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Órgano de difusión científica de la Subdivisión de Medicina Familiar
División de Estudios de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México
Aten. Fam. Volumen 27 no. 4 octubre-diciembre, 2020
www.fmposgrado.unam.mx ■ www.revistas.unam.mx
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doi: http://dx.doi.org/10.22201/facmed.14058871p
Artículos originales
• Prevalencia de depresión, ansiedad y estrés
 académico entre estudiantes de medicina,
 durante distintos periodos de estrés
• Enfermedades respiratorias y gastrointestinales
 en pediatría: ¿cómo las manejan los padres en casa? 
• Elección de especialidad y actitud de médicos
 internos de pregrado hacia la Medicina Familiar
• Comparación de estrategias educativas centradas 
en la sobrecarga del cuidador primario
• Salud familiar y nivel glucémico en mujeres durante 
el segundo y tercer trimestre de embarazo
Universidad nacional aUtónoma de méxico
Dr. Enrique Luis Graue Wiechers
Rector
FacUltad de medicina
Dr. Germán Enrique Fajardo Dolci
Director
Dra. Irene Durante Montiel
Secretaria general
Dr. Arturo Espinosa Velasco
Secretario del Consejo Técnico
Dra. María de los Ángeles Fernández Altuna
Secretaria de Servicios Escolares
Dr. Armando Ortiz Montalvo
Secretario de Educación Médica
Dra. Ana Elena Limón Rojas
Secretaria de Enseñanza Clínica
e Internado Médico
Dra. Marcia Hiriart Urdanivia
Jefa de la División de Investigación
división de estUdios de Posgrado
Dr. Rogelio Chavolla Magaña
Secretario académico
Dr. Gerhard Heinze Martin
Jefe de la Subdivisión de Especializaciones Médicas
Dr. Javier Santacruz Varela
Jefe de la Subdivisión de Medicina Familiar
Dr. Julio Cacho Salazar
Jefe de la Subdivisión de Graduados
y Educación Continua
atención Familiar
Dr. Juan José Mazón Ramírez
Fundador
Dr. Geovani López Ortiz
Editor responsable
Mtra. Lilia Aurora Arévalo Ramírez
Editora técnica
Dr. Raúl Ariza Andraca
Dr. Eduardo López Ortiz
Dra. Indira Mendiola Pastrana
Coeditores
dg David Cortés Álvarez
Diseñador
Libia Brenda Castro Rojano
Asistente editorial
Comité Editorial
Dra. Verónica Casado Vicente (España)
Dr. Javier Domínguez del Olmo (México)
Dr. Carlo Alberto Frati Munari (México)
Dr. Carlos Roberto Jaen (Estados Unidos) 
Dr. José Saura Llamas (España)
Traducción y corrección de estilo en inglés
Lic. Patricia A. Arévalo Ramírez
Atención Familiar
vol. 27, no. 4
octubre-diciembre de 2020
issn digital: en trámite
Publicación trimestral de la Universidad 
Nacional Autónoma de México,
Ciudad Universitaria, 
delegación Coyoacán, c.p. 04510, 
Ciudad de México, a través de la 
Subdivisión de Medicina Familiar, 
División de Estudios de Posgrado
de la Facultad de Medicina, 
Unidad de Posgrado, edificio G, 
segundo nivel, Circuito de Posgrados, 
Centro Cultural Universitario, 
Ciudad Universitaria, 
delegación Coyoacán, c.p. 04510, 
Ciudad de México
Editor responsable:
Dr. Geovani López Ortiz
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Para consultarse en internet:
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atencion_familiar
http://www.fmposgrado.unam.mx
doi: http://dx.doi.org/10.22201/
facmed.14058871p
Cualquier comentario o información 
se agradecerá a: 
atencionfamiliar@fmposgrado.unam.mx
Tel. 55 56 23 72 74
Las opiniones expresadas en los artículos 
firmados que se publican en Atención Fa-
miliar son responsabilidad de sus autores
Los artículos contenidos en esta publica-
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El Comité Editorial se reserva el derecho 
de realizar las adecuaciones pertinentes a 
los artículos.
Editorial
• 45 aniversario de la subdivisión de Medicina FaMiliar 1975-2020
Juan José Mazón Ramírez
artículos originalEs
• Prevalencia de dePresión, ansiedad y estrés acadéMico entre estudiantes de Medicina, durante distintos
 Periodos de estrés
Ángel A. Puig Lagunes, Jesús E. Vargas Álvarez, Luis E. Salinas Méndez, Kevin A. Ricaño Santos, Ángel Puig Nolasco
• enFerMedades resPiratorias y gastrointestinales en Pediatría: ¿cóMo las Manejan los Padres en casa?
Daniela Henao Vega, Silvia Rivera Largacha, José M. Suescún Vargas
• elección de esPecialidad y actitud de Médicos internos de Pregrado hacia la Medicina FaMiliar
Baltazar Joanico Morales, Ángel Giovani Duran Patiño, María de los Ángeles Salgado Jiménez,
Guillermina Juanico Morales, Gustavo Leyva Leyva
• coMParación de estrategias educativas centradas en la sobrecarga del cuidador PriMario
Oliver Daniel Villa Alarcón, Mauricio Paniagua Cortez, Olivia Reyes Jiménez
• salud FaMiliar y nivel glucéMico en Mujeres durante el segundo y tercer triMestre de eMbarazo
Lourdes Martínez Gómez, Ana Laura Guerrero Morales, Imer Guillermo Herrera Olvera
artículos dE rEvisión
• resurgiMiento de enFerMedades inFecciosas y MoviMiento antivacunas, ¿qué Pasa en México?
José Manuel Ramírez Aranda, Vania Gabriela Hinojosa Moreira, Paulina Alejandra Barragán Hernández
• Prevención cuaternaria: hacia un nuevo ParadigMa
Javier Lovo
idEntifiquE El caso
• rizartrosis
Luis Gerardo Domínguez Carrillo Luis Gerardo Domínguez Gasca
Órgano de difusión científica de la Subdivisión de Medicina Familiar
División de Estudios de Posgrado, Facultad de Medicina, unam
Aten. Fam. Volumen 27 no. 4 octubre-diciembre, 2020
www.fmposgrado.unam.mx
www.revistas.unam.mx
Contenido
163
165
192
179
198
203
212
208
216
Editorial
• 45th anniversary oF the FaMily Medicine section 1975-2020
Juan José Mazón Ramírez
original articlEs
• Prevalence oF dePression, anxiety, and acadeMic stress aMong Medical students during diFFerent Periods oF stress
Ángel A. Puig Lagunes, Jesús E. Vargas Álvarez, Luis E. Salinas Méndez, Kevin A. Ricaño Santos, Ángel Puig Nolasco
• resPiratory and gastrointestinal diseases in Pediatrics: how do Parents handle theM at hoMe?
Daniela Henao Vega, Silvia Rivera Largacha, José M. Suescún Vargas
• choice oF sPecialty and attitude oF undergraduate Medical interns towards FaMily Medicine 
Baltazar Joanico Morales, Ángel Giovani Duran Patiño, María de los Ángeles Salgado Jiménez,
Guillermina Juanico Morales, Gustavo Leyva Leyva
• coMParison oF educational strategies Focused on PriMary caregiver burden
Oliver Daniel Villa Alarcón, Mauricio Paniagua Cortez, Olivia Reyes Jiménez
• FaMily health and glyceMic level in woMen during the second and third triMester oF Pregnancy
Lourdes Martínez Gómez, Ana Laura Guerrero Morales, Imer Guillermo Herrera Olvera
rEviEw articlEs
• resurgence oF inFectious diseases and the antivaccine MoveMent, what is haPPening in Mexico?
José Manuel Ramírez Aranda, Vania Gabriela Hinojosa Moreira, Paulina Alejandra Barragán Hernández
• quaternary Prevention: towards a new ParadigM
Javier Lovo
idEntify a casE
• rhizarthrosis
Luis Gerardo Domínguez Carrillo Luis Gerardo Domínguez Gasca
Scientific Journal of the Subdivisión de Medicina Familiar
División de Estudios de Posgrado, Facultad de Medicina, unam
Aten. Fam. Volume 27 no. 4 october-december, 2020
Content
165
172
186
198
203
208
212
216
163
163
Editorial
La Medicina Familiar en la Facultad de Medicina de la UNAM se remonta al año de 1974, cuando el 
H. Consejo Técnico de la Facultad aprobó por unanimidad el “Programa de Residencia de Medicina 
Familiar” del Instituto Mexicano del Seguro Social (imss), este curso había iniciado el 15 de marzo de 
1971 con 32 médicos residentes.
Al año siguiente, en la sesión del H. Consejo Técnico del 13 de noviembre de 1975, se presentó 
el “Proyecto para la creación del Departamento de Medicina General, Familiar y Comunitaria.” En la 
discusión del proyecto el doctor José Laguna García, director de la Facultad de Medicina, aportó valiosos 
comentarios; fue relevante también la participación de losdoctores José Rodríguez Domínguez y José 
Narro Robles. Al someter el doctor Laguna el proyecto a votación, se aprobó la creación del Departamen-
to. En el número 12 de la Revista de la Facultad de Medicina de ese año, se señala: “Entre algunas de las 
premisas que fundamentan la creación del Departamento, se encuentran la intención de colaborar en la 
formación de un médico que alcance, en el ejercicio de la medicina de contacto primario, los objetivos 
fundamentales de eficiencia en la prevención y curación de la enfermedad, y que además enfatice el trato 
humano al individuo y a la familia en su ambiente natural, así como la necesidad de que las Facultades y 
Escuelas de Medicina ayuden a desarrollar modelos de organización de la atención médica y de la salud 
acordes con las demandas y posibilidades de nuestra población”. De entre los objetivos generales que se 
plantearon para el naciente Departamento se señalaron los de docencia y de investigación.
Así dio inicio la productiva vida del Departamento de Medicina General, Familiar y Comunitaria; el 
H. Consejo Técnico cambió ese nombre el 30 de enero de 1992, por el de “Departamento de Medicina 
Familiar.” Posteriormente, el 3 de octubre de 2012, el H. Consejo Técnico aprobó que el Departamento 
de Medicina Familiar se integrara a la División de Estudios de Posgrado como “Subdivisión de Medicina 
Familiar”.
Muchos son los hitos en la historia de la ahora Subdivisión de Medicina Familiar, a continuación, 
se señalan algunos de ellos:
Entre los programas prioritarios del naciente Departamento estaba el desarrollo del Curso de 
especialización en Medicina Familiar en la Secretaría de Salubridad y Asistencia (ssa) y en el Instituto 
45 aniversario de la Subdivisión de Medicina Familiar 1975-2020
45th Anniversary of the Family Medicine Section 1975-2020
Juan José Mazón Ramírez*
*Subdivisión de Medicina 
Familiar, División de Estudios 
de Posgrado, Facultad de 
Medicina, unaM.
Sugerencia de citación: Mazón Ramírez JJ. 45 aniversario de la Subdivisión de Medicina Familiar. Aten Fam. 2020:27(4): 163-164. http://
dx.doi.org/10.22201/fm.14058871p.2020.4.76890
164
de Seguridad y Servicios Sociales de los 
Trabajadores del Estado (issste), dicho 
curso dio inicio en ambas instituciones 
el 1 de marzo de 1980.
El 11 de agosto de 1992 la unam 
y el issste celebraron el convenio de 
colaboración para la creación del “Curso 
de Especialización en Medicina Fami-
liar para médicos generales adscritos 
al issste”, estrategia novedosa para la 
formación de los médicos generales 
adscritos al Instituto como médicos fa-
miliares, el curso inició el 1 de enero de 
1993 en 13 sedes académicas del Distrito 
Federal y 12 sedes en el interior de la 
República, fueron 479 los médicos ge-
nerales quienes iniciaron esta modalidad 
de especialización en Medicina familiar.
En el bimestre septiembre-octubre 
de 1993 se editó el primer número del 
Boletín Médico Familiar como órgano 
informativo del Departamento de Me-
dicina Familiar. El Boletín cambió su 
nombre al de Atención Familiar en 1999, 
al obtener el derecho al uso exclusivo del 
título ante Derechos de Autor de la Se-
cretaría de Educación Pública, así como 
el número internacional normalizado de 
publicaciones seriadas (issn).
El Departamento de Medicina Fa-
miliar organizó en 1992, 1993 y 1994 
tres congresos nacionales de Medicina 
Familiar, este hecho dio pie, en marzo 
de 1994, a la “Declaración de Ciudad 
Universitaria”, lo que llevó a la creación 
del “Colegio Mexicano de Medicina 
Familiar”.
El Curso de Especialización de Me-
dicina Familiar del imss, que obtuvo el 
reconocimiento universitario en 1974, 
antes de la creación del Departamento 
de Medicina General, Familiar y Co-
munitaria, se integró al Departamento 
de Medicina Familiar en 1998. En 
septiembre de 2001, la unam y el imss 
celebraron el convenio específico de co-
laboración cuyo objeto fue “La creación 
del Programa de Especialidad en Me-
dicina Familiar para médicos generales 
adscritos al imss”, el curso dio inicio el 
1 de marzo de 2002, en 57 sedes aca-
démicas con 960 alumnos en diferentes 
ciudades de la República.
El H. Consejo Técnico aprobó el 
28 de junio de 2006: “Las modifica-
ciones y adiciones en los requisitos de 
ingreso, permanencia y egreso de la 
especialización en Medicina Familiar”; 
esto llevó a la homogenización de los 
planes de estudio de las dos modali-
dades de especialización en Medicina 
Familiar: el “Curso de Especialización 
en Medicina Familiar dirigido a los 
médicos generales adscritos a una insti-
tución de salud”, cuya vía de ingreso es 
el Examen de Competencia Académica 
(eca), y el “Curso de Especialización en 
Medicina Familiar”, cuya vía de ingreso 
es el Examen Nacional para Aspirantes a 
Residencias Médicas (enarm).
En la actualidad, la Subdivisión de 
Medicina Familiar participa decidida-
mente en la formación de los médicos 
familiares del Siglo xxi: El “Curso de 
Especialización en Medicina Familiar”, 
en coordinación con el imss, cuenta 
con diecinueve sedes académicas, cuatro 
con el issste y una con la Secretaría 
de Salud de la Ciudad de México, las 
sedes académicas se encuentran en la 
Ciudad de México y en los Estados 
de México, Morelos, Guerrero, Mi-
choacán e Hidalgo con un total de 1 
121 médicos residentes. El “Curso de 
Especialización en Medicina Familiar 
para médicos generales adscritos a una 
institución de salud”, en coordinación 
con el imss, cuenta con 61 sedes acadé-
micas distribuidas en todos los estados 
de la República, tres con el Instituto de 
Seguridad Social del Estado de México 
y Municipios (issemym) y una sede en 
los estados de Guerrero, Querétaro y 
Sonora, con un total de 771 médicos 
residentes.
Se ha impulsado la investigación al 
fomentar cursos y talleres de metodolo-
gía científica y de redacción de escritos 
médicos para profesores y médicos 
residentes, así como un diplomado en 
investigación médica.
Es importante la profesionalización 
de la planta docente, la cual se lleva a 
cabo a través de diferentes programas 
educativos, principalmente a distancia, 
con el propósito de llegar a los profesores 
de las sedes académicas del interior de 
la República.
La evaluación del aprendizaje se 
ha fortalecido mediante la construc-
ción y aplicación de exámenes válidos 
y confiables, los cuales son analizados 
psicométricamente con diferentes pro-
gramas estadísticos.
Con el objeto de fortalecer los 
programas académicos se promueve 
el ingreso de las sedes académicas al 
Programa Nacional de Posgrados de 
Calidad (pnpc). Se impulsa además la 
movilidad estudiantil mediante estancias 
en el extranjero de los médicos residen-
tes y estancias en México para médicos 
residentes extranjeros. 
Esta revista, Atención Familiar, que 
naciera hace 27 años, se edita trimes-
tralmente y se ha convertido en el foro 
para que médicos familiares difundan 
conocimientos generados en el campo 
de la Medicina Familiar. 
El 45 aniversario de la Subdivisión 
de Medicina Familiar nos invita a co-
nocer el pasado de nuestra disciplina 
para reflexionar, analizar y comprender 
su presente y así seguir construyendo el 
futuro de la Medicina Familiar.
Mazón Ramírez JJ. 
Aten Fam. 2020:27(4): 163-164. http://dx.doi.org/10.22201/fm.14058871p.2020.4.76890
165
Original Article 
Summary
Objective: To determine the prevalence and severity of anxiety, depression and academic stress, as 
well as to evaluate the variation between a high stress level period (hsp) and a low stress level period 
(lsp). Methods: A longitudinal descriptive study was performed, using the Beck’s anxiety-depression 
inventories and academic stress, during a period of examinations and another free of evaluation 
in medicine students at the Universidad Veracruzana. Results: A prevalence of 75.4% of anxiety 
symptoms was observed in the hsp, decreasing 10.8% in lsp. There were 41% depressive symptoms 
in the hsp, decreasing 30.6% in lsp. Academic stress was observed in 70% in the hsp, decreasing19.5% in lsp, in both periods, the main stressors were exams, academic overload, lack of time and 
expositions. Conclusion: There is a significant decrease between the hsp and lsp, however, in the 
latter high levels of anxiety, depression and academic stress prevail. 
Keywords: Anxiety; Depression; Academic Stress; University Students
Prevalence of depression, anxiety, and academic stress among medical students 
during different periods of stress
Prevalencia de depresión, ansiedad y estrés académico entre estudiantes de medicina, 
durante distintos periodos de estrés
Ángel A. Puig Lagunes,* Jesús E. Vargas Álvarez,* Luis E. Salinas Méndez,* Kevin A. Ricaño Santos,* Ángel Puig Nolasco*
Recibido: 10/05/2020
Aceptado: 26/06/2020
*Facultad de Medicina, Universidad 
Veracruzana, Campus Minatitlán, 
Veracruz, México.
Correspondence:
Ángel A. Puig Lagunes
anpuig@uv.mx
Quote suggestion: Puig Lagunes AA, Vargas Álvarez JE, Salinas Méndez LE, Ricaño Santos KA, Puig Nolasco A. Prevalencia de depre-
sión, ansiedad y estrés académico entre estudiantes de medicina, durante distintos periodos de estrés. Aten Fam. 2020;27(4):165-171. 
http://dx.doi.org/10.22201/fm.14058871p.2020.4.76891
166
Resumen 
Objetivo: determinar la prevalencia y 
severidad de ansiedad, depresión y estrés 
académico; evaluar la variación entre 
un periodo con alto (pae) y bajo nivel 
de estrés (pbe). Métodos: Se realizó 
un estudio descriptivo longitudinal, 
utilizando los inventarios de Ansiedad-
Depresión de Beck y estrés académico, 
durante un periodo de exámenes y otro 
libre de evaluación en estudiantes de 
medicina de la Universidad Veracruzana. 
Resultados: En el pae la sintomatología 
de ansiedad fue de 75.4% y se redujo 
10.8% en el pbe. Se registró 41% de 
síntomas depresivos (pae), reduciendo 
30.6% (pbe). El estrés académico se 
observó en 70% (pae), disminuyendo 
19.5% (pbe), en ambos periodos los 
exámenes, la sobrecarga académica, falta 
de tiempo y exponer fueron los princi-
pales estresores. Conclusión: Existe una 
disminución significativa entre el pae y el 
pbe, sin embargo, en este último siguen 
prevalentes altos niveles de síntomas de 
ansiedad, depresión y estrés académico. 
Palabras clave: ansiedad, depresión, 
estrés académico, estudiantes uni-
versitarios 
Introduction 
Anxiety and depression have been seen 
as common problems among medical 
students,1-3 attributed to a high acade-
mic demand, long and discontinuous 
schedules that predispose to poor sleep 
and eating habits, among other factors 
that could lead to the development these 
psychopathologies.4-6
Anxiety can be understood as a re-
gular and normal response in everyday 
situations that serves as a warning signal 
regarding an imminent danger.7 Howe-
ver, sometimes it surpasses the adaptive 
capacity of the individual and becomes 
abnormal and/or pathological, manifes-
ting itself in physical, psychological and 
behavioral changes.8 The reported global 
prevalence of anxiety disorders is 7.3% 
and a greater frequency between 25 and 
45 years old, being more common in 
women.9 Reported prevalence among 
Latin American medical students osci-
llates between 35 and 82%.10-13
Experiencing stress and/or anxiety 
for prolonged periods leads to exhaus-
tion and is possibly association with 
depression.14 Nowadays, depression is a 
worldwide public health problem, being 
the fourth cause of disability in terms of 
loss of healthy life years, estimated to 
affect 350 million people worldwide.15 
In Latin America and the Caribbean, 
depression is the most common mental 
disorder and is estimated to affect 5% of 
the general population.16 The prevalence 
of depressive symptomatology in Latin 
American medical universities is around 
35%.10,11
Added to this, university students 
commonly report elevated time demands 
from academic activities and events, 
which in turn cause different internal 
conflicts that, when students are una-
ble to handle them properly, become a 
source of stress, referred to as academic 
stress.3,17,18 The prevalence of academic 
stress is around 50% and its main risk 
factors are academic overload and lack of 
time to complete activities and exams.1,3,17
Few studies have evaluated these 
symptoms during different periods, 
showing a significant increase in levels 
of stress, anxiety and depression near 
or during the examination period.19-21 
Therefore, due to the high prevalence of 
these psychopathologies in medical stu-
dents and the lack of studies evaluating 
different periods, the objective of this 
study was to determine the prevalence 
and severity of symptoms, as well as to 
evaluate the pattern of changes during a 
period with high level of stress and the 
other with a low level.
Methods
A descriptive longitudinal study was 
performed during the periods August 
2017 to June 2018, on a representative 
sample of medical students at the Univer-
sidad Veracruzana, Minatitlán campus, 
including students enrolled from the first 
to the tenth semester. The study design 
was reviewed and approved by the Insti-
tutional Research and Ethics Committee 
(folio cie 001-2019).
The students were asked to parti-
cipate voluntarily to answer the survey. 
All participants had detailed knowledge 
of the purpose of the study and prior 
consent ensured the confidentiality of 
their responses. Students were asked to 
complete survey questionnaires during 
two different periods. In the first one, 
they answered the survey during an exa-
mination period (November-December 
2017), assumed to be a high stress level 
period (hsp). In the second one, surveys 
were provided and answered at the begin-
ning of the semester when students were 
free from examination (February-March 
2018), which we assumed to be a low 
stress level period (lsp).
Three instruments were used: The 
Beck Anxiety Inventory (bai),22,23 the 
Beck Depression Inventory (bdi),22,24,25 
and the Academic Stress Inventory 
(asi).3,26
The bai consists of 21 items that are 
scored from 0 to 3 points. The final score 
consists of the sum of all items, leading 
to results that range from 0 to 63 points. 
We used the cut-offs suggested by Beck 
et al.,23 as follows: 0-7 minimal anxiety, 
Puig Lagunes AA et. al.
 Aten Fam. 2020;27(4):165-171. http://dx.doi.org/10.22201/fm.14058871p.2020.4.76891
167
Anxiety and depression in medical students
Aten Fam. 2020;27(4):165-171. http://dx.doi.org/10.22201/fm.14058871p.2020.4.76891
8-15 mild anxiety, 16-25 moderate 
anxiety and 26-63 severe anxiety.
The bdi consists of 21 self-rated 
items scored from 0 to 3. As with the 
bai, the final score for the bdi consists 
of the sum of all items, leading to results 
that range from 0 to 63 points. We used 
the cut-off suggested by Beck et al.,25 as 
follows: 1-10 highs and lows (considered 
normal), 11-16 mild mood disturbance, 
17-20 intermittent depression, 21-30 
moderate depression, 31-40 major 
depression, and more than 40 extreme 
depression.
The asi consists of 11 items that 
organize the main stressors according 
to the perception of the students. Each 
item is scored from 1 to 3 according 
to how much stress each activity is 
perceived to cause, with higher scores 
indicating higher levels of stress. The 
final score results from the sum of all 
items, leading to totals that range from 
12 to 25 points. We used the cut-offs 
suggested by Speilberger et al.,26 as 
follows: high: over 25 points, medium: 
18-24, low: 12-17.
Statistical analysis
Participants who did not complete the 
survey questionnaires in both periods 
were excluded from statistical analysis. 
For the descriptive data, frequencies and 
percentages were calculated. The compa-
rison between the periods was obtained 
by calculating the percentage of change 
that represents the amount of variation 
with respect to the value obtained in the 
first period (hsp), compared with the 
value obtained in the second period (lsp) 
using division (hsp/lsp), and then mul-
tiplied by 100. For the statistical analysis 
betweenperiods and the estimates of 
the relationship between sex, age and 
semesters, the chi-square test, Wilcoxon 
and the Kruskal-Wallis test were used. 
The chosen level of statistical significance 
was p <0.05. Statistical analyses were 
performed using GraphPad Prism 5. 0 
and spss v. 21, both versions for MacOs.
Results
Of a total of 311 students enrolled, only 
183 (58.8%) replied in both periods. 114 
(62.3%) were women and 69 (37.7%) 
were men, with an average age of 20.4 
years (range 18-26 years). The semesters 
were distributed as follows: 66 (36.1%) 
in the first semester, 41 (22.4%) in 
the third, 28 (15.3%) in the fifth, 25 
(13.7%) in the seventh, and 23 (12.6%) 
in the ninth.
Anxiety 
During the hsp, the prevalence of anxiety 
symptoms 75.4% in the population, 
while in the lsp it was 67.2%, recording a 
decrease of 10.8% between both periods 
(p<0.0007), reflected as follows: mild 
anxiety increased 1.1 percentage points, 
while there was a 2.2 and 7.1 percentage 
points decrease in the prevalence of mo-
derate and severe anxiety, respectively, 
see table 1.
No significant difference was obser-
ved when comparing the symptoms of 
Table 1. Anxiety symptomatology prevalence in medical students
in relation to the total sample, semester, sex and ages
hsp
Total Semester Sex Ages
n=183 9ºn=23
7º
n=25
5º
n=28
3º
n=41
1º
n=66
F
n=114
M
n=49
18-20 
n=100
21-23 
n=77
>24
n=6
Total 75.4 65.2 92.0 71.4 70.7 77.3 75.4 75.3 76 74.2 66.6
Mild 26.2 8.7 28.0 32.1 34.1 24.2 22.8 31.8 27 27.2 -
Moderate 29 34.8 40.0 28.6 17.1 30.3 35.1 18.8 30 26 50
Severe 20.2 21.7 24.0 10.7 19.5 22.7 17.5 24.6 19 21 16.6
lsp
Total 67.2 †* 73.7 72 †* 53.5 73.2 †* 63.6 †* 68.4 †* 65.2 †* 70 †* 66.3 †* 66.6
Mild 27.3 26 44 21.4 31.7 21.2 27.1 10.1 33 22.1 -
Moderate 26.8 43.4 12 25 17.1 31.8 25.3 27.5 23 28.5 66.6
Severe 13.1 4.3 16 7.1 24.4 10.6 14.9 27.5 14 13 -
High stress level period (phs), low level of stress period (pls)
Values expressed in percentage, † differences between periods *p<0.05
168
inter-semesters anxiety in both periods. 
However, significant differences were 
observed when comparing between 
semesters of the hsp and the lsp; the 
first and second semesters (p=0.003), 
the third and fourth (p=0.001) and the 
seventh and eighth (p=0.016).
When analyzing the age, a 76% 
prevalence of anxiety symptoms was 
observed in the hsp in students aged 
18-20 years, similar to those aged 21-23 
years (74.2%) and over 24 years (66%), 
while in the lsp, a decrease of 8% was 
observed in students aged 18-20 years, 
15.5% in those aged 21-23 years and no 
change in those aged over 24 years. No 
significant difference was observed when 
comparing age groups in each one of the 
periods. However, significant differences 
were observed in most age groups when 
comparing the prevalence of anxiety bet-
ween the hsp and the lsp (18-20 years, 
p=0.003 and 21-23 years, p=0.035).
Depression
In the hsp, the prevalence of depressive 
symptomatology was 41% (18% showed 
mild mood disturbance, 9.8% states of 
intermittent and moderate depression 
respectively and 3.3% major depression), 
while in the lsp it was 28.4%, with a 
30.6% decrease (p<0.0001), in which 
there was a 15.1% decrease in mild mood 
disturbance, 27.7% in intermittent 
states of depression, 55.5% in moderate 
depression, 66.6% in major depression, 
and a 100% increase in extreme depres-
sion, see table 2.
The distribution by semester shows 
in hsp the highest prevalence of depres-
sive symptomatology in first and seventh 
semester students, both with 48%; the 
semester with the lowest prevalence was 
the third semester with 31.7%; while 
in the lsp the highest prevalence was 
registered in the fourth semester with 
36.5%, followed by the ninth semester 
with 31.8% and the lowest prevalence 
in the sixth semester with 17.8% (see 
table 2). No significant differences in 
inter-semester depressive symptomato-
logy were found in any of the periods, 
however, significant differences were 
recorded when comparing the hsp and 
the lsp (p<0.0001, respectively for all 
semesters).
In relation to the sex, in the hsp 
42.1% of women and 39.1% of men 
had depressive symptomatology, while 
the lsp recorded a 30% decrease in the 
prevalence of symptomatology in wo-
men (p<0.00001) and 27.5% in men 
(p<0.00001) (see table 2). No significant 
Table 2. Depression symptomatology prevalence in medical students
in relation to the total sample, semester, sex and ages
hsp
Total Semester Sex Ages
n=183 9ºn=23
7º
n=25
5º
n=28
3º
n=41
1º
n=66
F
n=114
M
n=49
18-20 
n=100
21-23 
n=77
>24
n=6
Total 41 39 48 32.2 31.8 48.3 42.1 39.1 35 49.3 33.2
mmd 18 8.7 32 14.3 9.8 22.7 17.5 18.1 14 24.6 -
id 9.8 13 4 3.6 7.3 15.1 11.4 7 7 14.2 -
md 9.8 13 12 14.3 9.8 6 10.5 8.7 11 7.8 16.6
sd 3.3 4.3 - - 4.9 4.5 2.6 4.3 3 2.5 16.6
ed - - - - - - - - - - -
lsp
Total 28.4 †* 31.7 †* 26.8 †* 17.9 †* 36.5 †* 27.1 †* 29 †* 27.5 †* 29 †* 27.2 †* 16.6 †
mmd 15.3 18.1 19.2 7.14 19.1 13.6 14 17.3 17 14.2 -
id 7.1 9.1 7.7 10.8 4.9 6 9.6 2.8 8 5.2 -
md 4.4 - - - 7.3 7.5 4.3 4.3 1 7.8 16.6
sd 1.1 4.5 - - 2.4 - 0.8 1.4 2 - -
ed 0.5 - - - 2.4 - - 1.4 1 - -
High stress level period (phs), low level of stress period (pls), Mild mood disturbance (mmd), intermittent depression 
states (id), moderate depression (md), severe depression (sd), extreme depression (ed)
Values expressed in percentage, † differences between periods
*p<0.05
Puig Lagunes AA et. al.
 Aten Fam. 2020;27(4):165-171. http://dx.doi.org/10.22201/fm.14058871p.2020.4.76891
169
differences were observed when compa-
ring the sexes in both periods.
According to the age, in the hsp, 
49.3% of students aged 21-23 showed 
depressive symptoms, followed by 35% 
of those aged 18-20 and 16.6% of those 
aged 24 and older, while in the lsp there 
was a 45% decrease in the prevalence in 
students aged 21-23, followed by 17% of 
those aged 18-20, and 50% of those aged 
24 and older (see table 2). Significant di-
fferences were observed when comparing 
ages between hsp and lsp (18-20 years, 
p<0.0001; 21-23 years, p<0.0001; older 
than 24 years, p=0.0313), but not bet-
ween age groups in each of the periods.
Academic Stress
In the hsp it was observed that around 
70% of students present academic stress 
(20.2% showed high level and 49.7% 
medium), with the main academic 
stressors being taking exams (88.5%), 
academic overload (87.4%), lack of time 
(86.9%) and expositions (86.3%), on 
the other hand, the least relevant were 
overcrowding of classrooms (63.4%) 
and working in groups (60.7%). While 
in the lsp a 19.5% decrease in the pre-
valence of academic stress was observed 
(p<0.0001, 13.6% showed high level 
and 42.6% medium), decreasing 43% 
in competitiveness, 16% academic over-
load, 13% the lack of time, 8% taking 
exams, but increased 2% the expositions 
(see table 3).
Regarding to semesters, in the hsp 
it was observed that 76% of seventh 
semester showed academic stress, fo-
llowed by 73.9% of ninth semester and 
the lowest prevalence were of the third 
semester with 60.7%. The previous data 
Table 3. Stressing Academic factors prevalence in medical students
in relation to the total sample, semester, sex and ages
hsp lsp
n Any stress symptoms Medium High
Any stress 
symptoms Medium High
Items
Take an exam 183 88.5 53.5 35 81.4 47 34.4
Presentation 183 75.9 50.8 25.1 77.1 52.5 24.6
Participation 183 49.8 36.1 13.7 49.2 35.5 13.7
Academic 
overload 183 87.4 50.8 36.6 73.7 †* 39.3 34.4
Classroom
overpopulation 183 36.6 24.6 12 30.6 †* 23.5 7.1
Lack of time 183 86.5 40.4 46.1 75.4 †* 39.9 35.5
Other activities 183 44.3 33.9 10.4 39.9 29.5 10.4
Competitiveness 183 54.1 34.4 19.7 36 †* 25.1 10.9
School works 183 62.3 42.1 20.2 51.9 †* 39.3 12.6
Study tasks 183 45.9 33.9 12 39.9 †* 33.3 6.6
Work in groups 183 39.4 25.7 13.7 29.5 †* 25.7 3.8
Semester
1º 66 72.7 51.5 21.2 51.4 †* 45.4 6
3º 41 65.8 53.6 12.2 60.9 †* 34.1 26.8
5º 28 60.6 39.2 21.4 39.2 †* ¥* 35.7 3.5
7º 25 76 4828 64 48 16
9º 23 73.8 52.1 21.7 73.8 ¥* 52.1 21.7
Sex
Female 114 71.9 45.6 26.3 62.2% †* 47.3 14.9
Male 49 66.6 56.5 10.1 46.6 †* 34.7 11.5
Ages
18-20 100 70 51 19 58 41 17
21-23 77 71.5 52 19.5 54.5 46.7 7.8
>24 6 49.9 16.6 33.3 49.9 33.3 16.6
High stress level period (phs), low level of stress period (pls)
Values expressed in percentage, † differences between periods, ¥ intra-group differences 
*p<0.05.
Anxiety and depression in medical students
Aten Fam. 2020;27(4):165-171. http://dx.doi.org/10.22201/fm.14058871p.2020.4.76891
170
do not show differences when they are 
compared with each other. While in the 
lsp, tenth semester students showed a 
higher prevalence of academic stress 
with 77.2%, followed by 61.5% in the 
eighth semester and finally in the sixth 
semester showed a lower prevalence 
with 39.2% (Table 3). In the lsp signi-
ficant differences were observed when 
comparing the semesters (p=0.0402; 
Dunn’s test= tenth and sixth), in the 
same way differences were observed 
when comparing the hsp and the lsp, 
first with second seester (p<0.0001); 
third with fourth (p<0.0001) and fifth 
with sixth (p=0.0098).
According to the sex, 71.9% of 
women and 66.6% of men presented 
academic stress in the hsp, showing 
significant differences between se-
xes (p=0.030). While in the lsp, the 
prevalence decreased 15% in wo-
men (p=0.0013) and 30% in men 
(p=0.0151) (see table 3). No significant 
differences were found when comparing 
sex between hsp and lsp.
Regarding the ages, in the hsp it 
was observed that 70, 71.4 and 50% 
of students between 18-20, 21-23 and 
older than 24 years respectively showed 
academic stress. While in the lsp it was 
registered a decrease in prevalence of 
17% in students aged 18-20, 24% in 
those aged 21-23, and no change in 
those older than 24 years (see table 3). 
Significant differences were observed 
when comparing depressive symptoma-
tology and ages between hsp and lsp 
(18-20 years, p<0.0009; 21-23 years, 
p<0.0224), but it was not recorded 
when comparing age groups in each of 
the periods. 
Finally, in both hsp and the lsp, 
academic stress was associated with 
both anxiety (p<0.0005) and depressive 
symptoms (p<0.0005). Anxiety and de-
pressive symptoms were also associated 
with (p<0.0005).
Discussion
The results of this study show that me-
dical students in this university have a 
high prevalence of symptoms of anxiety, 
depression and academic stress, both in 
the examination period and in the free 
evaluation period. These psychopatho-
logies rise significantly when students 
are being evaluated. On the other hand, 
taking an exam, academic overload and 
lack of time are the main academic stres-
sors among students at this institution.
The levels of anxiety in both pe-
riods studied are high and are similar 
to those reported in other countries.11 
On the other hand, they are higher than 
the reports of the general population 
at the national and international level, 
which range between 5-15%,9 and 
those to the Latin American medical 
students, which range between 13-
61.3%.3,10,12,13,27-29 In this study a high 
number of students with severe anxiety 
was observed, being greater than the 
reports of other Latin American uni-
versities.10 Differences in prevalence 
could be explained by the fact that some 
studies were carried out using different 
instruments, in addition to the fact that 
each country’s culture and institutional 
demands are different.10
A high prevalence of depressive 
symptomatology was observed in both 
evaluated periods, similar to data from 
other universities.11 On the other hand, 
this prevalence surpasses national,15,24 
and international reports between 19-
34.6%.2,11,30,31 
Relationship between semester and 
depression was observed, since the stu-
dents of the first and seventh semesters 
are those that presented greater preva-
lence, whose causes could be similar to 
that of anxiety.10 This can be related to 
the adaptive and formative processes fa-
ced by students at that level of the career 
related to the symptoms of anxiety. In 
addition to factors such as the organi-
zation of time, lack of family support, 
migration from their places of origin, a 
low socio-economic level, among other 
characteristics that can contribute to the 
development of symptoms of stress and 
depression.7,32
The prevalence of academic stress 
in these students is high in both perio-
ds studied, coinciding with the data 
reported in Cuban medical students,33 
and surpassing others ranging from 
50-65%.1,17 Several studies show that 
stressors are constant, highlighting 
examinations, academic overload and 
lack of time, difficult schedules and fear 
of failure or poor performance.3,17,20,33 
Therefore, due to the high prevalence in 
both periods, it is advisable to continue 
with the study of internal and external 
factors that may promote or be associa-
ted with the increase of academic stress, 
as well as to design and implement 
strategies to lessen or counteract them, 
and to reduce their impact on students’ 
school performance.16 
Finally, several studies refer that 
symptoms of anxiety are associated 
with depression and academic stress 
among medical students.4,11,18 Our 
study corroborates this association, 
and provides support to the idea of 
monitoring anxiety symptoms among 
medical students, since this sympto-
matology can generate an unwanted 
impact on the physical and mental 
health of students, which may nega-
tively affect their performance in the 
classroom and in the clinic.3,19,24
Puig Lagunes AA et. al.
 Aten Fam. 2020;27(4):165-171. http://dx.doi.org/10.22201/fm.14058871p.2020.4.76891
171
Conclusions
The medical students at Minatitlán cam-
pus have a high prevalence of anxiety, 
depression and academic stress symp-
toms, which decrease significantly but 
remain elevated during periods without 
examinations. These results should help 
to plan and develop more effective in-
tervention and prevention programs and 
the implementation of a more balanced 
medical curricula. Measures should be 
proposed to carry out constant monito-
ring of mental health and the detection 
of external risk factors that influence 
medical students, since the career is one 
of the most demanding and competitive. 
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Anxiety and depression in medical students
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172
Original Article
Respiratory and Gastrointestinal Diseases in Pediatrics: 
How do Parents handle them at Home?
Enfermedades respiratorias y gastrointestinales en pediatría: 
¿cómo las manejan los padres en casa?
Daniela Henao Vega,* Silvia Rivera Largacha,** José M. Suescún Vargas***
Recieved: 19/10/2019
Accepted: 08/05/2020
*Universidad del Rosario Bogotá, 
Colombia.
**Escuela de Medicina y Ciencias 
de la Salud de la Universidad del 
Rosario Bogotá, Colombia.
***Universidades del Rosario, Andes 
y Sabana. Instituto Roosevelt. Bo-
gotá, Colombia. 
Correspondence:
Daniela Henao Vega
danielahenaov1@gmail.com
Summary
Objective: to identify how caregivers of pediatric patients handle respiratory and gastrointestinal 
symptoms and analyze different aspects such as their rooting and safety; as well as the possible 
impact of such practices on communication between caregivers and pediatricians. Methods: a 
qualitative, narrative study conducted at the Roosevelt Institute in Bogota, Colombia, through 
twelve interviews with caregivers of hospitalized pediatric patients who were having respiratory or 
gastrointestinal acute symptomatology. It was inquired the initial handling of the symptoms and 
their experience in sharing these practices with the treating physician. Results: the interviewed 
group included caregivers between the ages of 20 and 42, with different levels of school education; 
it was found variability of response in the type of treatments to attend respiratory and gastroin-
testinal symptoms. Within this variability, beneficial, safe or risky practices were identified for the 
management of these symptoms. Regarding communication, most caregivers feel that the physician 
does not provide a space to talk about it and if doing so they found rejection. Conclusions: some 
caregivers’ practices coincide with medical posture, and other practices, that should be corrected, 
were at high risk for children. The caregivers’ narrative needs to be integrated and validated to 
reduce dangerous practices that put children’s health at risk.
Keywords: Child Care, Diarrhea, Fever, Vomiting, Communication, Ambulatory Care
Suggestion of citation: Henao Vega D, Rivera Largacha S, Suescún Vargas JM. Enfermedades respiratorias y gastrointes-
tinales en pediatría: ¿cómo las manejan los padres en casa? Aten Fam. 2020;27(4):172-178. http://dx.doi.org/10.22201/
fm.14058871p.2020.4.76893
173
Respiratory and Gastrointestinal Diseases in Children
Aten Fam. 2020;27(4):172-178. http://dx.doi.org/10.22201/fm.14058871p.2020.4.76893
Resumen
Objetivo: identificar cómo los cuida-
dores de pacientes pediátricos manejan 
los síntomas respiratorios y gastroin-
testinales y analizar diferentes aspectos 
como su arraigo y seguridad; también 
el posible impacto de dichas prácticas 
en la comunicación entre cuidadores y 
pediatras. Métodos: se realizó un estu-
dio cualitativo, narrativo, desarrollado 
en el Instituto Roosevelt en Bogotá, 
Colombia, a través de doce entrevistas 
a cuidadores de pacientes pediátricos 
hospitalizados que cursaban con sinto-
matología respiratoria o gastrointestinalde forma aguda. Se indagó sobre el 
manejo inicial a dichos síntomas y su 
experiencia al compartir dichas prácticas 
con el médico tratante. Resultados: el 
grupo entrevistado incluyó cuidadores 
entre los veinte y los 42 años, con 
diferentes niveles de escolaridad; se 
encontró una variabilidad en el tipo de 
tratamientos para atender los síntomas 
respiratorios y gastrointestinales. Den-
tro de esta variabilidad se identificaron 
prácticas benéficas, inocuas o riesgosas 
para el manejo de los síntomas seña-
lados. Respecto a la comunicación, la 
mayoría de los cuidadores sienten que 
el médico no brinda un espacio para ha-
blar del tema y en caso de hacerlo hubo 
un rechazo. Conclusiones: se hallaron, 
por parte de los cuidadores, prácticas 
que coinciden con la postura médica, 
pero otras prácticas tenían alto riesgo 
para los menores y se deben corregir. Es 
necesario integrar y validar la narrativa 
del cuidador para disminuir prácticas 
peligrosas que pongan en riesgo la salud 
de los menores.
Palabras clave: puericultura, diarrea, 
fiebre, vómito, comunicación, atención 
ambulatoria
Introduction
In the pediatric population between one 
and five years of age, respiratory and 
gastrointestinal diseases are the most pre-
valent infections, and represent a major 
cause of morbidity in early childhood. 
The initial handling of symptoms in 
these diseases is usually done by care-
givers at home, and is determined by a 
variety of cultural, social and individual 
aspects which are present in the disease 
and treatment.1, 2
The model of social representa-
tions is a theory that tries to define how 
“knowledge of common sense, or natural 
thinking, is forged, as opposed to scien-
tific thought”.3 Social representations 
are socially constructed and modifiable 
concepts according to personal expe-
rience, socioeconomic, academic or 
historical environments in which a per-
son develops, and can influence people’s 
behavior when facing health and disease 
processes.2,4-6
Social representations are some-
times different and even contrary to 
medical concepts and can lead to an erro-
neous diagnosis, delay proper treatment 
or predispose to complications; this can 
also lead to communication and trust 
problems between the physician and 
caregiver, which can have an unfavorable 
impact on patient care.7-9
Most studies on social represen-
tations in caregivers focus on chronic 
diseases and palliative care, however, 
there is emerging literature documenting 
the relationship of social representations 
with childcare to their diet and gastroin-
testinal diseases10-11 in this context, the 
number of studies in which caregiver 
practices are classified, according to the 
risk posed by these diseases, is scarce. 
There is a qualitative study conducted 
in Chocontá (Colombia) on childcare 
practices under one year old, in which it 
was identified that ten practices should 
be restructured, eight, negotiated with 
the caregiver and only one could be 
preserved, because it did not affect the 
integrity of infants.12 These results in-
dicate the importance of knowing the 
practices carried out by caregivers, to 
identify potential risky behaviors and 
avoid future complications, through 
effective communication.
Given the referred context, the 
objective of this research was to identify 
how pediatric caregivers handle respira-
tory and gastrointestinal symptoms and 
to analyze different aspects such as the 
rooting and safety; also the possible im-
pact of such practices on communication 
between caregivers and pediatricians. The 
component of socialization of practices 
by caregiver with the physician was re-
searched and analyzed, and this gave way 
to reflection on possible communication 
failures when exercising childcare.
Methods
A qualitative narrative research was 
conducted, through twelve semi-struc-
tured audiotaped interviews, which 
were applied to caregivers of hospitali-
zed pediatric patients at the Roosevelt 
Institute, at the fourth-level care center 
in Bogota, Colombia; practices of the 
caregiver in dealing with respiratory and 
gastrointestinal symptoms, as well as 
communication with medical personnel 
in regard to these, were investigated. 
Hospital databases were reviewed 
to select caregivers for short-stay inpa-
tient, from one to five days. Caregivers 
were selected for acute inpatients. There 
was testimony from caregivers whose 
“common sense” knowledge of health 
and disease processes was contrasted 
with medical knowledge. The selection 
174
was based on our interest in identifying 
the social representations of caregivers 
of the processes of health and disease. 
In the study of social representations, 
we distinguish the universe of science, 
which, based on scientific rules and pro-
cedures, gives rise to scientific knowledge 
and differs from the consensual universe 
of social representation. In the latter, the 
general public elaborates and distributes 
forms of knowledge that constitute the 
content of common sense, in agreement 
or in opposition to the knowledge of 
science.
Patients between twelve months and 
five years of age were chosen, who were 
with respiratory or gastrointestinal symp-
tomatology in an acute manner, that 
were not secondary to a complication 
or exacerbation of some basic chronic 
pathology. The sample size was suspen-
ded once the responses no longer varied, 
reaching a saturation point. Additionally, 
the family members questioned were the 
main caregivers of the child and each of 
the topics was discussed regardless of the 
reason for hospitalization. There were no 
scenarios of deviation from the interview, 
little collaboration or complaints about 
the care received in the institution, so it 
was not necessary to exclude any inter-
view from the study.
The interviews were audiotaped and 
transcribed in full, all responses were ta-
bulated, and identifiable categories were 
created. The practices for the symptoms 
under study were investigated (cough, 
fever, vomiting and diarrhea), their 
effectiveness, other known management 
despite not having been practiced, the 
origin of such knowledge (the way the 
information was obtained), the possible 
cause or complication of fever and pre-
vention practices. These practices were 
signalized, using traffic light colors, in 
beneficial, safe, and dangerous, after a re-
view of the available literature. Research 
was also carried out on prevention prac-
tices and a common concept emerged 
spontaneously: the descuajo (a popular 
belief that a part of the stomach, falls 
due to children’s constant falling usually 
during their first steps). In addition, as-
pects related to communication between 
the caregiver and the physician were 
investigated with respect to addressing 
this issue during the consultation.
Caregivers were explained in de-
tail the purpose of the project and the 
handling of the information, ensuring 
its confidentiality and that there would 
be no post-interview impact. During the 
interview, the caregiver showed an inter-
est in his knowledge, thus achieving an 
environment of trust in interviews. The 
project was approved by the hospital’s 
ethics committee in office number 
2017-017. The obtained information 
was shared directly with the institution 
and the results were not disclosed to the 
caregivers of the hospitalized patients.
Results
The results were structured from the 
assumptions of the theory of social re-
presentations as emergent constructions 
of popular beliefs; from this approach, 
those beliefs are not systematically dero-
gated as deficient but, on the contrary, 
they are studied as convictions that have 
precise functions in the studied group. 
In this case, it was found that the social 
representations of the analyzed infectious 
diseases activate a series of socially trans-
mitted resources. These actions are part 
of the ways in which caregivers interact 
with their immediate circle. It is impor-
tant to point out that some practices of 
popularknowledge are not contrary to 
medical recommendations; hence the 
need to identify social representations 
and classify them according to their 
possibilities of being reconciled with 
medical knowledge.13 
The group interviewed included 
caregivers between the ages of twenty 
and forty-two; their levels of schooling 
included high school, technical and 
professional. Table 1 describes the va-
riability in the practices for managing 
fever, cough, vomiting and diarrhea 
described by caregivers, classified, from 
the scientific evidence available so far, as 
beneficial, safe or dangerous. Caregivers 
reported that most of the time these 
management practices resulted in impro-
vement, however, this improvement was 
transient or not significant. Caregivers 
described other forms of management 
that are popular, but whose effectiveness 
are unknown because they have not been 
proved before.
It was inquired the origin of the 
concepts of each of the practices referred 
to, the vast majority cited as reference 
their relatives: mother, grandmother or 
mother-in-law, followed by concepts 
transmitted by neighbors and friends, 
teachings by medical personnel or from 
the Internet and YouTube videos. On all 
occasions, caregivers considered fever to 
be secondary to a viral or bacterial infec-
tious process and described consequences 
for not treating it as including seizures, 
“stroke” or “breaking down defenses”.
 During the interviews, the ca-
regivers were asked about preventive 
measures for respiratory and gastroin-
testinal illnesses, described in Table 
2, which shows a m ix between oral 
tradition, what is taught by health per-
sonnel, and information received from 
the media.
In the segment of the interview 
referring to diarrhea, the concept of des-
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175
Table 1
Beneficial Harmless Dangerous
Fever
• To give Acetaminophen
• Wear fresh and light color clothes
• Warm water compress in forehead, 
armpits and feet
• Full bath shower
• Bath with soda
• To put Aloe vera in armpits and abdomen
• Potato, onion and lemon slices in armpits, 
hand and feet
• Cold water compress
• Cotton with alcohol in armpits
• Hot water bottle in feet
• Give the child to drink coke
Vomit
• Leave him/her to vomit
• Get scared and go the doctor
• Oral rehydration salts
• Chicken broth/soup
• Onion water
• Dandelion tea or infusion
• Water, garlic, coriander and onion
• Avoid dairy products
• Metoclopramide**
Diarrhea
• Soft diet
• Go to the doctor
• Solid diet, not only liquids
• Oral rehydration salts
• Pear juice
• Guava juice
• Aniseed water
• Barley water
• Banana soup
• Lactose free milk
• Roasted rice water
• Take a bath in Gualanday water 
(Jacaranda mimosifolia)
• Smecta**
• Lomotil**
• Metronidazole**
• Avoid dairy products
• Try not to give him/her liquids
• Coke and cookies
• Rub him/her, masseur or healer
Coughing
• Honey
• Nasal wash
• Honey with citrus 
(lemon, orange, ginger, etc.)
• Go to the doctor
• Hand wash
• Wrap up and avoid cold
• Honey, Orange and butter
• Aloe vera juice
• Willow water
• Milk with thyme
• Eucalyptus water
• Chamomile water
• Propolis syrup
• Warm orange juice
• Papaya seed water
• Orange, butter and mint
• Mango and aloe vera juice
• Shark oil and orange juice
• Unflavored gelatin, boiled water and mint
• Panela water, ginger and lemon
• Hot banana with butter
• Cough syrup
• Apply Vick Vaporub**
• Elderberry spray
• Antihistaminic: Loratadine**
Chlorphenamine**
• Eucalyptus mist
• Hot water mist
• White egg, wine, lemon and honey
**These drugs are classified as harmful because of self-medication and possible adverse effects without supervision or adequate indication.
Table 2
Prevention of an acute diarrheal disease Prevention of respiratory diseases
Purging Ginger water Guava juice
Drops of Lomotil** Multivitamins Shark oil
Metronidazole** Warm cloths Eucalyptus mist
Garlic in fasting, before getting up, without 
stepping on the cold floor Avoid dust Fruit rich diet
Had washing Vitamin C** The use of a red T-shirt
Avoid dairy products Orange juice Avoid strong odors
**These drugs are classified as harmful because of self-medication and possible adverse effects without supervision 
or adequate indication.
Table 3
Definition of descuajo
Having one foot higher than the other
Abdominal pain and diarrhea
Very liquid diarrhea with bad odor and vomit
Very strong odor diarrhea and vomit and having 
one leg longer that the other and a smaller eye
Darker green or black diarrhea
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cuajo (a popular belief that a part of the 
stomach falls due to children’s constant 
falling usually during their first steps) 
emerged on the part of the caregivers 
to refer to an entity of popular origin to 
which the origin of the diarrhea is attri-
buted; when investigating this concept, 
various definitions were found (table 
3). There is general agreement that the 
appropriate treatment is to “rub” the 
patient or the need for a bandage at the 
abdominal area. The participants stated 
that with these two treatments they have 
observed improvement in the symptoms. 
With regard to the origin of the “fall” 
they refer to the fact that it occurs after 
a fall or a blow, due to a bad movement 
at birth or because something “got out 
of place inside”.
In the final part of the interview, it 
was inquired the communication with 
the physician regarding this issue; in 
general, all the interviewed caregivers 
perceived that the physician does not 
provide a space to talk about the topic 
and, if he or she does, they felt scolded, 
rejected or mocked. The physician’s 
verbal and non-verbal responses are 
described in Table 4.
Discussion
The prevalence of respiratory and 
gastrointestinal diseases in pediatric 
population under five years makes ne-
cessary that treating physicians to know, 
in addition to the pathophysiological 
component, the social and cultural con-
text in which they develop, this part will 
depend on the good communication and 
confidence that can be established with 
caregivers. This study was able to identify 
70 practices for the management of this 
symptomatology, eighteen prevention 
practices, and the responses given by the 
physician referred by caregivers.
The interviewed caregivers were 
between the ages of 20 and 42, that is, 
there was almost a generation of diffe-
rence; however, similar practices were 
identified with a great cultural and family 
influence. Different levels of schooling 
were found: high school and technical, 
professional; but these differences did 
not generate particularities in care or 
prevention practices, since regardless of 
the educational level all people carried 
out culturally-instructed management.
The origin of the practices referred 
to by the caregivers is mostly attributed 
to relatives, it can be presumed that these 
are more rooted than those from other 
sources, since they contain a cultural 
and emotional burden that is important 
for the caregiver when taking care of the 
child.8, 14
In the literature, studies of social 
representations in pediatric care have 
shown the importance of knowing and 
validating the socio-cultural context 
when dealing with a pathology. In a 
study carried out in Cordoba, Argentina, 
regarding the relationship between social 
representations and healthy eating, it was 
concluded that eating practices cannot 
be attributed solely to educational pro-
blems, but that economic, cultural and 
social aspects must also be considered.10 
A study conducted in Bucaramanga, 
Colombia, on how caregivers managed 
acute diarrhea concluded that social 
characteristics, level of schooling, and 
the people from whom the caregiver 
learns influence the habits for managing 
diarrhea, consulting the doctor, going to 
the healer, and identifyingdehydration.11 
Another study conducted in Chocontá, 
Colombia, regarding practices in the care 
of children under one year old identified 
ten practices that should be restructured 
because they are risky, and concluded 
that it is necessary to know the beliefs 
and practices, in order to guide mothers, 
so that they can continue or not with 
their realization without disregarding the 
convictions of each caregiver.12 In this 
study, of the 70 practices for symptom 
management, it was found that 21 bene-
ficial practices should be reinforced, 29 
practices are considered safe and could 
be reconciled and 20 practices should be 
corrected to avoid complications.
With respect to fever manage-
ment, the official conduct according 
to scientific evidence is the provision 
Table 4. Doctor - Patient 
Communication
Physician response to caregiver management
I do not like those 
remedies Where did you get that?
That does not work Those are myths
Who told you that? Disdainful look
Well… you better 
do this
They only believe in gua-
va juice and vitamin C
Sometime they work, 
you do not know how 
but they work
Look, you have to be 
smarter
Are they doctors? Negative – scolding
You should not 
medicate
Who told you that 
you could do it?
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177
of antipyretics such as paracetamol/
acetaminophen or nonsteroidal anti-
inflammatory drugs (nsaids) and the 
use of appropriate clothing, with safe 
adjuvant measures such as warm wa-
ter compresses and increased fluid 
intake;15,17 these actions were identified 
in a group of interviewees.
There is evidence that practices such 
as bathing and padding with cold water 
and the use of alcohol-soaked cotton 
are potentially harmful. In both cases, 
surface vasoconstriction is increased, 
and in the second case, there is a risk 
of intoxication from skin absorption of 
alcohol.15 The use of a hot water bottle 
increases the risk of skin burns; the 
supply of carbonated beverages such as 
coke may increase dehydration because 
of its hyperosmolar composition,18 and 
finally, the use of lemon on the skin may 
generate local irritation.
Additionally, there is evidence of a 
lack of understanding by caregivers about 
the origin of fever and its consequences 
if left untreated. For example, there are 
concepts such as that fever produces 
convulsions, “stroke” or “ends defenses”, 
and this generates a great distress in the 
caregiver, belittling the beneficial effect 
of increased temperature. On the other 
hand, when caregivers believe that the 
only origin of the fever is the infectious 
processes, the self-medication of antibio-
tics can be favored.
As for the treatment of vomiting, 
potentially harmful behaviors such as 
self-medication with metoclopramide 
were identified. The official approach 
is hydration with oral rehydration salts, 
with glucose and electrolyte concen-
trations recommended by the World 
Health Organization (who).18 Study 
participants identified this practice, in 
combination with safe adjuvant measures 
such as a soft, sugar- and fat-free diet, 
to restart the solid diet and not just the 
liquid one. Other empirically effective 
described practices, without large studies 
measuring the evidence, include guava or 
pear juice, roasted rice water, or barley 
water;19 these can be reconciled with ca-
regivers, as they can be considered safe at 
this time, as long as they do not replace 
officially established management. It is 
important to clarify that the hydration 
plan A includes increased liquid intake, 
however, consumption of fruit juices 
does not guarantee nutritional value and 
because of the high carbohydrate content 
may increase symptoms.20 
Among the potentially harmful 
treatments mentioned by the interviewees 
were: the medication of metronidazole, 
loperamide hydrochloride or diosmecti-
te; these should be used with caution and 
under medical indication. In addition, 
“not giving the patient fluids” or ad-
ministering coke with cookies increases 
the risk of dehydration.18-21 As for avoi-
ding dairy products, recent studies do 
not contraindicate their consumption, 
especially in infants; restricting their 
consumption may promote dehydration 
or malnutrition.18,22
In the diarrhea segment of the in-
terview, the concept of descuajo (popular 
belief that a part of the stomach falls due 
to children’s constant falling usually du-
ring their first steps) as a possible cause 
of diarrhea emerges from the caregivers. 
The concept and treatment of this entity 
is deeply rooted in the Colombian cultu-
re, so it is advisable to assume an attitude 
of dialogue and education so that caregi-
vers do not delay a timely diagnosis and 
treatment, which can lead to dehydration 
or even a complication of the condition 
if the symptoms correspond to a surgical 
abdominal pathology.23 
In relation to coughing, the official 
recommendation is hydration, nasal 
washing and hand washing, with safe 
coadjutant measures such as avoiding 
cold currents or administering honey.24 
In the interviewed group, honey was ac-
companied by different foods which have 
not been shown to enhance the benefit of 
honey and, in fact, some combinations 
such as honey with onions can generate 
vomiting. Other approaches proposed by 
interviewees may be counterproductive, 
such as self-medication of antihistamines 
or cough syrups. With respect to the 
application of camphor, menthol and 
eucalyptus ointments, irritative effects, 
intoxication and even lipoid pneumonia 
have been described.25 
With respect to the prevention of 
respiratory diseases, the practices referred 
to by the interviewees that coincide with 
the official position are hand washing, 
wear warm clothes, a rich vitamin C 
diet, orange or guava juice, and a diet 
rich in fruit, due to its vitamin content; 
avoiding dust and strong odors. Other 
actions such as garlic with an empty 
stomach, avoiding dairy products, ginger 
water, shark oil, or the use of red cotton 
T-shirts, despite the lack of studies sup-
porting them, they are safe and should 
be discussed with the caregiver.
One of the most relevant aspects of 
the results is that, in all the interviews, 
the general perception that the caregivers 
have regarding the trust and space pro-
vided by the physician to talk about the 
measures taken at home is very limited. 
The caregivers refer to a derogatory atti-
tude, of rejection or mockery, on the part 
of some physicians in the face of traditio-
nal knowledge. These attitudes diminish 
their dignity as caregivers and call into 
question their capabilities; and they do 
not contribute to providing them with 
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178
tools to do their job better. The most 
frequent reaction of caregivers to this 
attitude is to protect their dignity as care-
givers, with attitudes such as withholding 
information or inadequate adherence to 
official treatment. This generates a frag-
mentation in the relationship between 
physician and caregiver that can affect 
the patient’s health.14,26
This study could have investigated 
more about the cultural and social con-
text in each interviewee to have a greater 
correlation between social representa-
tions and their different determinants 
(race, place of origin and social stratum). 
Another limitation was the performance 
in a hospitalized patient, an environment 
that can generate fear at the time of res-
ponse. On the other hand, the collected 
data seem sufficient to achieve a didactic 
document, from which health profes-
sionals can guide their clinical practice 
by being attentive to the customs of 
the caregivers and establishing assertive 
forms of communication that allow bet-
ter cooperation between caregivers and 
health professionals.
Conclusions
21 social representations considered 
beneficial wereidentified, which must 
be reinforced by medical staff; 20 prac-
tices are definitely risky for children 
and should be corrected during clinical 
practice; and 29 actions that, despite 
having no studies to support their 
effectiveness, are considered safe, so a 
conciliatory attitude must be assumed, 
taking advantage of the culture of care 
as a tool to strengthen the link between 
the physician and the caregiver. It 
emphasizes the importance of listening 
and showing an interest in the caregiver’s 
narrative, in order to empower it, reduce 
dangerous practices, and strengthen safe 
practices and to not dismiss non-risky 
actions that do not have scientific evi-
dence. Physicians should never assume 
an attitude of scolding, rejection or 
mockery. Physicians should strengthen 
caregivers for their care and care capabi-
lities through assertive communication 
and a relationship of trust.
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Artículo Original
Resumen
Objetivo: identificar cómo los cuidadores de pacientes pediátricos manejan los síntomas respiratorios 
y gastrointestinales y analizar diferentes aspectos como su arraigo y seguridad; también el posible 
impacto de dichas prácticas en la comunicación entre cuidadores y pediatras. Métodos: se realizó 
un estudio cualitativo, narrativo, desarrollado en el Instituto Roosevelt en Bogotá, Colombia, a 
través de doce entrevistas a cuidadores de pacientes pediátricos hospitalizados que cursaban con 
sintomatología respiratoria o gastrointestinal de forma aguda. Se indagó sobre el manejo inicial a 
dichos síntomas y su experiencia al compartir dichas prácticas con el médico tratante. Resultados: 
el grupo entrevistado incluyó cuidadores entre los veinte y los 42 años, con diferentes niveles de 
escolaridad; se encontró una variabilidad en el tipo de tratamientos para atender los síntomas respi-
ratorios y gastrointestinales. Dentro de esta variabilidad se identificaron prácticas benéficas, inocuas 
o riesgosas para el manejo de los síntomas señalados. Respecto a la comunicación, la mayoría de los 
cuidadores sienten que el médico no brinda un espacio para hablar del tema y en caso de hacerlo 
hubo un rechazo. Conclusiones: se hallaron, por parte de los cuidadores, prácticas que coinciden 
con la postura médica, pero otras prácticas tenían alto riesgo para los menores y se deben corregir. 
Es necesario integrar y validar la narrativa del cuidador para disminuir prácticas peligrosas que 
pongan en riesgo la salud de los menores.
Palabras clave: puericultura, diarrea, fiebre, vómito, comunicación, atención ambulatoria
Recibido: 19/10/2019
Aceptado: 08/05/2020
*Universidad del Rosario Bogotá, 
Colombia.
**Escuela de Medicina y Ciencias 
de la Salud de la Universidad del 
Rosario Bogotá, Colombia.
***Universidades del Rosario, An-
des y Sabana. Instituto Roosevelt. 
Bogotá, Colombia. 
Correspondencia:
Daniela Henao Vega
danielahenaov1@gmail.com
Enfermedades respiratorias y gastrointestinales en pediatría: 
¿cómo las manejan los padres en casa?
Respiratory and Gastrointestinal Diseases in Pediatrics: How do Parents handle them at Home?
Daniela Henao Vega,* Silvia Rivera Largacha,** José M. Suescún Vargas***
Sugerencia de citación: Henao Vega D, Rivera Largacha S, Suescún Vargas JM. Enfermedades respiratorias y gastrointestinales en pedi-
atría: ¿cómo las manejan los padres en casa? Aten Fam. 2020;27(4):179-185. http://dx.doi.org/10.22201/fm.14058871p.2020.4.76894
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Summary
Objective: to identify how caregivers of 
pediatric patients handle respiratory