El sesgo atencional en los trastornos relacionados con sustancias. Aspectos teóricos, evaluativos y de tratamiento / Attentional bias in substance-related disorders. Theoretical, evaluative and treatment aspects

Resumen En la actualidad, existe mayor interés sobre los estudios acerca de la cognición implícita y su función en la conducta. Los modelos explicativos actuales de la psicopatología tienen como limitante la escasa consideración de los procesos cognitivos automáticos en la conducta psicopatológica, como la relacionada con el consumo de sustancias. En este estudio, se revisa al sesgo atencional en los trastornos por consumo y sus implicaciones en la psicopatología, la medición del fenómeno y su aplicación para la intervención. El sesgo atencional hacia las señales críticas de sustancias o drogas es un mecanismo disfuncional de la atención selectiva que opera frecuentemente a nivel automático o implícito y en el que la asignación y focalización de la atención es desproporcionada en el tiempo, entre un estímulo específico (imagen o palabra relacionada con una droga) versus un estímulo neutro. Atrae la atención de la persona al estímulo crítico del que, posteriormente, resulta difícil de desacoplarse y facilita otros procesos cognitivos subsecuentes al consumo. Se presenta evidencia de la incidencia del sesgo atencional en el consumo, el curso, la gravedad, el craving (necesidad intensa de consumo), la abstinencia, la recaída y la probabilidad de fracaso en el tratamiento. Además, explica sobre el fenómeno del consumo, desde la cognición implícita, el inconsciente y la neurociencia cognitiva. Finalmente, en este estudio, se revisan propuestas de intervención sobre los problemas de consumo con técnicas de modificación del sesgo atencional complementarias a los tratamientos cognitivo-conductuales actuales. Se considera necesario explorar sobre esta línea de investigación y su relación con los trastornos por consumo de sustancias dentro de la región.

Abstract The objective of this work is to investigate attentional bias as an automatic cognitive process and its implications in substance use disorders. Cognitive processes are fundamental in the formulation of the different explanatory models about psychopathology. Of the various cognitive processes, attention is a significant determinant, because although it fulfils various activities such as orientation and wakefulness, it is cognitive control that arouses relevant interest for it. This is due to the fact that it fulfills a task of linking between signal uptake and the achievement of other cognitive processes that intervene in the behavioral response mechanism. When a cognitive process like attention is markedly altered it will trigger impaired sequential cognitive functioning, along with the emission of disturbing behavior. Psychology considers that cognitive processes operate consciously (voluntarily) and automatically (implicitly); that is, in a dual way in which these processes such as attention maintain a continuum of coordinated gradual variations that regulate behavior. Failure to consider automatic cognitive processes is a notorious limitation for current explanatory models of psychopathological behavior (including compulsive substance use); given that many of these underlying cognitive processes are often not considered to influence higher mental processes and therefore behavior, without the individual necessarily being aware of this. In fact, this can help to understand pathological behaviors that for the investigator or the professional of psychology can be incomprehensible or paradoxical. Among the various underlying and altered processes, the attentional bias towards critical signals associated with substances has investigative relevance. Since it is a dysfunctional mechanism of selective attention, which operates frequently at an automatic level and in which the allocation and focus of attention are disproportionate in time, between a specific stimulus (image or word related to a drug) versus a neutral stimulus. And it attracts a person's focus of attention to the critical stimulus, from which it later becomes difficult to decouple. This later facilitates other altered cognitive processes subsequent to consumption. The generation of an attentional bias towards a specific signal has its origin in the association between the signal and the behavior, which can be avoidant (recurrent in phobias) or attractive (frequent in substance or food consumption) and that is conditioned until becoming an automatic process of difficult voluntary control. Although it is true that attention bias may be present in all individuals, the evidence reveals the marked and recurrent presence in various pathologies such as mood disorders (depressive), anxiety, food intake, phobias, of personality among others. And also included in substance use disorders. The findings show that attention bias has an impact on substance use, course, the severity of the disorder, craving, withdrawal, relapse, and the probability of treatment failure. Working with an attentional bias for specific signals on substances can generate difficulty, in the case of evaluation because it is assessed through software that usually measures the eye-hand reaction time or eye movement when faced with neutral and critical signals, which can be a limitation for the usual clinic; while at the intervention level, it is required to formulate bias retraining processes that require continuous exercise as a complementary technique to the usual cognitive-behavioral treatment. It is considered necessary to explore this line of research and its relationship with substance use disorders within the region.

Participación, apoyo social y expectativas en la integración social de población venezolana en Ecuador / Participation, social support and expectations in the social integration of the Venezuelan population in Ecuador / Participação, apoio social e expectativas na integração social da população venezuelana no Equador

La integración social (IS) de población venezolana que se ha movilizado por América Latina resulta compleja, por el contexto político, social, laboral, económico y recientemente sanitario adverso, que les expone a dinámicas de discriminación, exclusión y vulneración de derechos. El presente trabajo tiene por objetivo analizar, desde un enfoque psicosocial, la participación social y el apoyo social como dimensiones de IS de venezolanas/os residentes en Quito, Ecuador. Para ello, se aplica una encuesta a 50 participantes (25 hombres y 25 mujeres) que evalúa los problemas y el vínculo con la sociedad de acogida, la participación social y el apoyo social percibido. Los resultados revelan que la población venezolana presenta diversas limitaciones en la IS, especialmente, en la incorporación laboral y el ámbito económico, pero que se están creando canales a nivel socio-comunitario que posibilitan mayores vínculos con la población local, a la vez que presenta una valoración positiva de las expectativas previas al proceso migratorio, que está incidiendo en un apoyo social. Se discuten estos hallazgos y la necesidad de que los Estados latinoamericanos generen políticas públicas que faciliten la IS de población venezolana.

The social integration (SI) of the Venezuelan population that has been moving through Latin America is complex, in an adverse political, social, labor, economic and recently health context, which exposes them to dynamics of discrimination, exclusion and violation of rights. The aim of this paper is to analyze, from a psychosocial approach, social participation and social support as dimensions of SI of Venezuelan residents in Quito, Ecuador. For this purpose, a survey was applied to 50 participants (25 men and 25 women) that evaluated the problems and the link with the host society, social participation and perceived social support, through group meetings. The results reveal that the Venezuelan population presents several limitations in the SI, especially in labor and economic incorporation, but that it is creating channels at the socio-community level that enable greater links with the local population, while presenting a positive appraisal of expectations prior to the migration process, which is influencing social support. These findings and the need for Latin American states to generate public policies that facilitate the SI of the Venezuelan population are discussed.

A integração social (SI) da população venezuelana que se deslocou pela América Latina é complexa, devido ao contexto adverso político, social, trabalhista, econômico e de saúde recente, o que os expõe a dinâmicas de discriminação, exclusão e violação de direitos. O objetivo deste documento é analizar, a partir de uma abordagem psicosocial, a participação social e o apoio social como dimensões da SI entre os venezuelanos residentes em Quito, Equador. Para este fim, uma pesquisa foi aplicada a 50 participantes (25 homens e 25 mulheres) para avaliar problemas e vínculos com a sociedade anfitriã, participação social e apoio social percebido. Os resultados revelam que a população venezuelana apresenta várias limitações no SI, especialmente no mercado de trabalho e na esfera econômica, mas que está criando canais em nível sócio-comunitário que permitem maiores vínculos com a população local, ao mesmo tempo em que apresenta uma avaliação positiva das expectativas antes do processo migratório, o que está tendo um impacto no apoio social. Estas descobertas e a necessidade dos estados latino-americanos de gerar políticas públicas que facilitem a SI da população venezuelana são discutidas.

Teleconsulta médica. Análisis y recomendaciones del Departamento de Ética del Colegio Médico de Chile / Medical teleconsultation. Analysis and recommendations from the ethics department of the Chilean medical association

The possibility of allowing patients access to health professionals, has been greatly facilitated by advances in technology. Indeed, nowadays it is possible not only direct contact between one health professional with another, but also the possibility of sending images and other tests to consult distant colleagues. This has undoubtedly enabled better health care for many patients. It is also possible for a patient to consult a doctor directly in a remote and synchronous way with oral and visual contact, thus establishing a new form of medical consultation. It is this last way of relationship, which has already spread as a practice in normal times, which arouses apprehensions about the ethical requirements that a consultation must meet. This work by the Ethics Department of the Chilean Medical Association seeks to reflect on the ethical demands of a medical consultation and on the shortcomings that teleconsultation has. It also aims to propose several recommendations, so that this new form of doctor-patient relationship serves as a complement to traditional care, without jeopardizing the objectives of a medical action.

Bienestar Subjetivo en contextos de desigualdad y derrota social en jóvenes universitarios de Chile y Ecuador

Resumen Los estudios macroeconómicos evidencian que países con mayor desigualdad social presentan peores indicadores de salud mental y bienestar, sin embargo, otros mecanismos intervinientes no están del todo claro. Recientes investigaciones han propuesto que la percepción de derrota social configura una variable clave para comprender los impactos de las desigualdades. El objetivo de este estudio fue explorar el rol predictor de la derrota social en el bienestar subjetivo de estudiantes universitarios provenientes de países latinoamericanos que exhiben niveles de desigualdad social. Los participantes fueron 347 estudiantes universitarios de Chile y 246 de Ecuador, en los cuales se evaluó la percepción de derrota social, fatalismo, participación social, bienestar social, y bienestar subjetivo. Los resultados del modelo de regresión muestran que la predicción del bienestar subjetivo mejora al incluir las dimensiones de derrota social en el modelo (r2 = .38). Se propone la derrota social como una variable que ayuda a comprender cómo un contexto de desigualdad social puede impactar en el bienestar percibido de jóvenes universitarios.

Abstract Macroeconomic studies show that countries with greater social inequality have worse indicators of mental health and well-being; however, other intervening mechanisms are not entirely clear. Recent research has proposed that the perception of social defeat is a key variable in understanding the impacts of inequalities. The aim of this study was to explore the predictive role of social defeat in the subjective well-being of university students from Latin American countries that exhibit levels of social inequality. The participants were 347 university students from Chile and 246 from Ecuador, in whom the perception of social defeat, fatalism, social participation, social well-being, and subjective well-being were evaluated. The results of the regression model show that the prediction of subjective well-being improves when including the dimensions of social defeat in the model (r2 = .38) Social defeat is proposed as a variable that helps to understand how a context of social inequality can impact the perceived well-being of young university students.

Cifosis patológica en la columna pediátrica / Pathologic kyphosis in the pediatric spine

En este manuscrito se revisan las diferentes causas que producen aumento de la cifosis torácica (dorso curvo), específicamente en niños y adolescentes. Las causas del dorso curvo que se analizan en este artículo son: Dorso curvo postural, idiopático, neuromuscular, congénito y enfermedad de Scheuermann. Se centra en los factores que producen su aparición, características de su evolución y tratamiento.

This manuscript reviews the different causes that lead to increased thoracic kyphosis, specifically in children and adolescents. The causes of increased thoracic kyphosis that will be discussed in this article are: postural, idiopathic, neuromuscular, congenital, and Scheuermann's disease. This paper focuses on the factors that produce its appearance, characteristics of its evolution, and treatment.

Tomografía computarizada de haz cónico como examen concluyente de hiperplasia de procesos coronoides bilateral. Reporte de tres casos / Cone beam computed tomography as a conclusive examination of bilateral coronoid process hyperplasia. Report of three cases

RESUMEN La hiperplasia del proceso coronoides (HPC) es un crecimiento exagerado del proceso coronoides. La HPC es poco frecuente y genera limitación asintomática de la apertura bucal debido a la impactación del proceso coronoides con el segmento posterior del hueso cigomático. La HPC es un posible diagnóstico en pacientes con limitación progresiva tanto de la apertura bucal como del movimiento protrusivo mandibular. En el presente artículo, se reportan tres casos de pacientes con limitación de apertura bucal. Mediante examen de tomografía computarizada de haz cónico (TCHC), se observó un aumento de tamaño uniforme de los procesos coronoides, confirmando el diagnóstico de HPC bilateral. La TCHC con campo de visión grande determinó el diagnóstico final, pues mostró la impactación del proceso coronoides con el segmento posterior del hueso cigomático en apertura bucal. Además, la TCHC permitió distinguir entre una HPC y una neoplasia del proceso coronoides y/o estructuras anatómicas vecinas.

SUMMARY Coronoid process hyperplasia (CPH) is an excessive coronoid process growing. CPH is infrequent and produces an asymptomatic mouth opening limitation due to the impaction of the coronoid process in the posterior portion of the zygomatic bone. CPH is a possible diagnosis in patients with both progressive mouth opening and protrusive movement limitations. In the present article, cases of three patients with mouth opening limitation are reported. In cone-beam computed tomography (CBCT) examination, a uniform growing of coronoid processes was observed, which confirmed the diagnosis of bilateral CPH. CBCT with large field of view allowed the determination of the final diagnosis, because the impaction of the coronoid process in the posterior portion of the zygomatic bone during mouth opening could be observed. Furthermore, CBCT allowed to distinguish between CPH and neoplasia of coronoid process and/or neighboring anatomical structures.

Argumentos éticos a favor y en contra de la participación del profesional médico en la muerte asistida. Análisis del Departamento de Ética del Colegio Médico de Chile / Ethical arguments for and against the participation of the medical profession in assisted death: analysis of the Ethics Department of the Chilean Medical Association

The discussion of a bill that allows medically assisted death (MAD) in Chile, revived the debate about the ethics of this practice. The Department of Ethics of the Chilean Medical Association herein analyzes arguments in favor or against the participation of the medical profession in MAD. Among the main arguments against the participation of physicians in this practice are that MAD conflicts with the basic ethical principles of medical practice, that it is contrary to the purposes of medicine and that it could erode the patients' and society's confidence in physicians. The arguments in favor are related to physician´s compassion and non-abandonment of patients during their illness, choosing palliative care and ushering them to the final instance. Additionally, there is social expectation that this practice will be carried out by trained physicians who can verify that the strict criteria established by the legislation are met, guarantee that it obeys to a repeated request of a fully capable patient, and who is able to deal with the complications of the procedure. In this document we aimed to represent the different perspectives about physicians' participation in MAD, offering arguments to colleagues and stimulating their participation in this important debate.

Development of a small panel of SNPs to infer ancestry in Chileans that distinguishes Aymara and Mapuche components

BACKGROUND: Current South American populations trace their origins mainly to three continental ancestries, i.e. European, Amerindian and African. Individual variation in relative proportions of each of these ancestries may be confounded with socio-economic factors due to population stratification. Therefore, ancestry is a potential confounder variable that should be considered in epidemiologic studies and in public health plans. However, there are few studies that have assessed the ancestry of the current admixed Chilean population. This is partly due to the high cost of genome-scale technologies commonly used to estimate ancestry. In this study we have designed a small panel of SNPs to accurately assess ancestry in the largest sampling to date of the Chilean mestizo population (n = 3349) from eight cities. Our panel is also able to distinguish between the two main Amerindian components of Chileans: Aymara from the north and Mapuche from the south. RESULTS: A panel of 150 ancestry-informative markers (AIMs) of SNP type was selected to maximize ancestry informativeness and genome coverage. Of these, 147 were successfully genotyped by KASPar assays in 2843 samples, with an average missing rate of 0.012, and a 0.95 concordance with microarray data. The ancestries estimated with the panel of AIMs had relative high correlations (0.88 for European, 0.91 for Amerindian, 0.70 for Aymara, and 0.68 for Mapuche components) with those obtained with AXIOM LAT1 array. The country's average ancestry was 0.53 ± 0.14 European, 0.04 ± 0.04 African, and 0.42 ± 0.14 Amerindian, disaggregated into 0.18 ± 0.15 Aymara and 0.25 ± 0.13 Mapuche. However, Mapuche ancestry was highest in the south (40.03%) and Aymara in the north (35.61%) as expected from the historical location of these ethnic groups. We make our results available through an online app and demonstrate how it can be used to adjust for ancestry when testing association between incidence of a disease and nongenetic risk factors. CONCLUSIONS: We have conducted the most extensive sampling, across many different cities, of current Chilean population. Ancestry varied significantly by latitude and human development. The panel of AIMs is available to the community for estimating ancestry at low cost in Chileans and other populations with similar ancestry.

El abordaje temprano y tratamiento mixto en el manejo de la esquizofrenia: Guía de práctica clínica basada en evidencia de un hospital especializado en salud mental del Ministerio de Salud del Perú / Early approach and mixed treatment in schizophrenia management: Evidence-based clinical practice guideline from a specialized mental health public hospital in the Ministry of Health of Peru

Introducción: La esquizofrenia es un trastorno psicótico caracterizado por alteración sustantiva del funcionamiento mental y efectos sobre la funcionalidad social de la persona afectada. Objetivo: Brindar recomendaciones basadas en la mejor evidencia disponible para abordaje temprano, tratamiento farmacológico y psicosocial. Métodos: Se elaboró una guía de práctica clínica basada en evidencias (GPC-BE), adaptada mediante proceso sistemático, riguroso, transparente, desarrollado por un grupo elaborador integrado por metodólogos y psiquiatras expertos en el manejo de esquizofrenia. La guía comprende cuatro preguntas clínicas y recomendaciones, se realizó búsqueda de guías que respondan al tema priorizado, se preseleccionaron y evaluaron guías mediante el instrumento "Appraisal of Guidelines for Research and Evaluation II" (AGREE-II), la de mejor calidad metodológica fue elegida para adaptación. La búsqueda sistemática de evidencias para cada pregunta clínica fue realizada en múltiples bases de datos: MEDLINE/Ovid, EMBASE/Ovid, EMB reviews/Ovid. La selección y análisis de evidencias se realizó mediante pares clínicos y metodológos, las recomendaciones fueron elaboradas aplicando metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Resultados: Con participación del panel de expertos clínicos de institutos y hospitales del Perú referentes en el manejo de esquizofrenia, se elaboraron cuatro recomendaciones para la intervención temprana, tratamiento farmacológico y mixto de pacientes adultos con esquizofrenia. Conclusiones: Se recomienda el abordaje temprano del primer episodio psicótico a través de centros de salud mental comunitarios (CSMC) y hospitales especializados y tratamiento farmacológico junto a terapia psicosocial estandarizada. El presente artículo resume la guía de práctica clínica basada en evidencias elaborada por un hospital público peruano especializado en salud mental.

Introduction: Schizophrenia is a psychotic disorder characterized by substantive alteration of mental functioning and effects on the social functionality of affected individuals. Objective: Provide recommendations based on the best available evidence for early approach, pharmacological and psychosocial treatment. Methods: An Evidence-based Clinical Practice Guide (GPC-BE) was developed, adapted through a systematic, rigorous, transparent process, by a working group composed of methodologists and psychiatrists who are experts in the management of schizophrenia. The guide includes four clinical questions and recommendations, we searched for guides that respond to the prioritized topic, guides were pre-selected and evaluated using the "Appraisal of Guidelines for Research and Evaluation II" (AGREE-II) instrument, the one with the best methodological quality was chosen for adaptation. The systematic search for evidence for each clinical question was performed in multiple databases: MEDLINE / Ovid, EMBASE / Ovid, EMB reviews / Ovid. The selection and analysis of evidence was carried out using clinical pairs and methodologists, the recommendations were prepared using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Results: With the participation of the panel of clinical experts from institutes and hospitals in Peru in the management of schizophrenia, four recommendations were established for the early intervention, pharmacological and mixed treatment of adult patients with schizophrenia. Conclusions: The early approach of the first psychotic episode through community mental health centers (CSMC) and specialized hospitals and pharmacological treatment together with standardized psychosocial therapy is recommended. This article summarizes the evidence-based clinical practice guideline developed by a Peruvian public hospital specializing in mental health disorders.

Consumo de alcohol en estudiantes en tres facultades de la Universidad Nacional de Chimborazo / Alcohol consumption in students in three faculties of Universidad Nacional de Chimborazo

Se realizó un estudio descriptivo, de campo, transversal con el objetivo de analizar el consumo de alcohol en la Universidad Nacional de Chimborazo, de la ciudad de Riobamba, donde parti-ciparon 512 estudiantes de las facultades de Ciencias de la Salud, Ciencias Políticas e Ingenie-ría, en el año 2017. Entre los resultados obtenidos, se observa un alto índice de consumo de alcohol, en la población universitaria, en la cual el 70.2% ha consumido por lo menos alguna vez en su vida alcohol, siendo la Facultad de Ingeniería y el género masculino con más alto nivel de consumo perjudicial y dependencia respecta. La clase social baja presentó un alto nivel de consumo perjudicial, y en la alta se observó un alto consumo riesgoso y dependencia al alcohol. Se comprobó que el consumo de alcohol estaba generalmente asociado a variables inherenytes a los estudiantes universitario, constituyendo un problema que trae consigo conse-cuencias negativas no solo para el consumidor, sino también a su familia y su grupo social.Palabras clave: consumo de bebidas alcohólicas, salud del estudiante, clase social.

A descriptive, cross-sectional study was carried out in order to analyze alcohol consumption in Universidad Nacional de Chimborazo, in the city of Riobamba. 512 students participated from the faculties of Health Sciences, Political Sciences, and Engineering, in the year 2017. Among the results obtained, a high rate of alcohol consumption is observed in the university population, in which 70.2% have consumed alcohol at least once in their life, the Faculty of Engineering and the male gender were the highest level of harmful consumption and depen-dence. The low social class presented a high level of harmful consumption, and the high social class showed a high risky consumption and alcohol dependence. This study proved that alco-hol consumption was generally associated with university students. So, it constitutes a problem that brought negative consequences not only for the student who consumed, but also for his family and his entire social group.

Aspectos éticos de la conducta del médico ante personas en huelga de hambre: opinión del Departamento de Ética del Colegio Médico de Chile / Ethical aspects of the doctors' behavior towards people on hunger strike: position paper from the Ethics Department of the Chilean Medical Association

Every so often, in Chile there is a discussion about the role of physicians in the care of people on hunger strike (HS). In this document, we review the ethical aspects of health care for persons in HS, aiming to provide guidelines to medical doctors who are required to attend them. First, we make an important distinction between HS and suicide, since the former is used as a protest and denunciation tool, while suicide seeks deliberately to end a life. Then we describe the three roles that the health professional can fulfill: as a treating doctor, as an expert or as an official of a prison. The respect for the autonomy and dignity of the person in HS must prevail whatever the role of the physician. Therefore, we maintain that under no circumstances, people who have autonomously decided to be in HS should be fed by force. Due to the complexity of the issue, we make special considerations about the management of minors and the non-competent persons in HS. In conclusion, we adhere to the principles that inspire the Declaration of Malta, which indicate that it would be preferable to "allow a person on hunger strike to die in dignity, rather than subjecting them to repeated interventions against their will".

Dimensiones de integración social en población colombiana y cubana que vive en Quito, Ecuador / Dimensions of Social Integration in the Colombian and Cuban Population Living in Quito, Ecuador

Resumen La integración social (IS) se presenta como un fenómeno clave en la complejidad de las sociedades actuales. Son escasas las investigaciones que consideran una perspectiva psicosocial para evaluar la IS. En el presente trabajo, se plantea una propuesta que tiene en cuenta tales dimensiones en población colombiana con desplazamiento forzado y cubana con migración económica, residentes en Quito (Ecuador). Participaron 255 personas a quienes se evalúan la anomia y arraigo social. Se encuentra que, en ambos grupos de participantes, la presencia o ausencia de trabajo condiciona la anomia o arraigo social. Estos resultados presentan implicaciones sobre diversas políticas de inmigración, en las cuales la integración social requeriría incorporar dimensiones psicosociales para abordar tal proceso.

Abstract Social Integration (SI) is presented as a key phenomenon in the complexity of today's societies. There are few investigations that considered psychosocial perspective to evaluate SI and here we propose a proposal that considers such dimensions in Colombian population with forced displacement and Cuban with economic migration residing in Quito, Ecuador. 255 persons participated who are evaluated anomia and social roots. The models of mediation show that in both groups of participants, the presence or absence of work conditions the social anomia or rootedness. These results have implications for various immigration policies, in which social integration requires incorporating psychosocial dimensions to address such a process. Keyword social integration; forced and economic migration in Ecuador; integration policies Introducción

Selective intra-dinucleotide interactions and periodicities of bases separated by K sites: a new vision and tool for phylogeny analyses

Direct tests of the random or non-random distribution of nucleotides on genomes have been devised to test the hypothesis of neutral, nearly-neutral or selective evolution. These tests are based on the direct base distribution and are independent of the functional (coding or non-coding) or structural (repeated or unique sequences) properties of the DNA. The first approach described the longitudinal distribution of bases in tandem repeats under the Bose-Einstein statistics. A huge deviation from randomness was found. A second approach was the study of the base distribution within dinucleotides whose bases were separated by 0, 1, 2... K nucleotides. Again an enormous difference from the random distribution was found with significances out of tables and programs. These test values were periodical and included the 16 dinucleotides. For example a high ¨positive¨ (more observed than expected dinucleotides) value, found in dinucleotides whose bases were separated by (3K + 2) sites, was preceded by two smaller ¨negative¨ (less observed than expected dinucleotides) values, whose bases were separated by (3K) or (3K + 1) sites. We examined mtDNAs, prokaryote genomes and some eukaryote chromosomes and found that the significant non-random interactions and periodicities were present up to 1000 or more sites of base separation and in human chromosome 21 until separations of more than 10 millions sites. Each nucleotide has its own significant value of its distance to neutrality; this yields 16 hierarchical significances. A three dimensional table with the number of sites of separation between the bases and the 16 significances (the third dimension is the dinucleotide, individual or taxon involved) gives directly an evolutionary state of the analyzed genome that can be used to obtain phylogenies. An example is provided.

Aproximación ética científica al doble efecto o único bien posible en el aborto terapéutico / Scientific ethical approach to double effect or only possible good in therapeutic abortion / Aproximação ética científica ao duplo efeito ou único bem possível no aborto terapêutico

El estudio muestra como la doctrina o principio del doble efecto (DDE) de una acción con efecto secundario negativo no puede aplicarse a todos los casos de aborto terapéutico (AT). Con el análisis de las causas e indicación de AT se demuestra que solo algunos de estos corresponden a DDE. Cuando no es el feto el que lleva a la madre a tener un embarazo de alto riesgo con amenaza de daño severo o muerte para ella, el caso puede adscribirse a la DDE; cuando es el feto directa o indirectamente el que causa a lleva a ese riesgo materno, el caso no se adscribe a la DDE. Si el feto es la causa de la muerte inminente de la madre, la remoción de la causa, que es la terapia adecuada, coincide con matarlo; entonces la acción buena (salvar a la madre tratándola causalmente) es la misma que la mala (matar al feto), situación que no puede asimilarse sea a la DDE o a la doctrina del mal menor. Más aún, decidir no interrumpir el embarazo produciría la muerte de la madre y el feto. El caso debería adscribirse al principio del único bien posible.

This study shows the inapplicability of the doctrine of double effect (DDE) to all the cases of therapeutic abortion (TA). The causes of the maternal risk define cases that cannot be included in the DDE. When it is not the embryo or fetus that produces the mother pathology the case can be assigned to the DDE. When the embryo or fetus produces directly or indirectly the process that threatens the mother’s life the case cannot be assigned to the DDE. If the fetus is the cause of the imminent mother’s death, the removal of the cause, that is the proper therapy, coincides with killing him or her; then the good action (to save therapeutically the mother) is the same to the bad action (to kill the fetus) and this situation cannot be assimilated either to the DDE or to the doctrine of the lesser evil. Deciding not to kill the fetus will produce the death of the mother and the fetus. So this situation should be ascribed to the principle of the unique possible well.

O estudo mostra como a doutrina ou princípio do duplo efeito (DDE) de uma ação com efeito secundário negativo não pode aplicar-se a todos os casos de aborto terapêutico (AT). Com a análise das causas e indicação de AT se demonstra que só alguns destes correspondem a DDE. Quando não é o feto que leva a mãe a ter uma gravidez de alto risco com ameaça de dano severo ou morte para ela, o caso pode circunscrever-se à DDE; quando é o feto direta ou indiretamente quem causa ou leva a esse risco materno, o caso não se circunscreve a DDE. Se o feto é a causa da morte iminente da mãe, a remoção da causa, que é a terapia adequada, coincide em matá-lo; então a ação boa (salvar a mãe tratando-a causalmente) é a mesma que a má (matar o feto), situação que não pode assimilar-se à DDE ou à doutrina do mal menor. Mais ainda, decidir não interromper a gravidez produziria a morte da mãe e do feto. O caso deveria circunscrever-se ao princípio do único bem possível.

El médico y la objeción de conciencia: opinión del Departamento de Ética del Colegio Médico de Chile A. G. / Position paper from the Department of Ethics of the Chilean College of Physicians about conscientious objection

The Chilean bill that regulates abortion for three cases (Bulletin Nº 9895-11) includes the possibility that health professionals may manifest their conscientious objection (CO) to perform this procedure. Due to the broad impact that the issue of C O had, the Ethics Department of the Chilean College of Physicians considered important to review this concept and its ethical and legal basis, especially in the field of sexual and reproductive health. In the present document, we define the practical limit s of CO, both for the proper fulfillment of the medical profession obligations, and for the due respect and non-discrimination that the professional objector deserves. We analyze the denial of some health institutions to perform abortions if it is legalize d, and we end with recommendations adjusted to the Chilean reality. Specifically, we recognize the right to conscientious objection that all physicians who directly participate in a professional act have. But we a lso recognize that physicians have ineludib le obligations towards their patients, including the obligation to inform about the existence of this service, how to access to it and -as set out in our code of ethics- to ensure that another colleague will continue attending the patient.

Reflexiones en torno a la ley N° 20.584 y sus implicancias para la investigación biomédica en Chile / Considerations on the new Chilean law about rights and duties of patients

After years of discussion by the Chilean legislature, the Law Nº 20.584, which regulates health care related rights and duties of people, entered into force in Chile in October 2012. This bill represents an important step in the recognition and protection of health care related rights, welfare, dignity and duties of persons. It also intends to protect potential participants in clinical research. However such protective measures include explicit prohibitions such as the review of clinical records or the inclusion of people with mental or psychological handicaps as research participants. We herein discuss the implications of this law in medical research.

Malignant melanoma in Chile: different site distribution between private and state patients

BACKGROUND: The body site location of primary Malignant Melanoma (MM) has been correlated with prognosis and survival. Ethnic, genetics, sun exposure factors are related to the anatomical distribution of MM. Low and high socioeconomic strata in Chile differ in ethnic, genetic and cultural conditions. The purpose of this study was to analyze the anatomical MM distribution in the Chilean population in both strata searching for differences due to their ethno-genetic-cultural differences. Records of 1148 MM, 575cases from state hospitals (Low Socioeconomic Strata, LSS) and 573 cases from private clinics (High Socioeconomic Strata, HSS) were analyzed by body site. RESULTS: Females from LSS showed a higher number of MM in soles, cheeks, and around the eye area. Females from the HSS showed a higher number of MM in dorsal feet and dorsal hands. Males from LSS showed a higher number of MM in soles, around the eye area, and cheeks. However, males from HSS showed a higher number of MM in the trunk, and in the arms. Acral MM was significantly higher in LSS than in the HSS in both sexes. The Chilean population from the HSS and LSS showed differences in the distribution of MM by site. Furthermore, gender differences in the proportion of MM analyzed by anatomical site are observed in both strata. CONCLUSIONS: Results show evidence that differential genetics factors, sun exposure, or other environmental or cultural factors of both strata may account for these differences.

The structure of selective dinucleotide interactions and periodicities in D melanogaster mtDNA

BACKGROUND: We found a strong selective 3-sites periodicity of deviations from randomness of the dinucleotide (DN) distribution, where both bases of DN were separated by 1, 2, K sites in prokaryotes and mtDNA. Three main aspects are studied. I) the specific 3 K-sites periodic structure of the 16 DN. II) to discard the possibility that the periodicity was produced by the highly nonrandom interactive association of contiguous bases, by studying the interaction of non-contiguous bases, the first one chosen each I sites and the second chosen J sites downstream. III) the difference between this selective periodicity of association (distance to randomness) of the four bases with the described fixed periodicities of base sequences. RESULTS: I) The 16 pairs presented a consistent periodicity in the strength of association of both bases of the pairs; the most deviated pairs are those where G and C are involved and the least deviated ones are those where A and T are involved. II) we found significant non-random interactions when the first nucleotide is chosen every I sites and the second J sites downstream until I=J=76. III) we showed conclusive differences between these internucleotide association periodicities and sequence periodicities. CONCLUSIONS: This relational selective periodicity is different from sequence periodicities and indicates that any base strongly interacts with the bases of the residual genome; this interaction and periodicity is highly structured and systematic for every pair of bases. This interaction should be destroyed in few generations by recurrent mutation; it is only compatible with the Synthetic Theory of Evolution and agrees with the Wright's adaptive landscape conception and evolution by shifting balanced adaptive peaks.

Foundational errors in the Neutral and Nearly-Neutral theories of evolution in relation to the Synthetic Theory: Is a new evolutionary paradigm necessary?

The Neutral Theory of Evolution (NTE) proposes mutation and random genetic drift as the most important evolutionary factors. The most conspicuous feature of evolution is the genomic stability during paleontological eras and lack of variation among taxa; 98% or more of nucleotide sites are monomorphic within a species. NTE explains this homology by random fixation of neutral bases and negative selection (purifying selection) that does not contribute either to evolution or polymorphisms. Purifying selection is insufficient to account for this evolutionary feature and the Nearly-Neutral Theory of Evolution (N-NTE) included negative selection with coefficients as low as mutation rate. These NTE and N-NTE propositions are thermodynamically (tendency to random distributions, second law), biotically (recurrent mutation), logically and mathematically (resilient equilibria instead of fixation by drift) untenable. Recurrent forward and backward mutation and random fluctuations of base frequencies alone in a site make life organization and fixations impossible. Drift is not a directional evolutionary factor, but a directional tendency of matter-energy processes (second law) which threatens the biotic organization. Drift cannot drive evolution. In a site, the mutation rates among bases and selection coefficients determine the resilient equilibrium frequency of bases that genetic drift cannot change. The expected neutral random interaction among nucleotides is zero; however, huge interactions and periodicities were found between bases of dinucleotides separated by 1, 2... and more than 1,000 sites. Every base is co-adapted with the whole genome. Neutralists found that neutral evolution is independent of population size (N); thus neutral evolution should be independent of drift, because drift effect is dependent upon N. Also, chromosome size and shape as well as protein size are far from random.

The monthly rhythm of incidence and age at menarche: thirty five years of research: The circa-vacation-study expectancy rhythm of incidence and age at menarche

The hypothesis that the vacation-study-expectancy scholar regime produces most of the monthly rhythm of the age at menarche (AaM) was tested. Studies on monthly menarche incidence (MI) refuted climatic factors as a main factor in this rhythm, and indicated that the main factor of this rhythm is the succession of expectancies of study (Stu-months) or vacation (Vac-months) months within a year. Thus the hypothesis of seasonal circa-annual rhythm should be modified to the circa-[vacation (fiesta)]-[study (non-fiesta)]-expectancies rhythm for the MI and age at menarche annual rhythms. In several countries Vac-months had higher MI than Stu-months. The high MI of Vac-months was followed by a large decrease when girls started their studies and a MI increase occurred as vacations approached. The hypothesis proposes that at the end of vacations and at the beginning of the study period the AaM should be lowest, and then the mean of AaM should increase because of the menarche delay of girls whose menarche was arrested by the initiation of school work. This pattern was found in four independent samples, from Chile, Colombia, USA and Brazil. The probability that this result be due to random fluctuation of means is extraordinarily low (P<10-8). I conclude that the influence of the expectancy of vacation and study periods on the monthly rhythm of the age at menarche is a real process that accounts for most of this rhythm.