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Biomedical subjects

R Florenzano

Publications and source records attributed to R Florenzano.

At least 19 recordsLinked to original sources

[Improving the quality of clinical interview teaching: evaluation of an intervention with medical students].

BACKGROUND: Quality of clinical interview is a key issue both for patient satisfaction and for diagnostic efficiency. Its adequacy relates to better clinical diagnosis treatment plans and patient compliance. AIM: To measure the quality of interviews performed by medical students in three Chilean medical schools before receiving specific training on the subject and to compare the scores obtained after introductory courses on interview. MATERIAL AND METHODS: The interviews were videotaped and then evaluated using an objective scale, that measures 33 skills grouped in six areas: opening, problem exploration, non verbal facilitation, interpersonal patient reaction and closing. The students were assigned to an experimental group that received an interactive workshop with role-plays, vignettes and videotape feedback, and to a non intervention group that received the usual bedside training on medical interviews. RESULTS: Both groups shared the same skill level before the training, with better scores on nonverbal, patient reaction and problem exploration, and worse ones on closing and interpersonal skills. Comparing pre and post-test results, the overall score improved in the experimental group (from 33.2 to 38.3, p = 0.002) and worsened among non intervened students. There were statistically significant changes for opening (p < 0.002), problem exploration (p < 0.05), non verbal facilitation (p < 0.0001) and closing (p < 0.0001). CONCLUSIONS: It is important to train students not only in specific knowledge contents but in the process of interview. This training should encourage the development of empathy and closing skills.

Education, Medical, Undergraduate↗

[Comorbidity of chronic diseases and psychiatric disorders among patients attending public primary care].

BACKGROUND: As a part of the World Health Organization multicentric study of emotional disorders in general medical care, we studied patients who had a chronic medical ailment and a psychiatric disorder, according to ICD-10. AIM: To report the prevalence of patients with coexisting medical and psychiatric disorders. PATIENTS AND METHODS: All patients, aged 15 to 65 years old, consulting in primary care outpatient clinics, were interviewed using a general health questionnaire. In a second phase, patients with chronic medical disorders were subjected to the World Health Organization Composite International Diagnostic Instrument. RESULTS: Sixty nine percent of interviewed Chilean patients had a medical condition, compared to 60.3% of the global study group. Of these, 66% had a coexisting psychiatric diagnosis, compared to 31% of the global study group. The most frequent diagnoses in the Chilean sample were somatization disorders in 25%, harmful alcohol use in 14%, depression in 35% and hypochondriasis in 6%. There was a higher prevalence and odds ratio for psychiatric diagnoses among Chilean women. CONCLUSIONS: Patients with chronic medical disorders should be considered a high risk group for the coexistence of psychiatric disturbances.

Adolescent↗

[Comparative study of the frequency and features of emotional disturbances in patients in primary care clinics].

BACKGROUND: Psychological problems are a frequent cause of consultation in primary care outpatient clinics. AIM: To report the results for Santiago de Chile of the World Health Organisation multicentric collaborative study on Psychological Symptoms in General Health Care. PATIENTS AND METHODS: The results of 1453 patients that attended three primary care clinics in East Metropolitan Santiago were compared with those of patients studied in 15 other centers throughout the world. Two hundred fifty three cases were studied in detail with a structured diagnostic interview (CIDI-PHC). The capacity of general physicians to recognise emotional disorders as well as their management of psychological cases was also assessed. RESULTS: Among the 253 patients studied in detail, 53% of patients had a definite psychiatric diagnosis, compared with 24% of patients, as an average, in other countries. There was a higher prevalence of depression, generalised anxiety disorder, neurasthenia and harmful use of alcohol. Chilean physicians recognised 74.1% of patients with psychiatric conditions, as compared with 48.9% of physicians abroad. Tranquilizing agents were the most often prescribed medications (40%) followed by antidepressants (18%). CONCLUSIONS: There is a high prevalence of emotional disorders in patients consulting at the primary care level.

Affective Symptoms↗

[The care of the terminally ill patient].

Drs. Alejandro Goic (internist), Ramón Florenzano (psychiatrist), Bernardino Piñera (physician and Catholic Bishop), Sergio Valdés (internist) and Rodolfo Armas (internist) participated in a round table about the care of the terminally ill, during a Postgraduate Course organized by the Chilean Society of Gastroenterology. After a general introduction, participants discussed the psychological aspects of terminally ill patients, about the sense of death from a Christian anthropological perspective, the terminally ill in intensive care units and finally about the education of medical students in this frequently neglected aspect of medical practice.

Attitude to Death↗

[Risk behavior in adolescent students in Santiago de Chile].

Aiming to measure the prevalence of risky behaviors, familial disturbances and their interrelations, a probabilistic sample of 1904 teenagers (aged 15.5 +/- 1.8 years, 42% male) was surveyed using and anonymous and self applied questionnaire. Fifty two percent of the sample smoked, 54% consumed alcohol, 12.5% marihuana, 3.2% amphetamines, 2.3% cocaine, 0.8% inhalants and 5.3% other drugs. Thirty two percent smoked frequently (monthly, weekly or daily); frequent alcohol, marihuana, amphetamines, cocaine and other drug consumption was found in 15.5, 5, 1.4, 0.4 and 1.4% of the sample. Substance abuse, except cigarette smoking was more prevalent among males. Substance abuse was more frequent among people over 15 years old. As to unsociable behaviors, 24% of teenagers referred vandalism in the last 24 months, 44% individual aggressions and 14% robbery. Twenty nine percent had school absenteeism. Parental separation, psychiatric treatments and treatments for alcoholism were present in 22, 6 and 4 percent of teenagers. Risky behaviors were significantly more frequent among offspring whose parents had any of these problems.

Adolescent↗

[Psychiatric patients from general hospitals: pathways followed before consultation].

A survey of all patients who consulted at the Psychiatric Service of a general hospital during a one month period was used to evaluate factors influencing the referral of the patient to the specialist. A preponderance of young females was observed. Patients presenting with somatic symptoms, anxiety or depression were usually referred from another physician, while patients with psychotic disorders and problems related to alcohol abuse were first seen by the specialist. Almost half of the patients had been previously treated, usually with anxiolytic drugs and the median time between the first consult and the referral was 52 weeks. Better systems for derivation of these patients must be developed.

Adolescent↗

Alcoholism and other substance abuse: preventive programs in Santiago, Chile.

This paper describes efforts that began in the 1970s to prevent alcohol and drug abuse among adolescents in Chile and discusses current health promotion programs that focus on prevention of health-endangering behaviors. Adolescent substance abuse has been found to be strongly correlated with familial dysfunction and parental drug abuse as well as with certain behavioral characteristics. Therefore, prevention activities should target high-risk children as identified by screening instruments. Interventions should be carried out at the individual, school, family, community, and societal levels. It is important to analyze the feasibility of implementing prevention activities and to systematically evaluate their effectiveness.

Adolescent↗

[Alcoholism and abuse of other drugs: prevention programs in Santiago, Chile].

This paper describes efforts that began in the 1970s to prevent alcohol and drug abuse among adolescents in Chile and discusses current health promotion programs that focus on prevention of health-endangering behaviors. Adolescent substance abuse has been found to be strongly correlated with familial dysfunction and parental drug abuse as well as with certain behavioral characteristics. Therefore, prevention activities should target high-risk children as identified by screening instruments. Interventions should be carried out at the individual, school, family, community, and societal levels. It is important to analyze the feasibility of implementing prevention activities and to systematically evaluate their effectiveness.

Adolescent↗

[Questionnaire for the evaluation of mental health in adolescence].

Procedures resorted to in building up a questionnaire for assessing adolescent's Mental Health are submitted. Questions were selected from DSM-III diagnosis categories and from Goldberg's General Health Questionnaire (GHQ) as well. The following variables were considered: socioeconomic characteristics, developmental level, and normal vs. psychopathologic criteria. The main results may be summarized as follows: a) Reliability and validity of data obtained allow the researchers to infere that this is an apt test for discriminating between normal and psychopathologic adolescents, b) Factorial analysis results confirm the constructional validity of the questionnaire, c) The most relevant variable was normal vs. psychopathological criteria even though the developmental level variable was also of significance. No significative differences were obtained in connection with socioeconomic level, d) As demonstrated in previous papers, psychopathology in adolescents is a mixed syndrome, and e) In similar questionnaires, adolescents got higher scores than adults.

Adolescent↗