stuck in the attempt to maintain it's own homeostasis. Avoidance of conflict There is a very low capacity for tolerating conflicts by the family and applies all possible methods to avoid it, which in the end the family only manages to hide the problem. In such a pattern, the patient plays a central and vital role by interfering every time the tension between the parents raises to a threat and the appearance of a symptom blocks the conflict by attracting the attention of the family members towards him/herself. The present study was done to characterize the organizational and functional profile of the nuclear family with one asthmatic child. Methods This is a descriptive semi-quantitative, non-experimental study to understand the family behavior and function of twenty nuclear families with one asthmatic child. The family function was evaluated in nine different areas with Emma Espejel Acco's the Scale of Family Function. This instrument was chosen because they could attain the desired objective and they were standardized for the Mexican population with a sensibility of 0.91 to discriminate between dysfunctional and functional families. Emma Espejel Acco's Scale of Family Function include the following areas: support, affect, disruptive conduct, communication, resources, authority, supervision, negative affect and control and final evaluation of each areas were reported in four categories: functional, fairly functional, poor functional and dysfunctional, attending Espejel Acco's recommendations. The study population was taken from a pool containing 102 psychosomatics families, whose participated in a previous study to characterize clinical patterns of asthma in children, also their relation with social and environmental factors leaded by Rodríguez-Orozco at the University of San Nicolás de Hidalgo, Morelia, México. Those nuclear families with an asthmatic children, within the ages six and twelve years, were included. There were only twenty families that fit the nuclear typology also, requirements for the study and those twenty were the ones included in this study; 95% was considered statistically significant and Pearson's Correlation was applied to study the relations between explored areas of the Scale of Family Function. The written consent was previously received for participant families and this study was run during 2005 at the University of San Nicolás de Hidalgo, Morelia, México. Results The 80% of the families were poorly functional in the area of affect. The communication was poorly functional in 60% of the families, in the area of resources 50 % of the families were fairly functional. Attending authority (75%), supervision(95%) and control (50%) of the families were fairly functional. 70 % of the families were fairly functional in support, and 65% were fairly functional when disruptive conducts were analized. In the area of negative affect almost 50% of the families were fairly functional. Within the obtained results, there was a positive correlation with a significance P <0.05 between the following areas authority and disruptive conduct r= .545 between the areas of authority and communication r=.518, and between disruptive conduct and resources r=.524 Discussion The principal characteristics found in the studied nuclear psychosomatic families with one son with asthma were agglutination, overprotection, rigidity and avoidance of conflict according to the four main characteristics referred in psychosomatic families. The familiar dinamics was really complex, even when all areas of the familiar function are compromised there is a predominance of poor efficacy to demonstrate affect and to communicate their feelings; it is associated with persistence of negative feelings which can not be treat adecuately due to a limited number of resources to solve conflicts. There was a positive correlation between authority and communication; authority and disruptive conduct and disruptive conduct and resources. This means that when authority resides in a parental subsystem, feelings are good expressed within the family; the emerging situations such as addictions and innapropiate social behaviour are well-discussed, despite of the major part of this innapropiate conducts remain unsolved because the family can not recognize the instruments to solve this problems. Conclusions The nuclear psychosomatics families with an asthmatic son, are rigid ones, and all areas of familiar functioning according. Espejel's Scale are affected, in agreement to other authors rigidity, as the crucial characteristics accompanied of avoidance of conflict, reciprocal-overprotection and agglutination. All evaluated areas of family function were affected in nuclear psychosomatic families with an asthmatic son. That is the way to stop the psychosomatic system. The psychological assistance is necessary to integrate to the medical treatment.<hr/>Introducción El asma es un problema de salud mundial, su incidencia continúa aumentando en nuestro medio y para su control en muchos casos no resulta suficiente el tratamiento farmacológico; por ello una perspectiva más integradora para su atención debe incluir el manejo de las circunstancias que detonan las crisis y las apuntan hacia la cronicidad de la enfermedad en la familia, la escuela y el trabajo. Bajo este enfoque sistemático, en la familia se encuentran las características que instigan el desarrollo de la enfermedad psicosomática y deviene en protagonista de los síntomas que el paciente exhibe. La familia psicosomática sufre básicamente problemas con las fronteras y los papeles que sus miembros tienden a entremezclar en una complicada madeja; en consecuencia, los deseos de unidad familiar están ligados a las dificultades para mantener los espacios individuales. Según Onnis (1990), existen cuatro características principales que caracterizan a la familia psicosomática: la aglutinación, la hiperprotección recíproca, la rigidez y la evitación de conflicto. La aglutinación se refiere al hecho de que los miembros de la familia se sobreinvolucran recíprocamente; cada uno mantiene tendencias intrusivas en los pensamientos, acciones, sentimientos y comunicaciones de los demás; los límites generacionales e interindividuales son frágiles, y se confunden papeles y funciones. La hiperprotección recíproca se establece cuando miembros de una familia muestran entre sí un alto grado de solicitud e interés recíproco; se estimulan y aportan respuestas de protección, en especial cuando el paciente asume el comportamiento sintomático todos se movilizan para protegerlo. La rigidez es una de las características más importantes del entorno psicosomático, una familia rígida es resistente al cambio aunque con frecuencia se presente unida y armónica, con escasas relaciones externas por lo que, aparentemente, el problema único es la enfermedad del paciente. La evitación del conflicto es otro de los rasgos típicos de la familia psicosomática, se aplican varios mecanismos para evitar el conflicto y ocultar el problema. Existe en la familia un bajo umbral de tolerancia al conflicto, por lo que es frecuente encontrar un niño en quien la aparición del síntoma consigue el bloque de las tensiones entre los padres y atrae hacia él la atención de la familia. Métodos La presente investigación se realizó en la ciudad de Morelia, Michoacán, durante el año de 2005; es una investigación de tipo cuantitativo, no experimental, transversal y descriptiva; se estudiaron 20 familias nucleares con un hijo asmático con edades entre seis y 12 años; el objetivo del estudio fue caracterizar el funcionamiento y la organización de la familia por su relación con la detonación y persistencia de los síntomas asmáticos en el miembro de la familia que experimenta la enfermedad. Para obtener las mediciones se aceptó un rango con 95% de confiabilidad y se usó la Correlación de Pearson para estimar la relación entre las áreas de función familiar evaluadas. Para estimar el funcionamiento de la familia se usó la Escala de Funcionamiento Familiar de Emma Espejel que permite evaluar nueve áreas: apoyo, recursos, afecto, conducta disruptiva, afecto negativo, comunicación, autoridad, supervisión y control, ésta última está validada para la población mexicana y puede discriminar familias funcionales de familias disfuncionales con una sensibilidad de 0.91. Resultados De las familias estudiadas 80% se mostraron poco funcionales en el área de afecto; 60% fueron poco funcionales en la comunicación; y 50% moderadamente funcionales en recursos. En las áreas de supervisión, autoridad y control fueron moderadamente funcionales 95%, 75% y 50% respectivamente. Fueron moderadamente funcionales en el area de apoyo, 70%. El 65% de las familias fueron moderadamente funcionales en el área que explora conductas disruptivas. En el área afecto negativo 50% de las familias fueron moderadamente funcionales. Las correlaciones positivas que más llamaron la atención entre las áreas de función familiar estudiadas fueron: entre autoridad y conducta disruptiva, r=.545, P<0.05; entre autoridad y comunicación, r=.518, P<0.05, y entre conducta disruptiva y recursos r=.524, P<0.05. Discusión El perfil organizativo-funcional encontrado en estas familias correspondió con las principales características reportadas por otros autores en las familias psicosomáticas: rigidez, sobreprotección, evitación de conflicto y aglutinación. Esta dinámica causa poca eficacia en cuanto a la demostración del afecto y para sustentar la comunicación, lo anterior se traduce en una permanencia de sentimientos negativos que repercute en la pobre utilización de recursos para salir adelante y, en ocasiones, se desconoce la existencia de éstos. La existencia de correlaciones positivas entre autoridad y comunicación, entre autoridad y conducta disruptiva y entre conducta disruptiva y recursos, significa que cuando la autoridad radica en el sistema parental los sentimientos son mejor expresados por la familia, se favorece el intercambio de puntos de vista y las situaciones emergentes como las adicciones y los comportamientos inapropiados son mejor discutidos. De igual forma los problemas en el comportamiento de la familia y las conductas inadecuadas tienden a no quedar resueltos debido a la limitación en el reconocimiento y manejo de las herramientas adecuadas para salir adelante. <![CDATA[<b>Autoevaluación</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252008000100012&lng=pt&nrm=iso&tlng=pt Introduction Asthma is a current problem worldwide. By one hand the prevalence of the disease has been increasing in México during the last decades; on the other hand there is a considerable number of patients in whose the disease can not be controlled. The analysis of familiar function is a convenient weapon to approach in a more integrated manner such problem. In this systematic focus, the family becomes the protagonist in the symptoms of the indicated patient. It is within the family where the study proposes to find characteristics that instigate the development of the psychosomatic disease. The psychosomatic family basically suffers problems with boundaries. As with most family problems, the psychosomatic illness pertains to this dynamic group of families where the family roles are intermixed. The desire for a unified family creates a difficult home environment for individual spaces. This difficulty interpreted by Minuchin (1990) as the absence of psychological distance and defined it as the moment where one, or various family members begin to function as a family subsystem to which they do not pertain. According to Onnis (1990), there are four main characteristics of the psychosomatic family: Agglutination This refers to the reciprocal over-involvement of the family members. Each member is prone to intrusive actions, thoughts, feelings and communication with the other members. Reciprocal over-protection The members of the family demonstrate a high grade of diligence and reciprocal interest, encouraging and supplying answers that are of a protective type. As a result, the illness of the patient has a protective function towards the family. Rigidity This is the principal characteristic of the psychosomatic family. The family is resistant to change, and show itself as a unified and harmonious one, where the only problem is the illness of the patient. Outside relationships are scarce and the family remains stuck in the attempt to maintain it's own homeostasis. Avoidance of conflict There is a very low capacity for tolerating conflicts by the family and applies all possible methods to avoid it, which in the end the family only manages to hide the problem. In such a pattern, the patient plays a central and vital role by interfering every time the tension between the parents raises to a threat and the appearance of a symptom blocks the conflict by attracting the attention of the family members towards him/herself. The present study was done to characterize the organizational and functional profile of the nuclear family with one asthmatic child. Methods This is a descriptive semi-quantitative, non-experimental study to understand the family behavior and function of twenty nuclear families with one asthmatic child. The family function was evaluated in nine different areas with Emma Espejel Acco's the Scale of Family Function. This instrument was chosen because they could attain the desired objective and they were standardized for the Mexican population with a sensibility of 0.91 to discriminate between dysfunctional and functional families. Emma Espejel Acco's Scale of Family Function include the following areas: support, affect, disruptive conduct, communication, resources, authority, supervision, negative affect and control and final evaluation of each areas were reported in four categories: functional, fairly functional, poor functional and dysfunctional, attending Espejel Acco's recommendations. The study population was taken from a pool containing 102 psychosomatics families, whose participated in a previous study to characterize clinical patterns of asthma in children, also their relation with social and environmental factors leaded by Rodríguez-Orozco at the University of San Nicolás de Hidalgo, Morelia, México. Those nuclear families with an asthmatic children, within the ages six and twelve years, were included. There were only twenty families that fit the nuclear typology also, requirements for the study and those twenty were the ones included in this study; 95% was considered statistically significant and Pearson's Correlation was applied to study the relations between explored areas of the Scale of Family Function. The written consent was previously received for participant families and this study was run during 2005 at the University of San Nicolás de Hidalgo, Morelia, México. Results The 80% of the families were poorly functional in the area of affect. The communication was poorly functional in 60% of the families, in the area of resources 50 % of the families were fairly functional. Attending authority (75%), supervision(95%) and control (50%) of the families were fairly functional. 70 % of the families were fairly functional in support, and 65% were fairly functional when disruptive conducts were analized. In the area of negative affect almost 50% of the families were fairly functional. Within the obtained results, there was a positive correlation with a significance P <0.05 between the following areas authority and disruptive conduct r= .545 between the areas of authority and communication r=.518, and between disruptive conduct and resources r=.524 Discussion The principal characteristics found in the studied nuclear psychosomatic families with one son with asthma were agglutination, overprotection, rigidity and avoidance of conflict according to the four main characteristics referred in psychosomatic families. The familiar dinamics was really complex, even when all areas of the familiar function are compromised there is a predominance of poor efficacy to demonstrate affect and to communicate their feelings; it is associated with persistence of negative feelings which can not be treat adecuately due to a limited number of resources to solve conflicts. There was a positive correlation between authority and communication; authority and disruptive conduct and disruptive conduct and resources. This means that when authority resides in a parental subsystem, feelings are good expressed within the family; the emerging situations such as addictions and innapropiate social behaviour are well-discussed, despite of the major part of this innapropiate conducts remain unsolved because the family can not recognize the instruments to solve this problems. Conclusions The nuclear psychosomatics families with an asthmatic son, are rigid ones, and all areas of familiar functioning according. Espejel's Scale are affected, in agreement to other authors rigidity, as the crucial characteristics accompanied of avoidance of conflict, reciprocal-overprotection and agglutination. All evaluated areas of family function were affected in nuclear psychosomatic families with an asthmatic son. That is the way to stop the psychosomatic system. The psychological assistance is necessary to integrate to the medical treatment.<hr/>Introducción El asma es un problema de salud mundial, su incidencia continúa aumentando en nuestro medio y para su control en muchos casos no resulta suficiente el tratamiento farmacológico; por ello una perspectiva más integradora para su atención debe incluir el manejo de las circunstancias que detonan las crisis y las apuntan hacia la cronicidad de la enfermedad en la familia, la escuela y el trabajo. Bajo este enfoque sistemático, en la familia se encuentran las características que instigan el desarrollo de la enfermedad psicosomática y deviene en protagonista de los síntomas que el paciente exhibe. La familia psicosomática sufre básicamente problemas con las fronteras y los papeles que sus miembros tienden a entremezclar en una complicada madeja; en consecuencia, los deseos de unidad familiar están ligados a las dificultades para mantener los espacios individuales. Según Onnis (1990), existen cuatro características principales que caracterizan a la familia psicosomática: la aglutinación, la hiperprotección recíproca, la rigidez y la evitación de conflicto. La aglutinación se refiere al hecho de que los miembros de la familia se sobreinvolucran recíprocamente; cada uno mantiene tendencias intrusivas en los pensamientos, acciones, sentimientos y comunicaciones de los demás; los límites generacionales e interindividuales son frágiles, y se confunden papeles y funciones. La hiperprotección recíproca se establece cuando miembros de una familia muestran entre sí un alto grado de solicitud e interés recíproco; se estimulan y aportan respuestas de protección, en especial cuando el paciente asume el comportamiento sintomático todos se movilizan para protegerlo. La rigidez es una de las características más importantes del entorno psicosomático, una familia rígida es resistente al cambio aunque con frecuencia se presente unida y armónica, con escasas relaciones externas por lo que, aparentemente, el problema único es la enfermedad del paciente. La evitación del conflicto es otro de los rasgos típicos de la familia psicosomática, se aplican varios mecanismos para evitar el conflicto y ocultar el problema. Existe en la familia un bajo umbral de tolerancia al conflicto, por lo que es frecuente encontrar un niño en quien la aparición del síntoma consigue el bloque de las tensiones entre los padres y atrae hacia él la atención de la familia. Métodos La presente investigación se realizó en la ciudad de Morelia, Michoacán, durante el año de 2005; es una investigación de tipo cuantitativo, no experimental, transversal y descriptiva; se estudiaron 20 familias nucleares con un hijo asmático con edades entre seis y 12 años; el objetivo del estudio fue caracterizar el funcionamiento y la organización de la familia por su relación con la detonación y persistencia de los síntomas asmáticos en el miembro de la familia que experimenta la enfermedad. Para obtener las mediciones se aceptó un rango con 95% de confiabilidad y se usó la Correlación de Pearson para estimar la relación entre las áreas de función familiar evaluadas. Para estimar el funcionamiento de la familia se usó la Escala de Funcionamiento Familiar de Emma Espejel que permite evaluar nueve áreas: apoyo, recursos, afecto, conducta disruptiva, afecto negativo, comunicación, autoridad, supervisión y control, ésta última está validada para la población mexicana y puede discriminar familias funcionales de familias disfuncionales con una sensibilidad de 0.91. Resultados De las familias estudiadas 80% se mostraron poco funcionales en el área de afecto; 60% fueron poco funcionales en la comunicación; y 50% moderadamente funcionales en recursos. En las áreas de supervisión, autoridad y control fueron moderadamente funcionales 95%, 75% y 50% respectivamente. Fueron moderadamente funcionales en el area de apoyo, 70%. El 65% de las familias fueron moderadamente funcionales en el área que explora conductas disruptivas. En el área afecto negativo 50% de las familias fueron moderadamente funcionales. Las correlaciones positivas que más llamaron la atención entre las áreas de función familiar estudiadas fueron: entre autoridad y conducta disruptiva, r=.545, P<0.05; entre autoridad y comunicación, r=.518, P<0.05, y entre conducta disruptiva y recursos r=.524, P<0.05. Discusión El perfil organizativo-funcional encontrado en estas familias correspondió con las principales características reportadas por otros autores en las familias psicosomáticas: rigidez, sobreprotección, evitación de conflicto y aglutinación. Esta dinámica causa poca eficacia en cuanto a la demostración del afecto y para sustentar la comunicación, lo anterior se traduce en una permanencia de sentimientos negativos que repercute en la pobre utilización de recursos para salir adelante y, en ocasiones, se desconoce la existencia de éstos. La existencia de correlaciones positivas entre autoridad y comunicación, entre autoridad y conducta disruptiva y entre conducta disruptiva y recursos, significa que cuando la autoridad radica en el sistema parental los sentimientos son mejor expresados por la familia, se favorece el intercambio de puntos de vista y las situaciones emergentes como las adicciones y los comportamientos inapropiados son mejor discutidos. De igual forma los problemas en el comportamiento de la familia y las conductas inadecuadas tienden a no quedar resueltos debido a la limitación en el reconocimiento y manejo de las herramientas adecuadas para salir adelante.