Adolescent Lifestyle Profile-Revised 2: validity and reliability among adolescents in Chile

Abstract Objective: The aims of this study were twofold. First, to provide evidence of the validity and reliability of the Adolescent Lifestyle Profile-Revised 2 (ALP-R2) among adolescents in Chile; and second, to examine the relationship between the health-promoting behaviors measured by this scale and several demographic variables. Methods: Cross-sectional survey. Students attending grades 9 through 12 from schools representing low-, middle-, and high-income families were included. All schools were in the city of San Felipe, Chile. Students completed the ALP-R2, a fourty-four-item scale aiming to assess health-promoting behaviors. To evaluate validity and reliability, confirmatory factor analysis and omega coefficient calculation were conducted, respectively. Results: The sample size was 572 students (82.5% of the eligible population). More males (56.6%) than females (43.4%) participated in the study, and the mean age was 16.4 (SD, 1.3) years. The ALP-R2 had adequate adjustment indicators in the confirmatory factor analysis, which means that the data supports the original theoretical model (seven subscales). The highest internal consistency was obtained for the total scale (Ω = 0.87); and (among the subscales), physical activity (Ω = 0.85) and spiritual health (Ω = 0.78) had the highest reliability. Conclusions: The ALP-R2 appears to be a valid and reliable instrument to assess health-promoting behaviors among adolescents attending secondary schools.

Influencia de las conductas promotoras de salud de los padres en la de sus hijos adolescentes / The influence of parental healthy behaviors on healthy lifestyles of early adolescents

Background: Family behavior models may influence health promoting conducts among adolescents. Aim: To determine the association between health promoting behaviors among parents and healthy behaviors of early adolescents. Material and Methods: Analysis of the baseline assessment of a longitudinal study of early adolescents in the city of San Felipe, Region of Valparaiso, Chile. Parents and their teenage children, attending 5th to 7th grade, from ten municipal schools, participated in this study. Self-reported questionnaires were used to assess healthy lifestyles, answered separately by parents and their children. Univariable and multivariable ordinal logistic regression analyses with complete data were carried out, using the students’ health promoting behaviors as dependent variables and the same behaviors among parents as the main predictors, controlling for other personal and family variables. Results: We contacted 1,035 parents and 682 consented to participate along with 560 students. The mean age of adolescents was 11.5 ± 1.2 years (49% females) The mean age of parents was 39.8 ± 8.8 years and 90% were women. The parental behaviors associated with teenage health promoting behaviors were eating vegetables (odds ratio (OR) = 1.22, p < 0.05), having breakfast (OR = 1.27, p < 0.05), do stretching exercises every day (OR = 1.19, p < 0.05) and take some time for relaxation (OR = 1.24, p < 0.05). Conclusions: These results show an association between healthy behaviors among parents and these behaviors among their adolescent offspring.

Consumo de tabaco y alcohol en adolescentes de 10 a 14 años de la ciudad de San Felipe, Chile: prevalencia y factores asociados / Smoking and alcohol use among Chilean teenagers aged 10 to 14 years

Background: Smoking and alcohol use are risky behaviors that can start early in life. Aim: To determine the lifetime prevalence of tobacco and alcohol use in adolescents aged 10 to 14 years and related factors. Subjects and Methods: A survey about smoking and alcohol use was answered by 1,392 teenagers aged 10 to 14 years (46% women) from seven schools in a small city near Santiago. Personal, family, and school factors were evaluated through self-report scales. Smoking and alcohol use, as dichotomous dependent variables, were defined as having consumed any of these substances throughout life. Prevalence was calculated as percentages with 95% confidence intervals. Association analyses were conducted using multivariable logistic regression models. Results: Six and eleven percent of participants reported having smoked and used alcohol in their life, respectively. Smoking was associated with age, having behavioral problems, mothers’ smoking, perceiving that parents had drug problems, and not living with both parents. Alcohol use was mainly associated with age, having behavioral problems, perceiving that other students consumed drugs, alcohol use by both parents, and perceiving a lack of family support. Conclusions: Tobacco and alcohol use is highly prevalent in adolescents aged 10-14 years. There were common risk factors for smoking and alcohol use such as age and having behavioral problems, while other factors were more specific such as mothers’ smoking, or parental alcohol use.

Prevalencia de trastornos psiquiátricos en adolescentes infractores de ley en Chile / Prevalence of psychiatric disorders among teenage offenders

Background: There has been a significant number of adolescents admitted to National Youth Service of Chile (SENAME) detention centers in recent years, specifically since the promulgation of a law reform on juveniles’ penal responsibility for people aged 14 to 18 years (2006). Aim: To determine the prevalence of psychiatric disorders in adolescent male offenders aged between 14 and 17 years. Material and Methods: The Mini International Neuropsychiatric Interview for Kids and Adolescents (MINI-KID) was applied to 489 adolescents admitted to detention centers, to determine the presence of psychiatric disorders. (Hypo) maniac episodes, eating disorders, pervasive developmental disorders, tic disorders, and psychotic disorders were excluded. Furthermore, for purposes of analysis, 23 cases that used a substance of abuse or had signs of consumption the day of the interview were excluded. Results: Eighty six percent of respondents had at least one psychiatric disorder. The most common were substance use disorders (76%). Among these, marijuana dependence disorder had the higher frequency (51%). Disruptive behavior disorders had also a high prevalence (38%), followed by anxiety disorders (27%), attention deficit and hyperactivity disorder (26%), and affective disorders (21%). Conclusions: There is a high prevalence of psychiatric morbidity among teenage offenders which could undermine rehabilitation.

Esclerosis múltiple recurrente remitente en el sector público de salud de Chile: Descripción clínica de 314 pacientes / Clinical features of 314 patients with relapsing-remitting multiple sclerosis

Background: Immunomodulatory drugs (IMD), Interferon β1a, β1 b and glatiramer acetate are available in the Chilean public health system since June 2008 for patients with relapsing-remitting multiple sclerosis (RR-MS). Diagnostic confirmation and programmed follow up of these patients is carried out at a public national reference center. Aim: To describe the epidemiological and clinical features of 314 patients evaluated in this center between 2008 and 2012. Patients and Methods: Review of clinical records, to obtain information about demographic background, medical history, expanded disability status scale of Kurtzke (EDSS), multiple sclerosis functional composite (MSfic), intensity fatigue scale of Krupp, Rao’s Brief Repeatable Battery of Neuropsychological Tests (BNR-R) and anxious-depressive manifestations using Hamilton and Beck questionnaires. Results: The ages of patients ranged from 12 to 63 years and 67% were women. The initial symptoms were sensory disturbances in 20%, motor alterations in 18% and optical neuritis in 16%. In 9% of patients, the disease began with several manifestations. The EDSS was 4 or less in 73% of patients and cognitive impairment was observed in 34%. Treatment failure during the first and second years, occurred in 23 and 26% of patients, respectively. Male gender, age under 40 and brainstem malfunction at the onset of disease, were predictive of treatment failure during the second year. Conclusions: The features of these patients are very similar to those reported abroad.

Factores asociados a conductas promotoras de salud en adolescentes chilenos / Factors associated with health promoting behaviors among Chilean adolescents

Background: Health-promoting behaviors are important to prevent diseases and prolong life in the population. People develop these behaviors throughout life. However, better benefits for health are obtained with an early development. Aim: To determine the prevalence of health-promoting behaviors among early adolescents and its associated factors. Material and Methods: Cross-sectional survey performed in 1,465 students of high, medium and low socio-economic status, attending fifth to eighth grades of schools located in a small Chilean city. Participants answered a questionnaire that gathered information about frequency of health-promoting behaviors such as health responsibility and nutrition, physical exercise and stress management, life appreciation, social support and different personal, school and familial factors. Results: A higher frequency of health-promoting behaviors was associated with better academic achievement, better school commitment, and higher perception of school membership. It also was associated with a better perception of health status and a higher conformity with physical appearance. Conclusions: Health promoting behaviors in these children are related to a better academic achievement and a higher integration with school environment.

Evaluación neuropsicológica en 129 pacientes chilenos con esclerosis múltiple recurrente remitente previo a inicio de fármacos inmunomoduladores / Neuropsychological assessment of patients with relapsing remitting multiple sclerosis prior to the use of immunomodulatory drugs

Background: The detection of cognitive changes (CC) and psychiatric disorders in relapsing remitting multiple sclerosis (MS-RR) contributes to patient clinical monitoring. Aim: To assess the frequency and characteristics of CC and psychiatric disorders in Chilean patients with MS-RR, before starting immunomodulatory treatment. Patients and Methods: Retrospective review of data that was obtained following a standard assessment protocol. It consisted in the application of the Expanded Disability Status Scale of Kurtzke (EDSS), Multiple Sclerosis Functional Composite (MSFC), fatigue intensity scale of Krupp, brief repeatable battery of neuropsychological Rao (BRN-R) and Hamilton's depression and anxiety questionnaires. Results: We evaluated 129 patients aged between 12 and 60 years of age (69% women). Ninetyfour percent of patients had eight or more years of schooling. The average EDSS score was 2.83. CC were detected in 62% of participants, in at least one subtest of the BRN-R. The main changes were verbal memory and speed in the processing information. The frequency of cognitive impairment (CI), defined as at least two BRN-R subtests altered, was 36%. The figures decreased to 17% when significant major depression or associated fatigue were excluded. Depressive symptoms were observed in 58% and anxiety in 76.7%. Conclusions: The results are consistent with those described in the literature. The type of instruments used in the investigation of CC and the definition of CI in MS should be standardized.

Consumo de sustancias y síntomas depresivos en escolares de liceos municipales de Santiago / Association between drug consumption and depression among high school students

Background: The presence of emotional problems may trigger drug abuse. Aim: To determine the association between illicit drug use and severity of depression symptoms among students of public secondary schools in Santiago, Chile. Material and Methods: A probabilistic sample of2,597 adolescents aged between 12 and 18 years (45% women), attending first year in public high-schools in Santiago, answered self-report questionnaires about consumption, during the last 30 days ,of alcohol, tobacco and marihuana, and the Beck Depression Inventory - II. Logistic regression models were used to study the association between drug use and severity of depression symptoms, adjusting by sex. Results: Tobacco and marihuana use was reported by 38 and 13% of students, respectively. Frequency of consumption was significantly higher among women. Mild, moderate or severe depressive symptoms were found among 16%, 14% and 9% of students, respectively. Depressive symptoms were more common among women. There was a significant association between drug use and severity of depression among participants of both genders. Conclusions: The association between depressive symptoms and drug use should be considered on the design of treatment guidelines for these health problems in Chile.

Experiencia de trombolisis sistematizada en infarto cerebral agudo en un hospital público de Chile / Thrombolysis for acute ischemic stroke with recombinant tissue plasminogen activator in a Chilean public hospital

Background: The only accepted treatment for acute ischemic stroke is thrombolysis with recombinant tissue plasminogen activator (t-PA). It was implemented in Chile in 1996, although its use was mainly restricted in Chile to private clinics. Recently, at year 2009, we have implemented this treatment in a public hospital. Aim: To describe the results of treatment of acute ischemic stroke with t-PA in a public hospital in Chile. Material and Methods: Prospective analysis of all eligible patients with acute ischemic stroke that were admitted within 4 hours of its onset and had no contraindications for thrombolysis. Results: In an eight months period, a total of 19 intravenous thrombolyses were performed in 12 males and seven females aged 28 to 79 years old. The mean lapse between onset of symptoms and onset of thrombolysis was 190 ± 57 min. Results were favorable, according to Rankin and National Institute of Health Stroke scales. Ninety days after treatment, 63 percent of patients had minimal or absent disability, 26 percent had moderate disability and only one (5 percent) had severe disability. One patient had a clinically not significant intracranial hemorrhage and one patient died six days after thrombolysis. Conclusions: These results indicate that thrombolysis can be successfully implemented in Chilean public hospitals. The limitations for its use in this setting are mostly administrative.

Procedimientos endovasculares como tratamiento de la esclerosis múltiple?: la hipótesis de la insuficiencia venosa crónica cerebro medular: [revisión] / Endovascular procedures as multiple sclerosis treatment?: the hipothesis of the chronic cerebrospinal venous insufficiency: [review]

In this "point of view" or special article, it has been reviewed the main bibliographic antecedents related to the entity denominated as chronic cerebrospinal venous insufficiency (CCSVI), which formulation has been stated by Zamboni et col, from the Vascular Diseases Center of the University of Ferrara-Italy, who have assigned it a pathogenic role or of aggravation one in Multiple Sclerosis (MS), what has led them to propose and carry out endovascular balloon angioplasty or venous stent in MS patients as a treatment. The bibliographic review at this stage of the knowledge of CCSVI does not let us to conclude whether this hypothetical entity has any role in the development or aggravation of MS. On the other hand, we agree with most of the clinicians and neuroimaging MS researchers because of the absence of arguments to indicate, support or propose envovascular "therapeutic" procedures for MS. To advance in the knowledge of CCSVI and the eventual relation with MS it is required some multicentric controlled studies carefully led and clinical and methodological rigorous procedures approved by committee of ethic in very well informed patients invited to participate in protocols of formal investigation who should be protected by complementary pertinent insurances and responsibilities connected to the investigation expenses.

En este artículo especial de la modalidad "puntos de vista", se revisan los antecedentes bibliográficos principales relacionados a la entidad denominada "Insuficiencia venosa crónica cerebro medular (IVCCM)" cuya formulación ha sido planteada por Zamboni y col, del Centro de Enfermedades Vasculares de la Universidad de Ferrara-Italia quienes le han adjudicado un rol patogénico o de agravación en la Esclerosis Múltiple (EM), que les ha llevado a proponer y realizar procedimientos de angioplastía mediante balón endovascular o stent venoso en pacientes con EM. La revisión de la bibliografía, en esta etapa del conocimiento de la IVCCM, no permite concluir si esta hipotética entidad tiene algún rol en el desarrollo o agravación de la EM. Por otro lado, concordamos con la mayoría de los clínicos e imagenólogos dedicados al estudio y tratamiento de la EM, en la ausencia de argumentos para indicar, alentar o propiciar procedimientos "terapéuticos" endovasculares para la EM. Para avanzar, en el conocimiento de la IVCCM y de eventual relación con la EM, se requieren estudios multicéntricos cuidadosamente conducidos, clínica y metodológicamente rigurosos, aprobados por comités de ética, en pacientes que sean invitados informadamente a participar en protocolos de investigación formales, que cuenten con las protecciones de seguros complementarios pertinentes y responsabilidades del gasto a costas de los investigadores.

La historia y los grandes médicos del pasado en Chile: sentido de una indagación / The history and the great doctors of the past in Chile: the sense of an investigation

Los grandes maestros de la medicina chilena es un tema habitual en la producción académica en Chile. Se trata, por lo general, de un discurso apologético por el cual se busca crear y sostener tradiciones médicas, pero con un contenido historiográfico débil. No está en discusión la jerarquía indudable de los grandes médicos del pasado; pero sí tal orientación de los estudios desarrollados. En este sentido el propósito de este artículo es iniciar una indagación histórica en torno a los maestros de la medicina chilena de modo de contraponerla al discurso académico. Se concluye destacando dos rasgos en la práctica de estos médicos del pasado: se trata de médicos que participaron en una fuerte y desarrollada medicina pública hospitalaria que arranca desde 1924 y alcanza su apogeo con el Servicio Nacional de Salud; y además de médicos que fueron parte central del sistema de cátedras universitarias anteriores a la reforma de 1968.

The great teachers of Chilean medicine are a recurrent subject in the academic production in Chile. In generally deals with an apologetic speech by which one looks to create and to support medical traditions, but with a weak historiographic content. It is not in discussion the doubtless hierarchy of the great doctors of the past, but the orientation of their studies. In this sense the purpose of this article is to begin a historical research around the teachers of Chilean medicine as a way to oppose it to the academic speech. The conclusion emphasizes two characteristics of the doctors of the past: one is that doctors who participated in a strong and developed public medicine at the hospital beginning in 1924 and reaching its apogee with the National Health Service; and also about doctors who were the central part of the university programmes system previous to the 1968 reform.

Programa piloto para pacientes beneficiarios de Fonasa, que padecen esclerosis multiple: tratamiento con inmunomoduladores en el sistema público de salud de Chile: Informe del primer año, 10 de julio 2008-30 de Junio 2009 / Pilot national treatment program for multiple sclerosis patients belonging to the public health care system of Chile (FONASA) with immunomodulating disease-modifying therapies: first year report from July 2008 to June 2009

Multiple Sclerosis (MS) is a chronic disease of the central nervous system. It is manifested in the young adult who presents at the beginning alternation between transient neurological dysfunction and normality, followed by a progressive level of disability. MS affects the quality of life in the young adults in their full productive and creative age limiting not only in their personal lives but also affects to the whole society in terms of "dreams and life projects". Besides, this illness also influences the family group who has to assume progressively the help and care for the patient. In healthcare aspect MS implies intensive and progressive resources. In Chile, although we don't have epidemiological studies that indicate which is the MS prevalence it exist a projection that states 14 per 100.000 inhabitants. Considering a population of 16.5 million of inhabitants our expectative of patients with MS is of 2310 cases in our country. The MS immunomodulating injectable disease-modifying therapies are of high cost and were not available in a regular way in the state health care system of Chile (FONASA) that attends the 70 percent of the population; the other 30 percent has different private health insurances. In 2008 the ministry of health decided to initiate and pilot (exploratory) program which had a great meaning and impact concerning to start offering immunomodulating therapies to relapsing remitting MS, for patients belonging to FONASA system. The pilot program was thought with a double mission, on the one hand to achieve that a very limited group of MS patients belonging to FONASA system (80 cases) from all over the country had access to immunomodulating injectable disease-modifying therapies of high cost in a regular way. The second objective was to obtain clinical and epidemiological information which let us to evaluate the clinical and administrative obstacles generated by the incorporation of this treatment in the public health...

Introducción El presente documento corresponde al informe del primer año de trabajo operativo del "Programa piloto de tratamiento con inmunomoduladores, para pacientes beneficiarios de Fonasa1, que padecen esclerosis múltiple (EM)", elaborado por el equipo del centro de referencia nacional, para este programa, con sede en el Servicio de Neurología del Complejo Asistencial Barros Luco (CABL) del SSMS2. Dado su origen no incluye antecedentes del proceso de gestión ni toma de decisiones del nivel Minsal3 o Fonasa. Este trabajo, no es ni aspira ser: un ensayo clínico, una guía de práctica clínica, una revisión bibliográfica, ni una puesta al día sobre el tratamiento de la Esclerosis Múltiple (EM), es simplemente el informe anual de un centro de referencia, para una tarea específica, a la autoridad ministerial competente. El informe incluye algunos antecedentes generales y referencias presentadas como "notas al pie", sólo para contextualizar la información presentada4. La EM es una enfermedad crónica del SNC, de origen incierto, inmunológicamente mediada, bien definida en sus características inmunopatogénicas, patológicas, imagenológicas y clínicas. Se expresa en el adulto joven, quien presenta inicialmente alternancia entre disfunción neurológica transitoria y normalidad y cuya progresión determina múltiples efectos discapacitantes. La EM afecta la calidad de vida de adultos jóvenes en plena edad productiva y creativa limitando tanto los "sueños y proyectos de vida" como el desarrollo laboral, social y afectivo. Además trasciende al grupo familiar, cuando deben asumir la asistencia del paciente. En lo sanitario, la EM, genera uso intensivo y progresivo de recursos. Las terapias inmunomoduladores para la EM, que tienen la posibilidad de detener o reducir la evolución de la modalidad recurrente remitente de la EM, no se encontraban disponibles en forma regular en el sector público de salud de nuestro país, por esto el presente programa piloto...