Intentos de suicidio y heridas auto-inferidas: 12 meses de seguimiento de conductas de riesgo de consumidores de cocaína no consultantes de servicios de rehabilitación / Suicide attempts and self inflicted harm: a one year follow up of risk behaviors among out of treatment cocaine users

Background: Cocaine users tend to have a higher frequency of risk behaviors. Aim: To compare risk behaviors of out ­of ­treatment Cocaine Base Paste (CBP) and Cocaine Hydrochloride (CH) users, by means of Privileged Access Interviewing in a one­ year prospective study. Material and Methods: Twenty ­eight interviewers were trained to recruit and administer a questionnaire on substance use patterns and related risk behaviors. Intentioned sampling was carried out in four municipalities of Santiago, Chile. Subjects who used CBP (group 1) or CH (group 2) at least once in the last month, with primary current use of CBP (group 1) or CH (group 2), and without treatment for substance abuse in the last six months were interviewed. Generalized Estimating Equations (GEE) were employed to compare risk behaviors during follow ­up. Results: Four hundred and two of 467 subjects (86.1%) were followed up for one year. CBP users (n = 204) reported greater frequency of self ­inflicted injuries (Odds Ratio (OR): 1.97 [95% confidence intervals (CI): 1.07­3.66]) and suicide attempts (OR: 2.68 [95% CI: 1.19­6.01]) than CH users. Conclusions: CBP users had a greater frequency of self ­inflicted injuries and suicide attempts, both life threatening risk behaviors, than CH users. This profile shows the high vulnerability of CBP users and should encourage further research and design of outreach interventions, particularly focused on this group.

Validez y confiabilidad de la versión chilena del Alcohol Use Disorders Identification Test (AUDIT) / Assessment of the alcohol use disorders identification test (AUDIT) to detect problem drinkers

Background: AUDIT is a self-reported questionnaire used to detect problem drinkers. It must be translated into Spanish and validated in order to be used in Chile. Aim: To assess the validity of a Chilean version of the AUDIT questionnaire. Material and methods: The English version of the questionnaire was translated into Spanish and adapted to the Chilean cultural environment. Using the Delphi method, an expert group examined the text and then decided on which would be the definitive version. This test was translated to English again and was approved by one of the original authors. It was then applied to 93 subjects aged 37 ± 12 years (60 percent males) consulting at a primary health care center These subjects also answered the Composite International Diagnostic Interview (CIDI), version 2.1 that was used as the gold standard for the diagnosis of hazardous drinking and alcohol dependence. Cronbach alpha and test-retest validity were analyzed. Sensitivity and specificity were determined using receiver operating (ROC) curves. Results: The internal consistency of AUDIT was 0.93, its test re-tests reliability was 0.97 (95 percent confidence intervals 0.96-0.98). Using a cutoff point of 6 for hazardous consumption, its sensitivity and specificity were 83 percent and 88 percent, respectively. The figures for dependence and harmful consumption, using a cutoff point of 9, were 87 percent and 85 percent, respectively. Conclusions: AUDIT is a valid questionnaire to detect problem drinkers.

Disfonía funcional: variables clínicas y terapéuticas / Functional dysphonia: clinical and therapeutic variables

Se ha observado en los últimos años, en el Hospital del Trabajador de Santiago, un incremento en el número de pacientes aquejados de patología funcional de la voz. Con el objetivo de optimizar su tratamiento, se analizaron las características sociodemográficas y clínicas de una muestra de pacientes con disfonía funcional y su posible relación con la respuesta terapéutica. Se estudiaron retrospectivamente 77 pacientes mujeres, con diagnóstico de disfonía funcional, derivadas a la unidad de salud mental del Hospital del Trabajador. El tratamiento fue ambulatorio e incluyó evaluaciones periódicas por otorrinolaringólogo, sesiones de foniatría y, la evaluación y tratamiento de salud mental cuando se estimó necesario. La muestra estuvo constituida en un 87 por ciento por profesores. Presentaron diagnóstico psiquiátrico el 74 por ciento de las pacientes, predominando los trastornos adaptativos y personalidades vulnerables. Los conflictos más frecuentes fueron de origen laboral y familiar. Se discute el rol de variables sociodemográficas y clínicas en el tratamiento y la evolución de la disfonía funcional.

Trastornos invernales del ánimo / Winter mood disorders

La existencia de trastornos del ánimo de recurrencia estacional está plenamente demostrada en el mundo, siendo denominado trastorno afectivo estacional (TAE). En Chile, el TAE no ha sido formlmente descrito. El presente trabajo tiene por objeto estudiar la concordancia clínica y terapéutica de una serie de pacientes con depresiones de recurrencia invernal, con las características de series extrajeras de TAE. Se reclutaron 12 pacientes con depresión mayor actual, que cumplieron con los requisitos internacionales de recurrencia estacional y se estudió su pérfil de síntomas y se evaluó su respuesta a 10 sesiones de fototerapia de acuerdo a un protocolo estandarizado. Se observó una estrecha concordancia de los síntomas y la respuesta a fototerapia con las series extranjeras. Se trata de la primera serie nacional de TAE. Se discute su relevancia clínica