Daño a terceros producido por el alcohol: resultados de un estudio poblacional en Chile / The harm to others from drinking: A population study

Background: Alcohol can harm both drinkers and their human environment. Most of research in Chile has focused on the drinker. This work focuses on the damage to others. Governmental expenditures due to drinking are estimated to quadruple the income earned through taxation. Aim: To report the results of a population survey conducted in Chile in 2013 to assess the harm done to others from drinking by a known or unknown drinker. Material and Methods: A household survey of a sample of 1500 subjects living in urban areas, predominantly over 50.000 inhabitants, was conducted by trained interviewers. Results: A significant number of respondents reported that the effect of alcohol consumption by third parties was somewhat (18.7%) or very negative (14.8%). The most frequent negative effects were verbal abuse (37.4%), being bullied (17.4%), feeling fearful at home or in a private meeting (19.6%) and family problems (16.9%). Conclusions: About one third of Chileans surveyed have suffered negative effects due to alcohol consumption of a known or unknown drinker. This finding signals the need of designing public policies addressed to minimize or prevent collateral effects of drinking.

Avaliação do neurodesenvolvimento de prematuros de muito baixo peso ao nascer entre 18 e 24 meses de idade corrigida pelas escalas Bayley III / Neurodevelopmental assessment of very low birth weight preterm infants at corrected age of 18-24 months by Bayley III scales

OBJETIVO: Avaliar a prevalência de atraso e fatores associados aos escores de desenvolvimento em crianças nascidas prematuras. MÉTODOS: Estudo transversal para avaliar o desenvolvimento por escalas Bayley III, incluindo-se prematuros de muito baixo peso de 18 a 24 meses de idade corrigida, acompanhados no Ambulatório de Prematuros da instituição. Excluíram-se: malformação congênita, síndrome genética, infecção congênita sintomática ao nascimento, surdez e cegueira. As variáveis numéricas foram comparadas por teste t de Student ou Mann-Whitney, e as categóricas, por qui-quadrado ou teste exato de Fisher. Para análise dos fatores associados aos escores de desenvolvimento, utilizou-se a regressão linear, considerando-se significante p < 0,05. RESULTADOS: Das 58 crianças avaliadas, quatro (6,9%) apresentaram alteração cognitiva; quatro (6,9%), motora; 17 (29,3%), de linguagem; 16 (27,6%), socioemocional; e 22 (37,9%), de comportamento adaptativo. À regressão linear múltipla, os fatores classe socioeconômica CDE (-13,27; IC95% -21,23 a -5,31) e dependência de oxigênio com 36 semanas de idade corrigida (-8,75; IC95% -17,10 a -0,39) diminuíram o escore cognitivo. A leucomalácia periventricular diminuiu o escore cognitivo (-15,21; IC95% -27,61 a -2,81), motor (-10,67; IC95% -19,74 a -1,59) e de comportamento adaptativo (-21,52; IC95% -35,60 a -7,44). O sexo feminino se associou ao maior escore motor (10,67; IC95% 2,77-12,97), de linguagem (15,74; IC95% 7,39-24,09) e socioemocional (10,27; IC95% 1,08-19,46). CONCLUSÕES: Prematuros de muito baixo peso apresentaram com maior frequência alterações na linguagem, comportamento adaptativo e socioemocional. As variáveis classe socioeconômica CDE, leucomalácia periventricular, displasia broncopulmonar e sexo masculino contribuíram para reduzir os escores de desenvolvimento.

OBJECTIVE: To evaluate the prevalence of delay and factors associated with neurodevelopmental scores in premature infants. METHODS: Cross-sectional study to assess the development by Bayley Scales III, including very low birth weight preterm infants aged 18 to 24 months who were under follow-up at the outpatient clinic for preterm infants. Congenital malformation, genetic syndrome, symptomatic congenital infection at birth, deafness, and blindness were excluded. Numerical variables were compared by Mann-Whitney or Student t test and categorical variables by chi-square or Fisher's exact test. Factors associated with developmental scores were analyzed by linear regression, and statistical significance level was established at p < 0.05. RESULTS: Out of the 58 children included, four (6.9%) presented cognitive delay, four (6.9%) motor, 17 (29.3%) language, 16 (27.6%) social-emotional and 22 (37.0%) adaptive-behavior delay. By multiple linear regression, the variables: social classes CDE (-13.27; 95%CI: -21.23 to -5.31), oxygen dependency at 36 weeks of corrected age (-8.75; 95%CI: -17.10 to -0.39) decreased the cognitive developmental score. Periventricular leukomalacia decreased the cognitive (-15.21; 95%CI: -27.61 to -2.81), motor (-10.67; 95%CI:-19.74 to -1.59) and adaptive-behavior scores (-21.52; 95%CI: -35.60 to -7.44). The female sex was associated with higher motor (10.67; 95%CI: 2.77 to 12.97), language (15.74; 95%CI: 7.39 to 24.09) and social-emotional developmental scores (10.27; 95%CI: 1.08 to 19.46). CONCLUSIONS: Very low birth weight preterm infants aged from 18 to 24 months of corrected age presented more frequently language, social-emotional and adaptive-behavior delays. The variables: social classes CDE, periventricular leukomalacia, bronchopulmonary dysplasia and male sex reduced the neurodevelopmental scores.

Rinite alérgica: indicadores de qualidade de vida / Allergic rhinitis: indicators of quality of life

O objetivo desta revisão foi apresentar evidências da relação entre rinite alérgica e redução da qualidade de vida. As fontes de dados foram artigos originais, revisões e consensos indexados nos bancos de dados Medline e LILACS entre 1997 e 2008. As palavras de busca foram "rinite alérgica", "qualidade de vida" e "distúrbios do sono". Os pacientes com rinite alérgica frequentemente têm redução na qualidade de vida causada pelos sintomas clássicos da doença (espirros, prurido, coriza e obstrução). Além disso, a fisiopatologia da rinite alérgica, com frequência, interrompe o sono, ocasionando fadiga, irritabilidade, déficits de memória, sonolência diurna e depressão. A carga total da doença recai não apenas no funcionamento social e físico prejudicados, mas também no impacto financeiro, que se torna maior quando se consideram as evidências de que a rinite alérgica é um possível fator casual de comorbidades, tais como a asma e a sinusite. A obstrução nasal, o mais proeminente dos sintomas, está associada a eventos respiratórios relacionados aos distúrbios do sono, uma condição que tem profundo efeito sobre a saúde mental, o aprendizado, o comportamento e a atenção. Finalmente, a rinite alérgica - doença crônica que afeta crianças, adolescentes e adultos - frequentemente é subdiagnosticada ou inadequadamente tratada. O impacto deletério dos distúrbios do sono associados à rinite alérgica sobre a habilidade para realizar as atividades de vida diária dos pacientes é um importante componente da morbidade da doença. Com um diagnóstico acurado, existem vários tratamentos disponíveis que podem reduzir a carga associada à rinite alérgica.

The objective of this review was to present evidence of the relationship between allergic rhinitis and impairment of quality of life. The data sources were original articles, reviews and consensus statements entered into the Medline and LILACS databases between 1997 and 2008. The following search terms were used: "allergic rhinitis"; "quality of life"; and "sleep disorders". Quality of life is often impaired in patients with allergic rhinitis, due to the classic symptoms of the disease (sneezing, pruritus, rhinorrhea and nasal obstruction). In addition, the pathophysiology of allergic rhinitis often disrupts sleep, leading to fatigue, irritability, memory deficits, daytime sleepiness and depression. The total burden of this disease goes beyond impairment of physical and social functioning. It has also a financial impact, which becomes greater when we consider the evidence that allergic rhinitis is a possible causal factor of comorbidities, such as asthma and sinusitis. Nasal obstruction, the most prominent symptom, is associated with sleep disorders, which can have a profound effect on mental health, learning, behavior and attention. Finally, allergic rhinitis-a chronic condition that affects adults, adolescents and children-is often underdiagnosed or inadequately treated. The deleterious impact that allergic rhinitis-related sleep disorders have on patient capacity to perform activities of daily living is an important component of the morbidity of the disease. With an accurate diagnosis, there are various available treatments that can reduce the burden of allergic rhinitis.

Factores psicosociales de riesgo de consumo de drogas ilícitas en una muestra de estudiantes mexicanos de educación media / Psychosocial risk factors for illicit drug use in a sample of Mexican high school students

OBJETIVOS: Identificar factores psicosociales de riesgo de consumo de sustancias ilícitas en estudiantes mexicanos y ofrecer elementos para el diseño de programas de prevención. MÉTODOS: Estudio transversal no experimental con una muestra de 516 estudiantes de secundaria y bachillerato de seis de las principales ciudades de México. Entre abril y junio de 2005 se aplicó una adaptación de la versión abreviada del Inventario de Tamizaje sobre el Consumo de Drogas (DUSI-R). El análisis comprendió ocho factores: abuso en el consumo de bebidas alcohólicas o drogas, malestar afectivo, bajo control conductual, baja adherencia escolar, baja competencia social, relaciones familiares disfuncionales, aislamiento social y pertenencia a redes sociales desviantes (cuyos integrantes consumen drogas y adoptan actitudes antisocia-les). Se identificaron factores de predicción del consumo de drogas ilícitas mediante regresión logística y se elaboró un modelo de ecuaciones estructurales para determinar las relaciones entre los factores. RESULTADOS: Los factores de predicción del consumo de sustancias ilícitas fueron presentar un bajo control conductual con tendencia a actuar impulsivamente y con agresividad, estar vinculado con pares desviantes y estar expuesto con frecuencia a situaciones familiares de conflicto y violencia y al consumo de sustancias ilícitas y alcohol en el hogar. El modelo de ecuaciones estructurales indicó que el consumo de estas sustancias forma parte de un grupo de trastornos de ajuste conductual, determinado directamente por la vinculación con pares desviantes y por una mayor prevalencia de trastornos socioafectivos, e indirectamente por las relaciones familiares disfuncionales. CONCLUSIONES: Se confirmaron algunas implicaciones de los modelos teóricos propuestos para explicar el consumo de drogas. Estos elementos empíricamente sustentados pueden contribuir al diseño de programas preventivos, principalmente de tipos selectivo e indicado.

OBJECTIVES: To identify psychosocial risk factors for substance abuse among Mexican students and to offer elements for the design of prevention programs. METHODS: A cross-sectional, nonexperimental study of a sample of 516 high school students in six of Mexico's most important cities. From April-June 2005, a customized version of the Drug Use Screening Inventory (revised) (DUSI-R) was administered. The analysis comprised eight factors: alcohol and drug abuse, affective disorders, poor self-control, poor school adjustment, low social competence, dysfunctional family relationships, social isolation, and being part of a detrimental social network (whose members take drugs and have antisocial attitudes). Factors predictive for illicit drug use were found by logistical regression, and a structural equation model was designed to determine the relationships among the factors. RESULTS: The factors that predicted substance abuse were poor self-control with a tendency to act impulsively and aggressively; associating with troublemakers; and being frequently exposed to family conflicts, violence, and drug and/or alcohol use in the home. The structural equation model indicated that substance abuse is one of a group of disorders directly determined by associating with detrimental peers, and a higher rate of socioaffective disorders, and indirectly, by dysfunctional family relationships. CONCLUSIONS: Some of the suggestions made by theoretical models to explain substance abuse were confirmed. These empirically-supported elements can contribute to the design of prevention programs, especially those that are selective and recommended.

Behavioral problems and tobacco use among adolescents in Chile

OBJECTIVE: To examine the association between behavioral problems and tobacco smoking among adolescent students in Chile. METHODS: Data were drawn from a study that included questionnaire surveys of 46 907 school-attending adolescents in all 13 of the administrative regions of Chile. Assessments were based on an adapted, Spanish-language version of the Drug Use Screening Inventory. The conditional form of the logistic regression model was used for analysis, with matching of students on individual schools, and with further statistical adjustments for sex, age, and selected risk factors. RESULTS: The prevalence of tobacco smoking among the adolescents was very high across all of Chile, with a level between 56 percent and 65 percent in each of the 13 regions. The estimated odds of tobacco use in youths at the highest level of behavioral problems was about twice that for youths at the lowest levels, both before and after controlling for sex, age, lack of participation in recreational activities, level of irritability, and levels of problems with school, family attention, and mental health. CONCLUSIONS: These findings help to complement and complete the evidence of prior studies on tobacco smoking among adolescents with behavior problems, including recent research on Central American youths. Although the magnitude of observed associations in Chile was not as great as that for the associations found in Central America, both the strength of these associations and their statistical significance were observed throughout Chile. This is the first study in Chile on potentially causal relationships such as these.

Identificación de la población adulta mayor en riesgo de perder su capacidad funcional a nivel comunitario / Identification of older adult population in risk of losing functional capacity at communitary level

Se realizaron entrevistas domiciliarias a 51 adultos mayores, habitantes de las comunas de Til-Til. Las edades fluctuaron entre los 60 y 91 años; todos eran jubilados pertenecientes a la Asociación de Jubilados de Til-Til. Se aplicaron 3 cuestionarios presentados por el Ministerio de Salud para detectar factores de riesgo de pérdida de la capacidad funcional (autonomía) en el adulto mayor y presencia de depresión y demencia valoradas según puntaje. Veintidos jubilados (43,1 por ciento) presentaron dos o más factores de declinación funcional. No se observó diferencias por sexo. Catorce (27,5 por ciento) presentaron depresión, con un 17,9 por ciento para hombres y 39,1 por ciento para mujeres (p < 0,05). Respecto a demencia, 18 individuos (35,3 por ciento) presentaron signos de deterioro cognitivo. Un mayor porcentaje de demencia fue observado en sujetos analfabetos (63,6 por ciento) con respecto a los alfabetizados (27,5 por ciento). Lo mismo se observó para depresión con un 54,5 por ciento versus 20 por ciento. Ambos significativo (p < 0,05). Estos resultados muestran que el instrumento usado podría ser útil para detectar población en riesgo de declinación funcional

Consumo de alcohol y familia: un estudio descriptivo en adolescentes / Alcohol consumption and family: a descriptive study in adolescents

To study abnormal alcohol ingestion among parents and family dysfunction of pregnant and non pregnant teenagers from 12 to 18 years old consulting in the Teenagers Health Unit of a public hospital outpatient clinic. Their degree of instruction attained, marital status, social behavior, alcohol, drug intake and history of child abuse was recorded. The level of instruction, marital status, alcohol ingestion and work stability of their fathers was also studied. One hundred sixteen pregnant and 60 non pregnant teenagers were studied. The fathers of pregnant girls had a higher level of alcohol consumption, more civil irregularities and a higher level of family dysfunction. Among these girls, a higher frequency of neurological abnormalities and fetal alcohol syndrome was observed. They had also a lower educational level and a higher degree of alcohol and drug use. Alcohol consumption among parents leads to family dysfunction and has adverse physical, intellectual and social consequences in the offspring

Frecuencia de conductas de riesgo entre adolescentes escolares hijos de padres separados / Incidence of risk behaviours among school adolescents with divorced parents

Para explorar algunos de los efectos de la separación de los padres sobre los hijos adolescentes se analizaron 1.904 respuestas obtenidas en escolares entre 10 y 19 años de edad en el área urbana de Santiago, Chile. Los participantes fueron seleccionados mediante muestreo probabilístico por conglomerados, en tres etapas, estratificado. El instrumento utilizado para la encuesta fue la Escala de Conducta de Riesgo en Adolescentes, en una versión modificada de la Encuesta de Salud de Adolescentes de Minnesota (de la Universidad homónima). La frecuencia declarada de separación fue de 21,8 por ciento. Los hijos de padres separados presentaron frecuencias significativamente mayores de síntomas emocionales, consumo de alcohol, cigarrillo, marihuana y otras drogas, consultas a psicólogos y psiquiátras y antecedentes de maltrato físico y abuso sexual que los hijos de matrimonios indemnes. La frecuencia de separación matrimonial declarada fue mayor que la detectada en una muestra encuestada diez años antes (12,9 por ciento). La separación parece predisponer, en los hijos adolescentes, a mayor frecuencia de conductas de riesgo

Diferentes concentraciones de tolueno provocan el síndrome serotonérgico / Different concentrations of toluene inducing serotonergic syndrome

Los efectos sobre la conducta observados durante la inhalación de "thiner" han sido atribuidos al tolueno. Diversos estudios definen al tolueno como una droga alucinógena, que ejerce su efecto probablemente a través de mecanismos serotonérgicos. En este trabajo se estudia el efecto de la exposición aguda a diferentes concentraciones de tolueno en la presentación del síndrome serotonérgico. Grupos de ratas macho Wistar fueronm expuestos a diversas concentraciones de tolueno durante 15 minutos por única vez, mediante un sistema estático de inhalación. Se registró la presencia de los signos que integran al síndrome serotonérgico; además se evaluó el reflejo de enderezamiento. La concentración efectiva media de tolueno para provocar el síndrome serotonérgico fue de 4,878 ppm. El efecto observado sobre el reflejo de enderezamiento fue la perdida de éste a partir de 7,638 ppm; el efecto se incrementó de manera dependiente de la concentración

Estudio diagnostico del paciente con trastorno de conducta / Diagnostic study of the patient with behavioral disorders

Se efectua una revision pormenorizada del extenso grupo de los transtornos contenidos bajo las alteraciones de conducta. Se revisan los elementos que componen los diagnosticos tomando en consideracion fenomenos culturales y socioeconomicos. Se hace enfasis en los aspectos del diagnostico multidisciplinario con instrumentos objetivables, los sintomas que componen el sindrome y los diagnosticos diferenciales que se deben conocer antes de hacer una intervencion terapeutica.