RESUMEN
Background The incidence of colorectal cancer (CRC) in the US has declined. The decreasing trend is observed in non-Hispanic Whites, Blacks, and Hispanics. However, close analysis of the trends demonstrates that the decline among Hispanics is less than other races/ethnicities. We investigate the burden of CRC in Hispanics living near the U.S.Mexico border, a subpopulation of Hispanics composed primarily of individuals of Mexican origin. Objectives The objective of this study was to investigate and compare incidence rates of CRC in non-Hispanic Whites and Hispanics living in counties along the U.S.Mexico border. Methods Data from the National Institutes of Health National Cancer Institute and State Cancer Profiles were analyzed to obtain CRC incidence rates (per 100,000 population) for persons ≥ 50 years of age residing in counties along the U.S.Mexico border by race (non-Hispanic White and Hispanic) and gender from 2011 to 2015. Results Incidence rates of CRC in Hispanic men ≥ 50 years of age, living in counties along the U.S.Mexico border, were higher than the national average for Hispanic men of similar age. In contrast, the incidence of CRC declined or remained stable in non-Hispanic Whites and women. Conclusions Our study unveils a significant disparity in CRC incidence among Hispanics living near the U.S.Mexico border, disproportionally affecting men ≥ 50 years of age. Socioeconomic and cultural/lifestyle factors are likely contributing to these disparities.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Neoplasias Colorrectales/epidemiología , Hispánicos o Latinos/estadística & datos numéricos , Población Blanca/estadística & datos numéricos , Disparidades en el Estado de Salud , Factores Socioeconómicos , Estados Unidos/epidemiología , Incidencia , Distribución por Sexo , Estilo de Vida/etnologíaRESUMEN
Insulin is a commonly used measure of pancreatic β-cell function but exhibits a short half-life in the human body. During biosynthesis, insulin release is accompanied by C-peptide at an equimolar concentration which has a much higher plasma half-life and is therefore projected as a precise measure of β-cell activity than insulin. Despite this, genetic studies of metabolic traits haveneglected the regulatory potential of C-peptide for therapeutic intervention of type-2 diabetes. The present study is aimed to search genomewide variants governing C-peptide levels in genetically diverse and high risk population for metabolic diseases—Indians. We performed whole genome genotyping in 877 healthy Indians of Indo-European origin followed by replication of variants with P ≤ 1 × 10−3 in an independent sample-set of 1829 Indians. Lead-associated signals were also tested in-silico in 773 Hispanics. To secure biological rationale for observed association, we further carried out DNA methylation quantitative trait loci analysis in 233 Indians and publicly available regulatory data was mined. We discovered novel lncRNA gene AC073333.8 with the strongest association with C-peptide levels in Indians that however missed genomewide significance. Also, noncoding genes, RP1-209A6.1 and RPS3AP5; protein gene regulators, ZNF831 and ETS2; and solute carrier protein gene SLC15A5 retained robust association with C-peptide after meta-analysis. Integration of methylation data revealed ETS2 and ZNF831 single-nucleotide polymorphisms as significant meth-QTLs in Indians. All genes showed reasonable expression in the human lung, signifying alternate important organs for C-peptide biology. Our findings mirror polygenic nature of C-peptide where multiple small-effect size variants in the regulatory genome principally govern the trait biology.
RESUMEN
ResumenPropósito:Conocer la asociación entre algunos factores de riesgo cardiovascular y la presión arterial en reposo de estudiantes universitarios costarricenses.Metodología:una muestra total de 269 estudiantes universitarios (138 varones, 131 mujeres; edad promedio= 19,1 ± 2,8 años) respondieron instrumentos de medición sobre datos demográficos, antecedentes familiares de hipertensión, consumo de alcohol, cantidad de tragos ingeridos semanalmente, hábito de fumar, cantidad de cigarros fumados por día, cantidad de METs de actividad física realizada semanalmente y estado de salud general. Se obtuvo de cada sujeto la presión arterial sistólica (PAs) y diastólica (PAd) en reposo, índice de masa corporal (IMC), índice cintura/cadera (ICC), porcentaje de grasa determinado utilizando el densitómetro óseo (DEXA, marca General Electric) y consumo máximo de oxígeno (VO2max) de forma indirecta. Los datos obtenidos se analizaron mediante Regresión Lineal Múltiple, específicamente aplicando 2 Regresiones de Modelos Lineales Generales (MLG).Resultados:Las variables predictoras incluidas en el modelo explican 28,3% (R2model = 0,283) de la variación en la PAs y un 15,8% (R2model = 0,158) de la variación en la PAd. Los factores que predicen de forma significativa la PAs son Género (p = 0,02) e IMC (p = 0,001) y la PAd es el IMC (p = 0,004). La PAs en reposo, ajustado por la cantidad de cigarros fumados diariamente, la cantidad de tragos consumidos en una semana, el IMC, el ICC, el porcentaje de grasa corporal, el VO2max y la cantidad de METs de actividad física realizados semanalmente, fue 15,8mmHg mayor en hombres en comparación con las mujeres (p = 0,02). Por cada aumento de un kg/m2 en el IMC aumentaron 2,5mmHg y 1,5mmHg la PAs y PAd respectivamente.Conclusión:Al ser el IMC el factor de riesgo modificable, la opción para controlar y retrasar la aparición de hipertensión en jóvenes universitarios, es realizar esfuerzos para mantener un peso saludable en esta población.
AbstractPurpose: The study was designed to determine the association between selected cardiovascular risk factors and resting blood pressure in Costa Rican college students.Methods: Volunteers were 269 students (138 males and 131 females; mean age = 19,1 ± 2,8 yrs.), who completed questionnaires on demographics, family history of hypertension, alcohol intake, quantity of weekly liquor drinks, smoking habits, number of daily cigarettes smoked, physical activity (METs/week), and the general health status. In addition, measurements were obtained on resting systolic (SBP) and diastolic (DBP) blood pressure, body mass index (BMI), waist-to-hip ratio (WHR), percent body fat (% body fat) determined by full-body Dual Energy X-Ray Absorptiometry (DEXA, Lunar Prodigy, General Electric, Madison, WI), and maximum oxygen consumption (VO2max). Multiple regression analysis was used to assess the relationships between the 12 predictor variables using a general lineal model, with both, systolic (SBP) and diastolic (DBP) blood pressure as dependent variables.Results: The predictor variables entered in the model explained 28,3% (R2model = 0,283) of the variance of SBP values and 15,8% (R2model = 0,158) of the variance in DBP values. Gender (p = 0,02) and BMI (p = 0,001) were significant predictors of SBP, and BMI (p = 0,004) was a significant predictor of DBP. The mean SBP adjusted for the number of daily cigarettes smoked, quantity of weekly liquor drinks, BMI, WHR, % body fat, VO2max and METs/week was 15,8 mm Hg higher in males compared to females (p = 0,02). For every increment of 1 kg/m2 in BMI, both, SBP and DBP increased by 2,5 and 1,5 mm Hg, respectively.Conclusions: The modifiable risk factor BMI was associated to changes in both, SBP and DBP, in Costa Rican college students. Serious efforts should be made to achieve a healthy body weight in a population at high risk for hypertension.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Salud del Estudiante , Capacidad Cardiovascular , Hipertensión/diagnóstico , Estudiantes , Sistema Cardiovascular , Medición de RiesgoRESUMEN
Resumen Las altas tasas desempleo observadas en Estados Unidos durante la reciente crisis económica, que además son diferenciadas de acuerdo al origen étnico, hacen pertinente indagar acerca de cómo este problema se relaciona con la salud mental de los empleados y desempleados. Por tanto, en este artículo analizamos la relación entre desempleo y salud mental de los inmigrantes mexicanos, mexicanos nacidos en EE.UU, y otros hispanos en comparación con nativos blancos no hispanos y afroestadounidenses. Para alcanzar este propósito calculamos prevalencias, razones de prevalencias y razones de momios en la población entre 18 y 65 años en la fuerza laboral. Utilizamos información de la National Health Interview Survey (1999 y 2009). Encontramos que en tiempos de crisis aumenta la prevalencia de Tensión Psicológica no Específica (TPNE) en la fuerza laboral para todos los grupos étnicos. Las razones de prevalencias indican que los desempleados tienen mayor riesgo de presentar una TPNE que los empleados, particularmente los hispanos no mexicanos, en contraste, los inmigrantes mexicanos muestran riesgos más bajos.
Abstract The high unemployment rates observed in the United States during the recent economic crisis, that moreover vary between ethnic groups, make it relevant to inquire into how this problem is linked to the mental health of employed and unemployed persons. Therefore, in this paper the relationship between unemployment and mental health among Mexican immigrants, Mexicans born in the US, and other Hispanics in comparison with non-Hispanic native whites and Afro-Americans in the US is analyzed. To achieve this objective prevalence, prevalence ratios and odds ratios for the population between 18 and 65 years of age in the labor force was calculated using data from the 1999 and 2009 National Health Interview Surveys. It was seen that in times of crisis the prevalence of Non-Specific Psychological Disorders (NSPD) in the labor force increased in all ethnic groups. The prevalence ratios indicate that the unemployed face a higher risk of suffering from NSPD than the employed, especially for the non-Mexican Hispanics. Mexican immigrants, in contrast, show the lowest risks.
Asunto(s)
Desempleo/psicología , Hispánicos o Latinos , Salud Mental , Emigrantes e Inmigrantes/psicología , Estados Unidos , Prevalencia , Población Blanca , México/etnologíaRESUMEN
Objective: To study the relationship between epicardial adipose tissue (EAT) thickness and plasma levels of adiponectin in Venezuelan patients. Subjects and methods: Thirty-one patients diagnosed with metabolic syndrome (study group) and 27 controls were selected and tested for glycemia, lipids, and adiponectin. EAT thickness, ejection fraction, diastolic function, left ventricular mass (LVM), and left atrial volume (LAV) were determined by transthoracic echocardiography. Results: EAT thickness was greater in metabolic syndrome patients (5.69 ± 1.12 vs. 3.52 ± 0.80 mm; p = 0.0001), correlating positively with body mass index (BMI) (r = 0.661; p = 0.0001); waist circumference (WC) (r = 0.664; p = 0.0001); systolic (SBP) (r = 0.607; p = 0.0001), and diastolic blood pressure (DBP) (r = 0.447; p = 0.0001); insulin (r = 0.505; p = 0.0001); Tg/HDL-C ratio (r = 0.447; p = 0.0001), non-HDL-C (r = 0.353; p = 0.007); LAV (r = 0.432; p = 0.001), and LVM (r = 0.469; p = 0.0001). EAT thickness correlated negatively with adiponectin (r = -0.499; p = 0.0001). Conclusion: A significant association exists between EAT thickness and both metabolic syndrome components and adiponectin concentration, a link that might be used as a biomarker for this disease. .
Objetivo: Estudar a relação entre a espessura do tecido adiposo epicárdico (TAE) e os níveis plasmáticos de adiponectina em pacientes venezuelanos. Sujeitos e métodos: Foram selecionados 31 pacientes com diagnóstico de síndrome metabólica (SM) (grupo de estudo) e 27 controles. Foram medidos a glicose, os lipídios e a adiponectina. Foram determinados a espessura do TAE, a fração de ejeção, a função diastólica, a massa ventricular esquerda (MVE) e o volume atrial esquerdo (VAI) pela ecocardiografia transtorácica. Resultados: A espessura do TAE foi maior em pacientes com SM (5,69 ± 1,12 contra 3,52 ± 0,80 mm; p = 0,0001) com uma correlação positiva com o índice de massa corporal (IMC) (r = 0,661; p = 0,0001), circunferência da cintura (CC) (r = 0,664; p = 0,0001), pressão arterial sistólica (PAS) (r = 0,607; p = 0,0001), diastólica (PAD) (r = 0,447; p = 0,0001), insulina (r = 0,505; p = 0,0001), com a relação TG/HDL-C (r = 0,447; p = 0,0001), com o colesterol HDL (r = 0,353; p = 0,007), VAI (r = 0,432; p = 0,001) e MVI (r = 0,469; p = 0,0001). A espessura do TAE se correlacionou negativamente com a adiponectina (r = -0,499; p = 0,0001). Conclusão: Existe uma relação significativa entre a espessura do TAE, os componentes do SM e a concentração plasmática de adiponectina, o que poderia ser utilizado como um biomarcador para essa doença. .
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adiponectina/sangre , Tejido Adiposo/patología , Síndrome Metabólico/patología , Pericardio/patología , Función del Atrio Izquierdo , Índice de Masa Corporal , Glucemia/análisis , Estudios Transversales , HDL-Colesterol/sangre , Colesterol/sangre , Ecocardiografía , Modelos Lineales , Síndrome Metabólico/sangre , Tamaño de los Órganos , Volumen Sistólico , Triglicéridos/sangre , Venezuela , Función Ventricular IzquierdaRESUMEN
Los hombres que se involucran en actividades sexuales con hombres (HSH) experimentan una serie de disparidades de salud, incluyendo altas tasas de infección por VIH, que se relacionan a actividades sexuales riesgosas y múltiples parejas, y a comportamientos sexuales riesgosos. Sin embargo, se conoce muy poco acerca de las relaciones entre HSH hispanos y de los factores que contribuyen al riesgo dentro de estas relaciones. Objetivos: El propósito de este estudio es explorar mediante el uso de métodos cualitativos, los factores responsables del comportamiento sexual de alto riesgo dentro de las relaciones primarias entre HSH hispanos, Métodos: Se reclutaron veinte HSH hispanos de comunidades del sur de Florida, para participar en grupos focales grabados en audio. La información obtenida fue transcrita y analizada utilizando análisis de contenido. Se recolectó información hasta obtener un nivel de saturación. Resultados: Los participantes identificaron temas que contribuyen al riesgo: drogas/alcohol, sexo fuera de la relación, encubrimiento de infección por VIH, violencia, violencia sexual consensual y no consensual y ausencia de apoyo familiar. También describieron la relación entre riesgo sexual, uso de sustancias y violencia. Conclusiones: Los resultados de este estudio proporcionaron importantes implicaciones clínicas a los profesionales de salud que brindan cuidados a HSH hispanos.
Men who have sex with men (MSM) experience a number of health disparities including high rates of HIV, which are related to high risk sexual behaviors and multiple sexual partners, and also to high risk sexual behaviors. However, relatively little is known about relationships among Hispanic MSM, and about the factors that contribute to risk within these primary relationships. Aims: The purpose of this study is to use qualitative methods to explore the factors responsible for high risk sexual behavior within primary relationships among Hispanic MSM. Methods: Twenty Hispanic MSM were recruited from community sites in South Florida to participate in auditotaped focus groups. Data from the focus groups were transcribed and analyzed using content analysis. Data were collected until saturation was achieved. Results: Participants identified topics that contribute to risk: drugs/alcohol, outside sex, concealment of HIV infection, violence, consensual and non-consensual sexual violence, and absent family support. They also described the relationship of sexual risk, substance abuse, and violence. Conclusions: The results of the study provided some important clinical implications for clinicians providing care to Hispanic MSM. From the results of this study, directions for future research focused on the relationships of Hispanic MSM are evident.
Asunto(s)
Humanos , Masculino , Adulto , Persona de Mediana Edad , Coito , Homosexualidad Masculina , Infecciones por VIH , Medición de Riesgo , Apoyo Social , Asunción de Riesgos , Estados Unidos/etnología , Hispánicos o Latinos , Investigación Cualitativa , Trastornos Relacionados con Sustancias , Delitos SexualesRESUMEN
Las investigaciones sobre la violencia entre parejas sugieren que las mujeres hispanas están siendo afectadas desproporcionadamente por la ocurrencia y consecuencias de este problema de salud pública. El objetivo del presente artículo es dar a conocer el estado del arte en relación a la epidemiología, consecuencias y factores de riesgo para violencia de pareja (VP) entre mujeres hispanas, discutiendo las implicancias para la investigación y la práctica. Las investigaciones han demostrado una fuerte asociación del estatus socioeconómico, abuso de las drogas y el alcohol, la salud mental, aculturación, inmigración, comportamientos sexuales riesgosos e historia de abuso con la violencia entre parejas. Sin embargo, más estudios se deben llevar a cabo para identifi car otros factores de riesgos y de protección a poblaciones hispanas no clínicas. Mientras que el conocimiento sobre la etiología de la VP entre mujeres hispanas se expanda, enfermeras y otros profesionales de la salud deben desarrollar, implementar y evaluar estrategias culturalmente adecuadas para la prevención primaria y secundaria de la violencia entre pareja.
Research on intimate partner violence indicates that Hispanic women are disproportionately affected by the occurrence and consequences of this public health problem. The objective of this article is to review the state of the art regarding the epidemiology, consequences and risk factors for Partner violence IPV among Hispanic women, as well as discuss the implications these have for research and practice. Research has demonstrated a strong association between socioeconomic factors, drug and alcohol abuse, mental health, acculturation, immigration, risky sexual behaviors, history of abuse and IPV among community samples of Hispanics. As research elucidates the etiology of IPV among Hispanic women, Nurses and other health professionals should develop, implement and evaluate culturally appropriate strategies for the primary and secondary prevention of IPV.
Asunto(s)
Humanos , Femenino , Maltrato Conyugal/estadística & datos numéricos , Maltrato Conyugal/prevención & control , Violencia contra la Mujer , Aculturación , Estados Unidos/etnología , Factores Culturales , Factores Socioeconómicos , Factores de Riesgo , Hispánicos o Latinos , Emigración e InmigraciónRESUMEN
OBJECTIVES: Stress cardiomyopathy is a cardiac syndrome that is characterized by transient left ventricular systolic dysfunction in the absence of obstructive coronary artery disease. Its epidemiology has been described in homogeneous Asian, Caucasian and Black populations, but its characteristics in heterogeneous populations are poorly understood. Our aim was to assess the characteristics of stress cardiomyopathy in a heterogeneous population that included a large percentage of Hispanics. METHODS: We reviewed 59 consecutive cases of stress cardiomyopathy that were confirmed by coronary angiography and were in agreement with the Mayo Clinic diagnostic criteria. RESULTS: The mean age of the patients was 74 years (range, 39-91 years), and 37 patients were female (62.7 percent). Twenty-nine patients (49.2 percent) were Latino/Hispanic, 26 (44 percent) were Caucasian, 3 (5 percent) were Asian, and 1 patient (1.7 percent) was Black. The most common chief symptom was dyspnea, followed by chest pain and an absence of symptoms in 54.2, 28.8, and 18.6 percent of the patients, respectively. The primary EKG abnormalities consisted of a T wave inversion, an ST segment elevation, and ST segment depression in 69.5 percent, 25.4 percent, and 15.3 percent of the patients, respectively. The stressor event was identified in 90 percent of the cases. In 32 cases (54 percent), the stressor event was physical stress or a medical illness, and in 21 cases (35.6 percent), the stressor event was emotional stress. The in-hospital mortality rate was 8.5 percent. CONCLUSIONS: In our heterogeneous study population, stress cardiomyopathy presented with a 3:2 female-to-male ratio, and dyspnea was the most common chief complaint. Stress cardiomyopathy exhibited a T wave inversion as the primary EKG abnormality. These findings differ from previous cases that have been reported, and further studies are needed.
Asunto(s)
Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cardiomiopatía de Takotsubo/diagnóstico , Cardiomiopatía de Takotsubo/etnología , Población Negra , Análisis de Varianza , Pueblo Asiatico , Población Blanca , Florida/etnología , Hispánicos o LatinosRESUMEN
In the last decade, our understanding of posttraumatic stress disorder (PTSD) has progressed from studies of war veterans and specific disaster victims to studies that examine the epidemiology of PTSD in the United States (USA) population. Epidemiologic data on PTSD in developing countries is an understudied area with the majority of studies were developed in the USA and other developed countries. Of the few epidemiological surveys undertaken in other countries, most of them have focused its interest on the prevalence rates of PTSD and its risk factors for following specific traumatic events. Besides increasing the international normative and descriptive data base on PTSD, an examination of prevalence rates and risk factors for PTSD in a socio-political and cultural context (that is markedly different to established market economies) can deepen our understanding of the phenomenology and determinants of PTSD. Although many psychiatric diagnoses can be related with previous traumatic experiences, PTSD has been identified as a disorder that requires a previous traumatic exposure for its diagnosis. A growing literature strongly suggests that early exposure to traumatic events disrupts crucial normal stages of childhood development and predisposes children to subsequent psychiatric sequelae. A series of epidemiological studies has demonstrated that childhood sexual abuse is associated with a range of psychiatric disorders in adulthood that includes mood, anxiety, and substance use disorders, even after adjusting for possible confounds, such as family factors and parental psychopathological disorders or other childhood adversities. There is little evidence of diagnostic specificity of childhood sexual abuse, although a consistent finding has been that alcohol and drug disorders are more strongly related to childhood sexual abuse than other psychiatric disorders. Other forms of childhood traumas have been less well studied. This article reviews the findings of an epidemiological study that took place in Chile and examined prevalence rates of PTSD, traumatic events most often associated with PTSD, comorbidity of PTSD with other lifetime psychiatric disorders, gender differences in PTSD as well as trauma exposure in a representative sample of Chileans. This article also reported a comparison of prevalence rates of various psychiatric disorders among persons who reported the first trauma during their childhood, those who reported the first trauma during their adulthood, and those with no trauma history. The study was based on a household-stratified sample of people defined by the health service system to be adults (aged 15 years and older). The study was designed to represent the population of Chile. This analysis is limited to three geographically distinct provinces, chosen as being representative of the distribution of much of the population. The interviews were administered to a representative sample of 2390 persons aged 15 to over 64 years. The measures used were the DSM-III-R PTSD and antisocial personality disorder modules from the Diagnostic Interview Schedule and modules for a range of DSM-III-R diagnoses from the Composite International Diagnostic. Traumatic events were categorized into one of 11 categories: military combat, rape, physical assault, seeing someone hurt or killed, disaster, threat, narrow escape, sudden injury/ accident, news of a sudden death or accident, other event (e.g. kidnapping, torture), or other experience. The translation into Spanish was conducted using the protocol outlined by the World Health Organization. The interviewers were all university students in their senior year studying social sciences. Taylor series linearization method was used to estimate the standard errors due to the sample design and the need for weighting. The analysis was conducted using procedures without replacement for non-respondents. The region, province, comuna, and district selected were used as the defined strata. Logistic regression with the corresponding 95% confidence interval was used to examine associations among PTSD, demographic risk factors, and trauma type. To examine whether the association between PTSD and gender could be explained by other risk factors, multivariate logistic regression analyses were also conducted. The first analysis found that the lifetime prevalence of PTSD was 4.4% (2.5% for men and 6.2% for women). Among the traumatic events, rape was most strongly associated with PTSD diagnosis. Among those exposed to traumas, women were significantly more likely to develop PTSD than men, after controlling for assaultive violence. The second analysis revealed that exposure to a lifetime trauma was associated with a higher probability of psychiatric morbidity in comparison with no trauma exposure. Traumas with childhood onset were significantly related to lifetime panic disorder, independent of number of lifetime traumas and demographic differences. This revealed that women had more probabilities than men of developing PTSD once they are exposed to trauma, independent of previous traumas, experiences of sexual assault, other violent experiences or level of education. Some authors have proposed that women have a higher vulnerability than men to develop PTSD and that there are sex differences in brain morphology, in the social interpretation of trauma, or/and in the peritraumatic dissociative experience. Although many theories have been proposed to explain this gender difference in PTSD, more research is needed to evaluate them empirically. This study highlights the importance of investigating the prevalence of PTSD, the patterns of comorbidity of PTSD, as well as gender differences of PTSD in non-English speaking countries. Although Chile has a different historical and socio-cultural context with respect to other countries in which the epidemiology of PTSD has been examined, in general, this study achieved similar results as those found in other studies. The results showed that PTSD is not an uncommon psychiatric illness, it is associated with a high degree of psychiatric comorbidity, it is more likely to predate other psychiatric disorders. Also, the results showed that men are more likely to be exposed to traumas than women, women are more likely than men to develop PTSD, and that PTSD is associated with relatively high treatment utilization. However, compared to another country in Latin America, such as Mexico, Chile has a lower prevalence of PTSD and trauma exposure, which may due to socio-economic factors, such as less inequity between the wealthy and the poor and less violence, crime, and poverty in Chile than Mexico. These studies also suggest that traumatic events that occur in childhood are related to specific disorders rather than those that occurred later in life. Individuals with childhood interpersonal trauma exposure are more likely to suffer from lifetime panic disorder, agoraphobia or PTSD compared to those who experience interpersonal trauma as an adult. However, research should examine the specificity of these disorders in relation to various types of childhood traumas. Limitations of the current study include the use of lay interviewers who, despite acceptable levels of reliability and validity, may be less accurate than clinicians as interviewers. Also the retrospective recall of lifetime disorders is likely to be less accurate than a more recent time frame. The sample used in this study does not show nation wide perspective, because the Southern portion of the country which includes much of the indigenous population was excluded. This study, like most epidemiological studies, did not use an-depth or validated index of trauma, which may have diluted findings. Since this study was cross-sectional, a direct cause-effect relationship cannot be assumed between trauma exposure and subsequent disorders.
Durante la década de 1990 en los Estados Unidos (EU), el conocimiento sobre el trastorno de estrés post-traumático (TEPT) evolucionó de estudios específicos en un principio, sobre veteranos de guerra y sobre víctimas de desastres, a estudios epidemiológicos más tarde, sin embargo, la epidemiología del TEPT en países en desarrollo ha sido un área poco estudiada hasta ahora. Los expertos en el área de trauma han propuesto que los sucesos traumáticos que ocurren en la niñez son más perjudiciales para la salud mental que aquellos que ocurren más tarde en la vida. Este trabajo revisa los resultados de un estudio epidemiológico llevado a cabo en Chile. Específicamente, se revisan los resultados sobre las tasas de prevalencia del TEPT, traumas asociados más frecuentemente con él, así como la comorbilidad de este trastorno con otros trastornos psiquiátricos a lo largo de la vida. Igualmente se analizaron las diferencias del TEPT en cada sexo, así como la exposición a traumas en una muestra representativa de chilenos. Además se comparó la prevalencia de trastornos psiquiátricos en personas que sufrieron su primer trauma durante la niñez, durante la edad adulta, o que no reportaron traumas durante su vida. En estos estudios epidemiológicos se usaron módulos del TEPT y trastorno de personalidad antisocial (TPA) de la entrevista diagnóstica siguiendo los criterios del DSM-III-R (DIS-III-R). Para evaluar el resto de los trastornos psiquiátricos se usó la Entrevista Diagnóstica Internacional Compuesta (CIDI). Estos instrumentos fueron administrados en tres ciudades chilenas a 2390 personas mayores de 15 años. Para estimar los errores estándares (EE) debido al diseño de la muestra y a la necesidad de ajuste se usó el método Taylor de linearización seriada. También se usó un análisis de regresión logística para examinar la relación entre el TEPT, los factores demográficos de riesgo y el tipo de trauma. Además se utilizó la regresión logística multivariada para evaluar si la relación entre el TEPT y el sexo pudiera ser explicada por medio de otros factores de riesgo, así como para calcular las tasas y la oportunidad relativa (razón de productos cruzados) de trastornos psiquiátricos a lo largo de la vida. El primer análisis arrojó que la prevalencia de TEPT a lo largo de la vida fue de 4.4% (2.5% para hombres y 6.2% para mujeres). De los hechos traumáticos reportados, la violación sexual tuvo una correlación más alta con el TEPT que los demás hechos traumáticos. Las mujeres tuvieron más probabilidades de experimentar TEPT que los hombres, después de controlar la variable asalto violento. El segundo análisis evidenció que los que habían sufrido traumas a lo largo de la vida tuvieron mayor probabilidad de tener un trastorno psiquiátrico en comparación con aquellos que no reportaron traumas. También se encontró que los que sufrieron su primer trauma durante la infancia tuvieron más probabilidad de desarrollar trastornos de pánico a lo largo de la vida que aquellos que sufrieron su primer trauma en la edad adulta, independientemente del número de traumas que sufrieron y de las diferencias demográficas. Aunque Chile tiene un contexto histórico-cultural y una economía diferente a otros países en los que se ha estudiado anteriormente la epidemiología del TEPT, el presente estudio reflejó tendencias similares a las reportadas en estudios previos. Los hallazgos expuestos enfatizan la importancia de investigar la prevalencia del TEPT, los patrones de comorbilidad del TEPT y las diferencias de sexo en la prevalencia del TEPT en diferentes países. También estos resultados sugieren que los sucesos traumáticos en la infancia (y no en la adultez) pueden estar relacionados con la ocurrencia de trastornos psiquiátricos específicos.