Consumo de alcohol en escolares de un territorio de la Araucanía-Chile: etnicidad y residencia / Alcohol consumption among high school students from the Araucanía-Chile: ethnicity and residence

INTRODUCCIÓN: Se describe el consumo de alcohol en estudiantes de enseñanza media del territorio costero de la región de La Araucanía, relacionado con etnicidad, género y residencia. SUJETOS Y MÉTODOS: Diseño de corte transversal, con 2.763 estudiantes entre 14-18 años a quienes se les aplicó el test AUDIT. La recolección de datos se realizó mediante a) un formulario con antecedentes sociodemográficos y origen étnico, preguntas sobre autoreporte de consumo de alcohol en el último mes y edad de primer consumo de alcohol, y percepción sobre acceso de alcohol entre los jóvenes; y b) el test AUDIT para evaluar los diversos niveles de consumo de alcohol en los estudiantes. La condición étnica se trianguló con autoadscripción, apellidos, y pertenencia a comunidad Mapuche. Los datos se recolectaron en las salas y horario de clases de los estudiantes con autorización del director, profesor del curso y supervisada por el equipo investigador. El AUDIT es un test autoadministrado que consta de 10 preguntas de formato estructurado en una escala de 0-4, con rango desde 0 a 40 puntos, los cuales representan cuatro categorías de consumo. Se realizó análisis descriptivo e inferencial con t-Student para comparación de promedios, Chi-cuadrado para tablas de asociación, intervalos de confianza 95% para estimación, y 5% para significación estadística. RESULTADOS: 48,1% fueron Mapuche, edad promedio 15,7 años (DS = 1,2), 49,1% mujeres y 50,9% residentes rurales. El consumo de alcohol en el último mes fue 38,2% (39,6% hombres 36,7% mujeres (p < 0,001)); 85% reportó beber antes de los 15 años y 87% indicó fácil acceso al alcohol. La aplicación del AUDIT mostró un consumo en los niveles de riesgo, perjudicial o con síntomas de dependencia (en adelante riesgo-AUDIT) de 13,9% [IC 95%: 12,6-15,2]. Mayor en hombres 20,3% [IC 95%: 18,1-22,4] que en mujeres 7,7% [IC 95%: 6,4-9,1]. Estudiantes Mapuche mostraron menor consumo de riesgo-AUDIT: 12,5% [IC 95%: 10,7-14,3] que los no Mapuche 15,2% [IC 95%: 13,3-17,1]. El 17,4% [IC 95%: 15,2-19,5] de los urbanos presentaron consumo de riesgo-AUDIT en comparación a los rurales, 11,2% [IC 95%: 9,6-12,8]. CONCLUSIONES: El consumo de alcohol fue mayor al observado a nivel nacional, y a medida que aumenta la edad aumenta el nivel de riesgo especialmente en hombres. El consumo de riesgo de alcohol se asoció a etnia, lugar de residencia y género. El ser no Mapuche, residente urbano y hombre son factores asociados al consumo de riesgo de alcohol entre los estudiantes.

INTRODUCTION: This study describes the alcohol consumption in association with residence, gender and ethnicity among high school students from the coastal area of the Araucania Region in Chile. SUBJECTS AND METHOD: Cross-sectional study on a population of 2,763 high school students aged bet ween 14 to 18 years. Statistical analysis: exploratory-descriptive analysis was used for all variables and inferential statistical analysis for associations among variables using 95% confidence interval for the estimates and 5% statistical significance for the statistical test. Data collection: alcohol consumption reported by AUDIT test and sociodemographic records. RESULTS: 48.1% of students were Mapuche, mean age of 15.7 years (SD = 1.2), mostly from rural areas (50.9%). Alcohol consumption in the last month was 38.2%; 39.6% male 36.7% female (p < 0.001). 37.5% drank at least once in their life and 85% did so before age 15. 87% reported easy access to alcohol. According to AUDIT test, the levels of risk, harm and symptoms of dependence are 13.9% [95% CI: 12.6-15.2], 20.3% higher in men [95% CI: 18.2-22.5] than women 7.7% [6.4-9.3]. Mapuche students present risk consumption lower than non-Mapuche ones, 12.5% and 15.2% respectively. Urban-rural residence and risk consumption is 12.6% and 8.2% respectively (p < 0.001). CONCLUSIONS: The alcohol consumption was higher than that observed at the national level, and as age increases, the level of risk increases, especially in men. Alcohol risk consumption was associated with ethnicity, place of residence and gender. The fact of being non-Mapuche, urban resident and man are factors associated with the risk of alcohol con sumption among students.

Epidemiología del cáncer de tiroides en Chile: Resultados del estudio INCATIR / Estimation of thyroid cancer incidence in Chile based on pathological reports

Background: Thyroid cancer (TC) detection is increasing steadily. Aim: To determine the incidence of TC based on pathological reports of thyroidectomies. Material and Methods: Fifty pathology laboratories performing thyroid gland pathological studies were identified. Those that accepted to participate were required to send trimestral reports of all thyroid pathological studies, from March 2011 to February 2012. Results: In the study period, 1309 case of TC were confirmed in 2614 thyroidectomy surgical samples. Considering the susceptible population according to 2012 census, the estimated incidence of TC during 2011 should be higher than 7.86 cases per 100,000 persons/year. Papillary cancer was the most common pathological type in 92% of samples (95% confidence intervals 90-93%). The proportion of microtumors was significantly higher in women than in men and among papillary than in follicular or medullary tumors. Only one fourth of tumors came from thyroidectomies performed in the Ministry of Health network. Conclusions: The incidence and features of TC in Chile are similar to the figures reported abroad.

Asociación entre malnutrición por exceso con caries temprana de la infancia / Association between overweight and early childhood caries

Objective: To determine whether overweight is a risk factor for the development of early childhood caries (ECC) in preschoolers. Patients and Method: An observational retrospective cohort study was performed in 196 children under 2 years of age at Calbuco Hospital, Los Lagos Region, Chile, who were admitted between 2007 and 2009. Patients were grouped based on their nutritional status at admission in the two following categories: eutrophic and overweighed children as a result of excessive intake. Information regarding caries incidence and nutritional status were annually retrieved from records until the age of 5 years, according to medical and dental records. Results: At the beginning of the study, 33.67% were overweight and 16.33% were obese, reaching 40% overweight and 20.56% obese at four years of age. The incidence of early childhood caries in overweighed children was 57.14% compared to 40.82% in normal weight children (p = 0.022), with 1.4 RR (95% CI, 1044-1.88). Conclusions: The increased risk of early childhood decay in overweighed patients makes necessary to create instances of timely mutual referral between the professional that diagnoses overweighed children and the pediatric dentist in order to develop preventive treatments for both diseases.

Objetivo: Determinar si la malnutrición por exceso es un factor de riesgo para el desarrollo de caries temprana de la infancia (CTI) en preescolares. Pacientes y Método: Se realizó un estudio observacional de cohorte retrospectivo en 196 niños de 2 años del Hospital de Calbuco, Región de Los Lagos, Chile, ingresados durante los años 2007 a 2009. Los pacientes fueron agrupados de acuerdo a su estado nutricional al ingreso en niños eutróficos y niños con malnutrición por exceso. La información respecto a incidencia de caries y el estado nutricional fueron recuperados de la ficha anualmente hasta la edad de 5 años, según registro de las fichas médicas y odontológicas. Resultados: El 33,67% estaba en sobrepeso al inicio de la cohorte y el 16,33% obeso, alcanzando 40% sobrepeso y 20,56% obesidad a los cuatro años de edad. La incidencia de caries temprana de la infancia en niños con malnutrición por exceso fue de 57,14% en relación al 40,82% de los niños eutróficos (p = 0,022) con RR de 1,4 (95% IC, 1.044-1,88). Conclusiones: El mayor riesgo asociado a CTI en pacientes con malnutrición por exceso invita a generar las instancias de derivación oportuna desde el profesional que pesquisa a niños con malnutrición por exceso hacia el odontólogo infantil, con el fin de desarrollar intervenciones preventivas para ambas patologías.

Perfil de metilación de genes supresores de tumores APAF1, ASSP1, p73 y FHIT en pacientes con leucemia linfoblástica aguda infantil / Detection of hypermethylation in tumor suppressor genes APAF1, ASSP1, p73 and FHIT in childhood acute lymphoblastic leukemia

La leucemia linfoblástica aguda (LLA), es la neoplasia mas frecuente en la población infantil. Se manifiesta por una perdida de diferenciación de progenitores linfoides produciendo un aumento de células inmaduras. La hipermetilación en la región promotora de genes supresores de tumores (GST) puede producir un silenciamiento génico que le proporciona a la célula leucémica una ventaja proliferativa o la previene de la apoptosis. Se estudia el estado de hipermetilación de 4 GST involucrados en la apoptosis: APAF1, ASPP1, p73 y FHIT y su asociación con la sobrevida de pacientes menores de 15 años con diagnóstico de LLA. Se analizaron 38 muestras de médula ósea mediante modificación con bisulfito del ADN y reacción en cadena de la polimerasa especifica de metilación (MSP). El rango de edad al diagnóstico fue de 10 meses a 13,8 años. La sobrevida global fue de 69 por ciento a los 5 años. El 81,5 por ciento de los pacientes tuvo al menos un gen hipermetilado. La frecuencia de metilación observada fue: APAF1 68,4 por ciento, FHIT 56,4 por ciento, p73 42 por ciento y ASPP1 18,4 por ciento. La asociación entre hipermetilación y grupo <5 años y 5 años fue: Global p=0,20, APAF1 p=0,03, FHIT p=0,51, p73 p=0,51 y ASPP1 p=0.67. Las curvas de sobrevida se calcularon según frecuencia de hipermetilación de cada gen: APAF1 p=0,05, FHIT p=0,31, p73 p=0,98 y ASPP1 p=0,82. La alta frecuencia de hipermetilación obtenida reafirma la participación de la metilación en la región promotora de GST en la patogénesis de la LLA. La hipermetilación del gen APAF1 fue muy frecuente y se asoció significativamente a la sobrevida del grupo de estudio, mostrando a este gen como un factor predictivo de mal pronostico en pacientes con LLA.

Acute lymphoblastic leukemia (ALL) is the most common malignancy in children. It is manifested by a loss of differentiation of lymphoid progenitors, producing an increase of immature cells. Hypermethylation in promoter region of tumor suppressor genes (GST) may produce a gene silencing that provides a leukemic cell a proliferative advantage or prevent apoptosis. We studied the hypermethylation status of 4 GST involved in apoptosis: APAF1, ASPP1, p73 and FHIT and its association with survival of patients <15 years diagnosed with ALL. We analyzed 38 samples of bone marrow by DNA bisulfite modification and chain reaction methylation-specific polymerase (MSP). The mean age at diagnosis was 10 months to 13.8 years. Overall survival was 69 percent at 5 years. 81.5 percent of patients had at least one hypermethylated gene. The frequency observed was: APAF1 68.4 percent, 56.4 percent FHIT, p73 ASPP1 42 percent and 18.4 percent. The association between hypermethylation and group <5 years and 5 years was: Global p = 0.20, APAF1 p = 0.03, FHIT p = 0.51, p73 p = 0.51, ASPP1 p = 0.67. Survival curves were calculated by frequency of hypermethylation of each gene: APAF1 p = 0.05, p = 0.31 FHIT, p73 p = 0.98 and ASPP1 p = 0.82. The high frequency of hypermethylation obtained confirms enrollment of methylation in the promoter region of GST in the pathogenesis of ALL. APAF1 gene hypermethylation was very frequent and was significantly associated with survival in the study group, showing this gene as a predictor of poor prognosis in patients with ALL.

Factores asociados a síndrome metabólico en la comuna de Temuco, Chile / Risk factors for metabolic syndrome in a case control study in Temuco, Chile

Background: Metabolic syndrome is becoming an important public health problem in affluent societies. Aim: To identify factors associated to metabolic syndrome in a Southern Chilean city. Material and methods: Using a case control design, 200 participants, aged 35 to 70 years with at least three criteria for metabolic syndrome according to the National Cholesterol Education Program (NCEP_ATPIII) and 200 subjects with less than three criteria, were studied. Both groups were compared in terms of ethnic background, educational level, family history of diabetes and coronary artery disease, menopausal status, smoking, stress and depression, physical activity, changes in body mass index in the last five years and diet. Results: Among subjects aged more than 54 years, among males and among overweight individuals, having a Mapuche origin was a risk factor with odds ratios (OR) of 7.2; 88 and 3.9 respectively. Among subjects aged more than 54 years, among women and among overweight individuals, a family history of diabetes was a risk factor with OR of 17.7; 3.2 and 3.9 respectively. Among subjects aged more than 54 years and among women a change in body mass index of more than three points was a risk factor with OR of 12.5 and 7.4, respectively. Depression also was a risk factor among subjects aged more than 54 years (OR 3.3). Regular consumption of wine was a protective factor among participants of more than 54 years, with an OR of 0.17. Conclusions: The risk factors for metabolic syndrome detected in this group of participants, were having a Mapuche origin, a family history of diabetes mellitus and depression. Wine consumption was associated with a lower risk.

Perfil de metilación de genes supresores de tumores como factor pronóstico en pacientes con leucemia mieloide aguda / Promoter methylation profile in tumor suppressor genes as prognosis factor in patients with acute myeloid leukemia

Existe creciente evidencia que apoya la presencia de un perfil de metilación específico para Leucemia Mieloide Aguda (LMA). La metilación de los islotes CpG en las regiones promotoras de los genes supresores de tumores es un importante mecanismo de control epigenético y participa en el silenciamiento transcripcional. Esto puede contribuir a un nuevo entendimiento de la biología de la enfermedad y vislumbrar nuevas oportunidades terapéuticas. Identificar el perfil de metilación de las áreas promotoras de un grupo de genes supresores de tumores; (p15, p16, ESR1, IGSF4, SOCS1, RARB y DAPK), y relacionar el estatus de metilación gen especifica o combinada con diferentes parámetros clínico patológicos. Se utilizaron muestras de sangre o médula ósea obtenidas al momento del diagnóstico de 33 pacientes con LMA, infantil y del adulto, recolectadas entre los años 1997 y 2008 en el Hospital Hernán Henríquez de Temuco. Se evaluó la presencia de hipermetilación mediante una Reacción de Polimerasa en Cadena Metilación Específica (MSP), previa modificación con bisulfito de sodio. La frecuencia de metilación de los pacientes estudiados fue de 88 por ciento, 27 por ciento, 27 por ciento, 21 por ciento, 15 por ciento, 3 por ciento y 0 por ciento para ESR1, RARb, IGSF4, p15, SOCS1, DAPK, y P16, respectivamente. La hipermetilación de P15 y RARb presentó una asociación significativa para una menor supervivencia en forma individual (p=0,03 y p=0,02), y combinada (p=0,002). No se encontraron diferencias significativas entre metilación y los otros parámetros clínicos analizados. Los pacientes con LMA presentan hipermetilación de la región promotora en algunos genes supresores de tumores, afectando negativamente la supervivencia. Esto pudiese eventualmente contribuir al establecimiento de un patrón de metilación determinado con utilidad clínica.

There is growing evidence than acute myeloid leukemia presents a specific methylation profile. The Methylation of CpG islands within gene promoters is a major epigenetic transcriptional control mechanism and plays a critical role in the transcriptional silencing of tumor suppressor genes. This provides new insights into the biology of the disease and it may offer novel therapeutic opportunities. To identify the promoter methylation profile of tumor suppressor genes (p15, p16, ESR1, IGSF4, SOCS1, RARB y DAPK), and to relate the percentage of methylation with clinicopathological features, as age, gender, white cell count, disease classification and survival rates. Bone marrow and peripheral blood samples were collected at diagnosis from 33 patients with acute myeloid leukemia, infants and adult, between 1997 and 2008 from Hernán Henríquez Aravena Hospital, Temuco, Chile. Methylation in the promoter areas of each tumor suppressor gene was analyzed using the mehylation specific polymerase chain reaction (MSP) technique using sodium bisulfite modification. The frequency of hypermethylation among the patient samples was 88 percent, 27 percent, 27 percent, 21 percent, 15 percent, 3 percent and 0 percent for ESR1, RARb, IGSF4, p15, SOCS1, DAPK, and P16 for each one. Methylation was significantly associated with an inferior overall survival (p=0.03 and p=0.02). When both genes are used, inferior survival is even more significant (p=0.002). There is no significant correlation between methylation and clinicopathological features.Patients with AML have hipermetilation at the promoter region of some tumor supressor genes, with a negative effect in the overall survival. This could eventually become part of establishing a characteristical methilation pattern with clinical utility.

Colesterolosis y cáncer de la vesícula biliar / Association between cholesterolosis and gallbladder cancer

Background: Cholesterolosis is frequently observed in cholecystectomies performed for lithiasis or chronic cholecystitis. Aim: To determine the degree of association between cholesterolosis and gallbladder cancer. Material and Methods: In a prospective study of gallbladder cancer, all gallbladders obtained during cholecystectomies were processed for pathological study, following a special protocol. As part of this study, 23304 surgical samples obtained between 1993 and 2002 were studied, looking for a relationship between cholesterolosis and chronic cholecystitis, adenomas, dysplasia and gallbladder cancer. Results: Seventy nine percent of patients were women. Cholesterolosis was observed in 3,123 cases (13.4 percent). Cholesterolosis was more common in women (14.2 percent) than in men (10.2 percent) (p < 0.001). In the same period, 29 patients were diagnosed with adenomas (0.12 percent), 179 cases with dysplasia not associated with gallbladder cancer (0.8 percent) and 739 gallbladder cancer (3.2 percent). The frequency of cholesterolosis was 13.8 percent in chronic cholecystitis, 13.7 percent in adenomas, 12.1 percent in dysplasias and 1.35 percent in patients with gallbladder cancer (p < 0.01). Of the thirteen cases with gallbladder cancer and cholesterolosis, 10 were early gallbladder carcinomas. Patients with cholesterolosis were 9.2 times less likely to have cancer than those who did not have cholesterolosis. Conclusions: Cholesterolosis has a strong negative association with gallbladder cancer.

Comparación del efecto de la terapia prolongada con antipsicóticos atípicos o convencionales en la incidencia de diabetes mellitus 2: Revisión sistemática y metaanálisis / Risk of type 2 diabetes mellitus among users of atypical antipsychotic drugs or conventional treatment: Systematic review

Atypical antipsychotic drugs have less extra pyramidal side effects and are more effective to control the clinical manifestations of schizophrenia. However, their use may be associated to a higher incidence of weight gain, dyslipidemia, metabolic syndrome, glucose intolerance and type 2 diabetes mellitus. We performed a systematic literature search to evaluate the risk of type 2 diabetes mellitus incidence associated to the use of atypical antipsychotic drugs, compared to conventional treatment. If users of all types of atypical antipsychotic drugs are compared with users of conventional treatment, no significant differences in the incidence of type 2 diabetes mellitus were observed. If individual drugs are evaluated, clozapine and risperidone are associated with a higher risk of diabetes than haloperidol. Quetiapine is associated with a lower risk of diabetes than conventional treatment. The quality of the evidence found was low; therefore, new studies should been performed.

Desde la displasia hasta el cáncer de la vesícula biliar / Natural history of gallbladder cancer Analysis of biopsy specimens

Background: There is scarcity of knowledge about the development of gallbladder cancer. Aim: To study the features of development and progression of gallbladder cancer. Material and methods: Review of histopathological studies of gallbladder obtained in 25,971 cholecytectomies performed in patients aged 45± 16 years, 79 percent females, between 1993 and 2004. Among these, 210 had a dysplasia not associated to cancer and 1,039 had a gallbladder cancer Clinical and morphological parameters of preneoplastic and neoplastic lesions were analyzed. Ninety five percent of patients were followed. Results: All cases of dysplasia were incidental findings. Metaplasia, dysplasia and carcinoma in situ were present in the adjacent mucosa in 66 percent, 81 percent y 69 percent of gallbladder carcinomas, respectively. Twenty five percent of gallbladders studied were carcinomas (mucous carcinoma in 18 percent and muscular carcinoma in 7 percent). Ninety two percent of cases had chronic inflammation in the gallbladder wall. Seventy two percent of mucous carcinomas were not detected macroscopically Five years survival of mucous carcinoma was 92 percent. There was an association between the intensity of the lesion and the age of the patients. The age difference between chronic cholecystitis and gallbladder cancer was 11 years for women and nine for men. Conclusions: From a morphological standpoint, the period in which a dysplasia becomes a carcinoma is approximately 10 years.

Medición en salud: Algunas consideraciones metodológicas / Some methodological issues about measurements in health

Measurement process is a part of everyday work of health professionals. Technological advances have created precise and sensitive instruments whose results are highly accurate and cast little doubts. However, health care has diversified, becoming a multidimensional and complex task. This means that new aspects, that are difficult to measure, must be addressed, such as health perception by patients or cost usefulness ratios of health actions. Therefore, clinicians and researchers must have a good perception of the quality of measures that they use in their daily work, to make the correct diagnostic, therapeutic or prognostic decisions. This article explores the operational concepts that help in the development and assessment of measuring instruments in terms of validity and truthfulness.

Violencia y factores sociales en mujeres de la ciudad de Temuco / Social and familial determinants of anxiety and depressive symptoms in middle to low income women

Background: Among women, risk factors for mental disorders are violence, economical inequities and disadvantages and discrimination. Aim: To determine the prevalence of anxiety and depressive symptoms in women and to determine factors associated with them. Material and methods: A cross sectional study of a probabilistic sample of 422 women aged 34 years as a mean, living in a medium to low income neighborhood in Temuco, Chile. Mental health was assessed with the self reporting questionnaire (SRQ20), partner violence was evaluated using a 12 item scale and family conflict and violence was evaluated using the Conflicts Tactics scale. A logistic repression analysis was used to identify factors associated with mental health alterations. Results: Forty one percent of women had anxiety or depressive symptoms. The main associated factors with these symptoms were severe physical violence against children (odds ratio (OR) =14.3), sexual violence against women (OR =9.7), self perception of health (OR =4.5), alcohol abuse (OR =4.4), psychological violence during childhood (OR =3.2) and lack of family support network (OR =2.7). Unemployment and lack of a support network of relatives had an OR 3.3 for mental health alterations. The OR for psychological violence plus sexual violence was 18.5. The figure for psychological violence plus sexual violence plus a history of parental violence during childhood was 26.5. Conclusions: Forty one percent of this group of women had mental health alterations. There is a strong association between these alterations, family violence and socioeconomic factors.

Identificación de factores de riesgo y factores protectores del embarazo en adolescentes de la novena región / Identification of risk factors and protective factors of pregnancy in adolescents of the ninth region

Objetivo: Comprender los factores relacionados con el embarazo no planificado en las adolescentes, desde la perspectiva de las escolares nuligestas.Método: Estudio cualitativo de casos, en mujeres entre 15 y 19 años, pertenecientes a dos establecimientos educacionales, con altos índices de embarazo, en la ciudad de Temuco, Chile. Se realizaron cuatro grupos focales, constituidos por 14 adolescentes no embarazadas,identificándose factores en las dimensiones individuales, familiares y sociales. Para el análisis se utilizó el programa ATLAS-ti 4,1. Se trianguló por investigador en la ejecución del estudio y análisis de los datos. Resultados: En la dimensión individual aparecen como relevantes factores de riesgo que favorecen el embarazo (FFE): "amor romántico", no uso de métodos anticonceptivos, baja autoestima, irresponsabilidad masculina y falta de conocimiento en sexualidad. En la dimensión familiar destacan los factores: límite estrecho familiar y negligencia paterna. Surgen factores percibidos por las adolescentes como protectoras del embarazo no planificado (FPE), en la dimensión individual destacan: capacidad reflexiva y proyecto de vida; en la dimensión familiar: "familia cuidadora" y límites claros; y en la dimensión social la categoría o factor con mayor peso es "sanción social". Conclusiones: Entre los hallazgos destacan como FFE relevantes el "amor romántico" y los límites polares familiares. Como FPE, la capacidad de reflexión y "familia cuidadora". Estos elementos debieran ser considerados en la prevención del embarazo no planificado en población adolescente.

Objective: To identify and understand factors associated to pregnancy in adolescents under the perspective of the never pregnant adolescent. Methods: Qualitative study undergone on women 15 to 19 years of age. School based sample of women were drawn from 2 schools chosen due to their high pregnancy rate. Four focus groups were created and each one was composed by 14 eligible women. Factors associated to individuals, to family, and to social environment were studied. Triangulation was performed during the study conduction and data analysis. Analysis was done by using ATLAS-ti 4.1. Results: Factors which appear to be favouring pregnancy at the individuals were: "romantic love", no use of contraceptives, low self esteem, male irresponsibility, lack of knowledge in sexuality. At the family level, the factors are: the permit's restriction and paternal negligence. Factors which help in avoiding pregnancy in adolescents at the individual level are: subject's reflexive capacity and project of life. At the family level, protective family and clearly defined limits are the ones which help preventing pregnancy. Social punishment is the main social factor associated. Conclusions: The view of the never pregnant adolescent and the multilevel model used in the focus group will allow decision makers to design strategies at the subject, family and social levels to help in reducing the unwanted pregnancy in adolescents. Main factors here identified are: "romantic love", permit`s restriction, paternal negligence as favouring pregnancy; reflexive capacity and protective family are the ones shown as preventives.

Expresión inmunohistoquímica del complejo E-caderina-catenina en cáncer gástrico: Relación con variables clínico-morfológicas y sobrevida de pacientes / Immunohistochemical expression of the E-cadherin-catenin complex in gastric cancer

Background: The E-cadherin/catenin complex plays an essential role in the control of epithelial differentiation. Abnormal expression in tumors correlates with histological grade, advanced stage and poor prognosis. Aim: To evaluate the expression pattern of E-cadherin/catenin complex in gastric carcinoma and analyze their association with tumor clinicopathological features and patient survival. Material and Methods: Inmunohistochemical staining of E-cadherin, alpha and ß-catenin was performed from paraffin specimens of 65 gastric carcinomas. Results: Abnormal expression of E-cadherin, alpha and ß-catenin was demonstrated in 82 percent, 85 percent and 88 percent of gastric carcinomas, respectively. There was a significant correlation between abnormal expression and Lauren pathological classification and depth of infiltration, but not with tumor stage, positive lymph node metastases and survival. Conclusion: Abnormal expression of E-cadherin, alpha and ß-catenin occurs frequently in gastric carcinoma and correlates with histological grade.

Cáncer de colon: elección de un tipo de terapia quirúrgica basado en la evidencia revisión sistemática de la literatura / Surgery for colon cancer: open or laparoscopic approach? systematic review

Introducción: A pesar de que hay algunas experiencias publicadas acerca de tratamiento laparoscópicos de pacientes con cáncer de colon. ésta, es una alternativa aún controversial. El objetivo de este trabajo es determinar la mejor opción quirúrgica para cirugía electiva en pacientes con cáncer de colon no complicado, comparando cirugía abierta vs laparoscópica. Material y método: Revisión sistemática de la literatura. Se analizaron estudios en población humana, adulta, con cáncer de colon no complicado tratados con cirugía abierta y laparoscópica, publicados entre 1990 y 2002. Se utilizaron las bases de datos Cochrane-MEDLINE; y LILACS, utilizando términos MeSH y palabras libres. Los estudios seleccionados fueron analizados utilizando un escore de calidad metodológica con validez de fachada y contenido para comparación de artículos de terapia con diferente tipo de diseños. Se consideraron las variables número de pacientes tratados, supervivencia actuarial y libre de enfermedad a 3 años, recurrencia, morbilidad, mortalidad y calidad metodológica de los estudios primarios. Se calcularon promedios, medianas y promedios ponderados, y posteriormente se compararon los grupos en estudio utilizando intervalos de confianza del 95 por ciento de las medianas. Resultados: Se encontraron 680 artículos relacionados. Sólo 14 de ellos cumplían con los criterios de selección, y 11 de ellos fueron finalmente analizados. 17 series de pacientes fueron estudiadas, las que incluyen un total de 3033 sujetos tratados. La estancia hospitalarias fue de 10.1 día para cirugía abierta y 6,5 días para cirugía laparoscópica. La morbilidad fue 19,5 por ciento para cirugía abierta y 26,9 por ciento para cirugía laparoscópica; y la mortalidad fue 1,6 por ciento y 1,7 por ciento respectivamente. Con un promedio de seguimiento de 58 meses para cirugía abierta y 30 meses para cirugía laparoscópica, la supervivencia actuarial y libre enfermedad fue 74,3 por ciento y 75,6 por ciento para cirugía abierta, 87,0 por ciento y 89,5 por ciento para cirugía laparoscópica. La mediana del escore de calidad metodológica fue 16 y 18,5 puntos respectivamente. Conclusiones: La calidad metodológica de los estudios primarios es intermedia. Los resultados a corto y mediano plazo de la colectomía laparoscópica para pacientes con cáncer de colon no complicado son esperanzadores.

Experiencia y resultados del tratamiento de pacientes con cáncer de vesícula biliar / Experience and results of patients treatment with gallblader cancer

Antecedentes: El cáncer de la vesícula biliar (CaVB) persiste como una neoplasia frecuente, y en general del mal pronóstico. Los tratamientos utilizados hasta la fecha son diversos, pero en general coinciden en la práctica de una resección quirúrgica de aseo, asociado o no a esquemas de neoadyuvancia y adyuvancia, ya sean éstos de quimio y/o radioterapia. Objetivo: Describir los resultados de un protocolo de tratamiento para CaVB en diferentes estadios de la enfermedad. Material y Método: Estudio observacional, descriptivo y prospectivos para valorar un esquema terapeútico en pacientes con CaVB, realizado entre julio de 1994 y julio de 2000. Se trataron consecutivamente a todos los pacientes colecistectomizados cuyo estudio histológico reveló carcinoma infiltrante de la vesícula biliar y se encontraban en etapas intermedias y avanzadas de la enfermedad. Para ello, se realizó bisegmentectomía parcial de los segmentos IV y V del hígado y linfadenectomía regional, asociada a una adyuvancia con quimioterapia ambulatoria en base a 5-FU y leucovorina (6 ciclos). Con un seguimiento promedio de la serie de 35,6 meses, se valoró evolución, morbilidad, mortalidad operatoria, y supervivencia actuaria. Se realizó un análisis exploratorio descriptivo de los datos y análisis de supervivencia. Resultados: Fueron incluidos en este protocolo 20 pacientes, con una edad promedio de 60,9 años (42-85 años), de los cuales 15 son mujeres (75 por ciento). Nivel de invasión: muscular 5 pacientes (25 por ciento), subserosa 6 casos (30 por ciento), serosa 6 pacientes (30 por ciento), y grasa perivesicular 3 casos (15 por ciento). La morbilidad de la serie fue de 30 por ciento. No hubo mortalidad operatoria. La quimioterapia fue bien tolerada, y sólo un paciente no la completó pues falleció antes. La supervivencia actuarial global de la serie fue de 76,5 por ciento a los 60 meses. Conclusiones: El tratamiento realizado es satisfactorio desde el punto de vista de la morbilidad y mortalidad, con una supervivencia actuarial global y por estadio, dentro de rangos aceptables

Violencia conyugal en la ciudad de Temuco: un estudio de prevalencia y factores asociados / Conjugal violence in Temuco: prevalence and predictive factors

Background: Violence against women is a recognized public health problem in developed countries. There is increasing awareness on family violence in Chile, but there is scant information about its prevalence. Aim: To determine the prevalence of family violence against women in a population sample in Temuco, Chile. Material and methods: A standardized questionnaire about family violence was applied to a sample of 422 women at their homes. The questionnaire had six sections that included a list of violent behaviors from husbands or partners, a standardized instrument to assess mental health and alcohol consumption by the couple, history of child abuse, community support, type of employment and years of school education. Results: Forty nine percent of women reported psychological aggression, 13 per cent reported physical violence and 5.5 per cent, sexual violence. The presence of anxiety or depressive symptoms, being witness of violence between parents during childhood, a lower educational level, being a housewife, alcohol abuse and lack of community support were risk factors for violence among women. Among men, the history of child abuse, a lower education level, and alcohol abuse were identified as risk factors for violent behaviors. Conclusions: Conjugal violence is a significant mental health problem in Temuco, Chile

Maltrato infantil en la ciudad de Temuco: estudio de prevalencia y factores asociados / Child abuse in Temuco, Chile: prevalence and risk factors

Background: Child maltreatment is recognised as a significant health problem in developed countries. There is increasing awareness on family violence in Chile, becoming a health priority in the last five years, but there is scant information about its prevalence. Aim: Determine prevalence of child abuse, and associated factors in a population sample from Temuco, Chile. Material and methods: A standardised questionnaire was applied to a sample of 422 women at their homes. Instrument had questions about disciplinary practices by caretakers, a standardised questionnaire to assess mental health, as measures of risk and protective factors for violence Results: The prevalence of psychological aggression delivered by mothers or fathers was 17.5 per cent and 6.8 per cent respectively. The figures for corporal punishment delivered by mother or fathers were 42.3 per cent and 17 per cent respectively. Three percent of mothers and 1.2 per cent of fathers recognised severe physical abuse. Associated factors were mother impaired mental health, antecedents of child abuse in both parents, parents alcohol abuse and child emotional/behavioral problem. Conclusion: Child abuse is a extended significant problem in Temuco that requires multidisciplinary intervention programs

Hepatocarcinoma: descripción de características clínicas verificadas en una región del sur de Chile / Hepatocellular carcinoma: description of clinical features in south region from Chile

Background: Hepatocellular carcinoma is the most frequent primary tumor of the liver. It is associated to chronic liver diseases and has a high prevalence in some regions of Africa and Asia. Aim: To describe the clinical characteristics of patients with hepatocellular carcinoma, admitted to two hospitals of the IX region of southern Chile. Material and methods: Prospective study of 29 consecutive patients admitted to two hospitals in Temuco, Chile. Clinical features, laboratory values and viral markers were analyzed. Results: Eighteen patients were male and ages ranged from 29 to 75 years old. The most frequent presenting symptom was abdominal pain in 21 patients. Seven subjects had a history of alcoholism. Serum bilirubin values ranged from 0.1 to 15.8 mg/dl, alkaline phosphatases ranged from 171 to 3476 U/l, ASAT from 24 to 5400 U/l and alpha feto protein from 1.4 to 350 ng/ml. Two patients had a positive hepatitis B surface antigen and all had negative hepatitis C virus antibodies. Mean tumoral diameter was 9.6 cm and the most common presentation was nodular. Mean survival after the diagnosis was 6.3 months. Conclusions: These patients with hepatocellular carcinoma have a low frequency of positive viral markers and tumors of large sizes on presentation