Brain lesions associated with eosinophilia. A useful clue for neurotoxocariasis. Report of one case

ABSTRACT Neurotoxocariasis is uncommon. Its manifestations include events of meningitis, encephalitis and less frequently vasculitis, which manifest as headache, seizures, focalization, confusion, cognitive alterations and /or fever. Peripheral eosinophilia with clinical and neurological imaging elements, allow its early suspicion. We report a 48-year-old agricultural worker, admitted in our hospital for one week of gastrointestinal complaints, headache, progressive left hemiparesis and impaired consciousness. He had leukocytosis (13,530/μL) with peripheral eosinophilia (25%, absolute count 3,400 /μL). CSF analysis revealed no abnormalities and brain CT showed poorly defined hypodense lesions on subcortical areas and semioval centers. Magnetic resonance imaging showed multiple foci with increased signals predominantly in the white matter in both hemispheres, especially at frontal and occipital regions and at semioval centers. Lesions reinforced after paramagnetic contrast. Serological studies found specific IgG antibodies by ELISA against antigens of the genus Toxocara, which were confirmed by a positive IgG Western Blot. The patient was treated with albendazole (800 mg/d) for 14 days associated with parenteral and then oral corticosteroids with a favorable response and gradual complete recovery.

La neurotoxocariasis es infrecuente. Sus manifestaciones incluyen eventos de meningitis, encefalitis y con menor frecuencia vasculitis, que se manifiestan como cefalea, convulsiones, focalización, confusión, alteraciones cognitivas o fiebre. La eosinofilia periférica, junto a elementos clínicos e imágenes compatibles, permiten su sospecha. Informamos el caso de un trabajador agrícola de 48 años que ingresó por una semana de molestias gastrointestinales, cefalea, hemiparesia izquierda progresiva y deterioro de conciencia. Los exámenes revelaron leucocitosis (13.530/μL) con eosinofilia periférica (25%, recuento absoluto 3.400/μL). El análisis del LCR sin anomalías y la tomografía computada cerebral mostró lesiones hipodensas mal definidas en áreas subcorticales y centros semiovales. La resonancia magnética mostró múltiples focos con aumento de la señal predominantemente en la sustancia blanca en ambos hemisferios. Las lesiones presentaron refuerzo tras contraste paramagnético. Los estudios serológicos indicaron anticuerpos IgG específicos por ELISA contra antígenos del género Toxocara. El paciente fue tratado con albendazol (800 mg /día) durante 14 días asociado a corticoides con respuesta favorable y una recuperación gradual completa.

Impacto del maltrato infantil en la prevalencia de trastornos mentales en niños y adolescentes chilenos

RESUMEN Introducción: La mala salud mental está fuertemente asociada con la violencia interpersonal. El maltrato infantil es un problema cultural y global de salud pública que atenta contra los derechos de los niños. Objetivo: Examinar la asociación entre la experiencia de maltrato y presentación de trastornos mentales en niños y adolescentes. Material y Método: Estudio cuantitativo, no experimental, analítico de corte transversal, dirigido a niños y adolescentes chilenos. La muestra estuvo compuesta por 1558 participantes entre 4 y 18 años, el instrumento recolector de datos estuvo compuesto por la entrevista diagnóstica estructurada para niños, versión computarizada DISC-IV, un cuestionario de maltrato infantil y datos sociodemográficos. El análisis estadístico se realizó mediante regresión logística con el programa R versión 3. Resultados: En el grupo de los niños, los trastornos ansiosos y disruptivos prevalentes y subumbral se relacionaron con abuso sexual, maltrato psicológico y físico. En el grupo de los adolescentes, los trastornos del ánimo se asociaron con maltrato psicológico y abuso sexual, los trastornos disruptivos prevalentes y subumbrales se asociaron con todos los tipos de maltrato, y el trastorno por consumo de drogas se asoció con abuso sexual. Conclusión: Existe relación significativa entre el maltrato en sus diferentes categorías, especialmente abuso sexual con la expresión de trastornos mentales en niños y adolescentes. Es importante detectar tempranamente los niveles subumbrales para tratar de reparar el problema, educar a la población, procurar comunidades menos violentas y ambientes tranquilos para el crecimiento de niños y adolescentes.

ABSTRACT Introduction: Poor mental health is strongly associated with interpersonal violence. Child abuse is a cultural and global public health problem that violates children's rights. Objective: To examine the relation between experience of abuse and presence of mental disorders in children and adolescents. Materials and methods: Quantitative, non-experimental, cross-sectional analytical study, aimed at Chilean children and adolescents. The sample consisted of 1558 participants who were between 4 and 18 years old. The data-collection instrument included the Structured Diagnostic Interview for Children, computerized version DISC-IV, a child abuse questionnaire and sociodemographic data. Statistical analysis was performed by logistic regression using the R program version 3. Results: In the group of children, prevalent and sub-threshold anxiety and disruptive disorders were related to sexual abuse, psychological and physical abuse. In the adolescent group, mood disorders were associated with psychological and sexual abuse; prevalent and sub-threshold disorders were associated with all types of abuse, and drug use disorder was associated with sexual abuse. Conclusion: There is a significant relationship between abuse in its different categories, especially sexual abuse, and the occurrence of mental disorders in children and adolescents. It is important to detect early sub-threshold levels in order to try to solve the problem, educate the population, and have less violent communities and quiet environments for the growth of children and adolescents.

RESUMO Introdução: A saúde mental precária está fortemente associada à violência interpessoal. O abuso infantil é um problema cultural e global de saúde pública que compromete os direitos da criança. Objetivo: Examinar a associação entre a experiência de abuso e a apresentação de transtornos mentais em crianças e adolescentes. Material e Método: Estudo analítico quantitativo, não experimental, transversal, destinado a crianças e adolescentes chilenos. A amostra foi composta por 1558 participantes, entre 4 e 18 anos, o instrumento de coleta de dados foi composto pela Entrevista Diagnóstica Estruturada para Crianças, versão computadorizada DISC-IV, questionário de abuso infantil e dados sociodemográficos. A análise estatística foi realizada por meio de regressão logística com o programa R versão 3. Resultados: No grupo de crianças, os transtornos ansiosos e disruptivos prevalentes e abaixo do limiar estavam relacionados ao abuso sexual, psicológico e físico. No grupo de adolescentes, os transtornos do humor foram associados a abuso psicológico e abuso sexual, os transtornos disruptivos predominantes e inferiores ao limiar foram associados a todos os tipos de abuso, e o transtorno por uso de drogas foi associado ao abuso sexual. Conclusão: Existe uma relação significativa entre os abusos em suas diferentes categorias, principalmente o abuso sexual com a expressão de transtornos mentais em crianças e adolescentes. É importante detectar precocemente níveis inferiores ao limiar para tentar solucionar o problema, educar a população, para conseguir comunidades menos violentas e ambientes calmos para o crescimento de crianças e adolescentes.

Servicios de salud mental en contexto escolar / Health mental services within educational process

RESUMEN Introducción: Son escasos los servicios en salud mental dentro del contexto escolar que permitan una integración intersectorial para superar la brecha de falta de asistencia en salud mental en la población infanto - juvenil, aun cuando, es en la escuela donde se detectan mayoritariamente los problemas de salud mental. Objetivo: Comentar el uso de servicios de salud mental en el ambiente escolar en relación con los trastornos mentales y trastornos subumbrales. Método: El presente resultado se obtiene a partir del "Estudio de Prevalencia Comunitaria de Trastornos Psiquiátricos y Utilización de Servicios de la Población Infanto-Juvenil Chilena". La muestra estuvo representada por sujetos entre 4 y 18 años (N=1556). La información sobre el uso de servicio de salud mental se recogió con una versión modificada de la Escala Service Assesment for Children and Adolescent (SACA). Se realizó un modelo de regresión logística para analizar cinco áreas del uso de servicios en el ambiente escolar, las cuales se correlacionaron con diagnósticos de trastorno mentales y trastorno subumbral de ansiedad, disruptivo y depresión en el último año. Resultados: Las escuelas se enfrentan a grandes desafíos sobre cómo proporcionar apoyo efectivo de salud mental para los estudiantes, que presentan algún tipo de trastorno mental o trastorno subumbral. Discussión: Las instituciones educativas requieren ser visualizadas como una entidad que podría satisfacer las necesidades que se advierten de manera urgente en atención, prevención y promoción de problemas mentales en la población infanto- juvenil, si se vinculan de forma más directa con los servicios de salud mental.

ABSTRACT Introduction: Mental health services are scarce within the school context that allow intersectoral integration to overcome the gap in mental health care in the child and adolescent population, being the school where mental health problems are mostly detected. Objective: to know the use of mental health services in the school environment in relation to mental disorders and subthreshold disorders. Method: The present secondary study is carried out from the "Study of Community Prevalence of Psychiatric Disorders and Utilization of Services of the Chilean Child-Youth Population". The sample was represented by subjects between 4 and 18 years old (N = 1556). Information on the use of mental health service was collected with a modified version of the Service Assessment Scale for Children and Adolescents (SACA). A logistic regression model was performed to analyze five areas of the use of services in the school environment, which were correlated with diagnoses of mental disorders and subthreshold anxiety, disruptive and depression disorder in the last year. Results: Schools face great challenges on how to provide effective mental health support for students, who present some type of mental disorder or subthreshold disorder. Discusion: Educational institutions need to be visualized as an entity that could meet the needs that are urgently noticed in attention, prevention and promotion of mental problems in the child and adolescent population, if it is linked more directly with health services.

Cross-Cultural Adaptation of the Children's Emotion Regulation Processes Survey (CERP) in Chilean Preschoolers / Adaptação Transcultural do Questionário de Processos de Regulação Emocional (CERP) em Pré-Escolares Chilenos / Adaptación Transcultural del Cuestionario de Procesos de Regulación Emocional (CERP) en una Muestra de Preescolares Chilenos

Abstract Emotion regulation is an important aspect for the adaptation of human beings that influences their development and mental health. In actuality, it is an important challenge to have culturally valid instruments that allow to evaluate this construct. In this study, an analysis of the psychometric properties of the Children's Emotion Regulation Processes Survey (CERP) in a sample of Chilean preschoolers is presented. CERP is a third-party report questionnaire that assesses the strategies of emotion regulation in children, providing a vision based on development. The instrument was applied to mothers and fathers of 483 children, between the ages of 4 and 6 that attended preschool. Factorial structure, internal consistency and the relation with the Child Behavior Checklist (CBCL) as indicator of convergent validity was analyzed. The results showed a four factor structure, coherent with the empirical evidence. Also, all of the factors presented adequate reliability indexes and correlation with the internalization and externalization scales of CBCL. It is concluded that CERP exhibits positive reliability and validity indicators to be used in this population.

Resumo A regulação emocional é um aspecto de relevância para a adaptação dos indivíduos que influencia em seu desenvolvimento e saúde mental. Na atualidade, um desafio importante é contar com instrumentos válidos culturalmente que permitam avaliar este constructo. Neste estudo se apresenta a análise das propriedades psicométricas do Questionário de Processos de Regulação Emocional Infantil (CERP) em uma amostra de pré-escolares chilenos. O CERP é um questionário de relatórios de terceiros que avaliam estratégias de regulação emocional em crianças, entregando uma visão baseada no desenvolvimento. O instrumento foi aplicado a pais e mães de 483 crianças, entre 4 e 6 anos que cursavam a educação pré-escolar. Foi analisada a estrutura fatorial, consistência interna e o relacionamento com o Inventario de Condutas Infantis (CBCL) como indicador de validade convergente. Os resultados evidenciaram uma estrutura de quatro fatores, coerentes com a evidencia empírica. Além disso, todos os fatores apresentaram índices adequados de confiabilidade e correlações com as escalas de internalização e terceirização do CBCL. Se conclui que o CERP mostra indicadores de confiabilidade e validez positivos para serem usados nesta população.

Resumen La regulación emocional es un aspecto de relevancia para la adaptación de los individuos que influye en su desarrollo y salud mental. Actualmente, es un desafío contar con instrumentos válidos culturalmente para evaluar este constructo. En este estudio, se presenta el análisis de las propiedades psicométricas del Cuestionario de Procesos de Regulación Emocional Infantil (CERP) en una muestra de preescolares chilenos. El CERP es un cuestionario de reporte de terceros que evalúa las estrategias de regulación emocional en niños/as, entregando una visión basada en el desarrollo. Se aplicó el instrumento a padres y madres de 483 niños/as de edades entre 4 y 6 años que cursaban educación preescolar. Se analizó la estructura factorial, consistencia interna y relación con el Inventario de Conductas Infantiles (CBCL) como indicador de validez convergente. Los resultados evidenciaron una estructura de cuatro factores, coherentes con la evidencia empírica. Además, todos los factores presentaron adecuados índices de confiabilidad y correlaciones con las escalas de internalización y externalización del CBCL. Se concluye que el CERP muestra indicadores de confiabilidad y validez positivos para ser usado en esta población.

Variables asociadas al funcionamiento social en usuarios de hogares y residencias protegidas / Variables associated with the social performance of users in supported housing

RESUMEN Objetivo: Determinar las variables asociadas al funcionamiento social de usuarios que viven en hogares y residencias protegidas, en particular las características personales y clínicas de los residentes, factores del dispositivo residencial y de las áreas de salud a las que pertenecen. Material y método: Estudio descriptivo y correlacional cuya muestra estuvo compuesta por 122 residentes y 30 cuidadores de 15 hogares y 6 residencias protegidas. Se evaluó el desempeño social usando la Escala de Habilidades Básicas de la Vida Diaria que consta de 4 subescalas: autocuidado, habilidades domésticas, habilidades comunitarias, actividad y relaciones sociales. Para analizar los datos se utilizó un modelo lineal mixto. Resultados: En las subescalas de autocuidado, habilidades comunitarias y actividades y relaciones sociales, la varianza depende fundamentalmente de las características personales, en tanto en las habilidades domésticas el 47,6% corresponde a características del dispositivo y del área sanitaria. El nivel de restrictividad, el tiempo de permanencia en el dispositivo, el diagnóstico, la edad de los residentes y el apoyo social percibido fueron variables predictoras del funcionamiento social. Conclusión: El funcionamiento social de usuarios que viven en hogares y residencias está determinado, principalmente, por características individuales, sin embargo, variables del dispositivo y del área sanitaria tienen influencia dependiendo del tipo de habilidad social.

ABSTRACT Objective: Determine the variables associated with the social performance of users living in supported housing, in particular the personal and clinical characteristics of the residents, factors of the centre and of the health areas to which they belong. Method: Descriptive and correlational study whose sample consisted in 122 residents and 30 caregivers of 15 supported housing and 6 residential housing. Social performance was assessed through the Basic Everyday Living Skills Scale, which consisted of four sub-scales: self-care, domestic skills, community skills and activity and social relationships. In order to analyze the data, a mixed linear model was used. Results: In the sub-scales of self-care, community skills and activities and social relations the variance depends primarily on the personal characteristics. On the other hand, in the domestic skills 47.6% corresponds to centre characteristics and health area. The level of restrictiveness, time of residence in the facility, diagnosis of the users, age of residents and social support received corresponded to the statistically significant variables on the prediction of the social performance. Conclusion: Social performance of the users who live in supported housing is mainly determined by individual characteristics. However, variables of the centre and health area have a different weight depending on the type of social skill.

Autoeficacia cuestionario de autorregulación de estudio readiness / Questionário de autoeficácia para a autorregulação para estudar (readiness) / Self-efficacy questionnaire of the self-directed-learning readiness

La investigación ha demostrado la importancia de los instrumentos que miden la autoeficacia ligada a áreas de funcionamiento diferenciado, como el aprendizaje autorregulado. El objetivo de este trabajo fue proyectar y estudiar el comportamiento psicométrico del Cuestionario de Autoeficacia para la Autorregulación de la Disposición al Estudio. Se aplicó el instrumento, compuesto por nueve ítems, a una muestra por conveniencia de 695 estudiantes, en cinco universidades de la provincia de Concepción, CHILE. Mediante análisis factorial exploratorio, fue encontrada una estructura con un factor general (M=3.87; DE=0.65) y tres sub-factores, que fue demostrada en un análisis factorial confirmatorio. El instrumento muestra niveles adecuados de confiabilidad (α=0.84), una estructura latente con buen ajuste para los datos y correlaciones leves, pero estadísticamente significativas, con clasificaciones autoreferidas. Por lo tanto, el instrumento presenta propiedades psicométricas adecuadas para ser aplicadas en formato de auto-informe a distintos grupos de estudiantes. (AU)

A investigação tem demonstrado a importância dos instrumentos que medem a autoeficácia ligada às áreas de funcionamento diferencial, como a aprendizagem autorregulada. O objetivo deste trabalho é projetar e estudar o comportamento psicométrico do Questionário de Autoeficácia para a Autorregulação da Disposição para Estudar. O instrumento, composto por nove itens, foi aplicado em uma amostra por conveniência de 695 estudantes de cinco universidades da Província de Concepción, Chile. Por meio de análise fatorial exploratória, foi encontrada uma estrutura com um fator geral (M=3,87; DE=0,65) e três subfatores, a qual foi provada em uma análise fatorial confirmatória. O instrumento mostra níveis adequados de confiabilidade (α=0,84), uma estrutura latente com bom ajuste para os dados e as correlações leves, mas estatisticamente significativas, com classificações autorreferidas. Portanto, o instrumento apresenta propriedades psicométricas adequadas para serem aplicadas em formato de autorrelato, para diferentes grupos de alunos. (AU)

The investigation has demonstrated the importance of instruments that measure self-efficacy linked to areas of differential functioning, such as self-directed learning. The objective of this work is to design and study the psychometric behavior of the SelfEfficacy Questionnaire for Self-Directed-Learning. The instrument, composed of nine items, was applied to a convenience sample of 695 students from five universities in the province of Concepción, Chile. Through exploratory factor analysis, a structure with one general factor (M=3.87, SD=0.65) and three sub-factors was found, which was proved through confirmatory factor analysis. The instrument shows adequate levels of reliability (α=0.84), a latent structure with good fit for the data, and slight but statistically significant correlations with self-reported classifications. Therefore, the instrument has adequate psychometric properties to be applied in a self-report format for different groups of students. (AU)

Construcción y características psicométricas de la escala de estrategias de estimulación del autoconcepto académico / Escala de estratégias de estimulação do autoconceito acadêmico / Scale of strategies for stimulating academic self-concept

Se elaboró y se evaluó el comportamiento psicométrico de una escala de estrategias de estimulación del autoconcepto académico, asociada a comportamientos observados en la interacción profesor-alumno. Participaron del estudio 819 estudiantes de Eseñanza Primaria, de 16 escuelas de alta vulnerabilidad social, de la ciudad de Concepción, en Chile. La escala fue construída después de una revisión teórica, aplicación de dos pilotos con los alumnos y una validación interjueces. Los resultados del análisis factorial exploratorio indican que la escala final, con 15 preguntas, tiene una estructura de tres factores de primer orden (estrategias de capacidad, procedimientos de trabajo y de participación), que explican 66% de la varianza, con un factor de segundo orden con un omega jerárquico de 0,89. Esta estructura es corroborada por medio de un análisis factorial confirmatorio. Se observa validez concurrente con la subescala de autoestima escolar del Inventario de Autoestima de Coopersmith. (AU)

Elaborou-se e avaliou-se o comportamento psicométrico de uma escala de estratégias de estimulação do autoconceito acadêmico associada a comportamentos observáveis da interação professor-aluno. O estudo contou com a participação de 819 alunos do ensino fundamental de 16 escolas de alta vulnerabilidade social na cidade chilena de Concepción. A escala foi construída após uma revisão teórica, a aplicação de dois pilotos com os alunos e uma validação interjuízes. Os resultados de uma análise exploratória indicam que a escala final, com 15 perguntas, tem uma estrutura de três fatores de primeira ordem (estratégias de capacidade, de procedimentos de trabalho e de participação), que explicam 66% da variância, com um fator de segunda ordem com um ômega hierárquico de 0,89. Esta estrutura é corroborada por uma análise fatorial confirmatória. Observa-se validade concorrente com a subescala de autoestima escolar do Inventário de Autoestima de Coopersmith. (AU)

The objective of this study was to elaborate and evaluate behavioral psychometrics of a scale for stimulating academic self-concept strategies associated with observable teacher-student interaction behaviors. A total of 819 elementary students from 16 schools with high social vulnerability in the Chilean city of Concepción. The scale was constructed after a theoretical revision, the application of two pilot studies with the students, and an inter-judicial validation. Exploratory analysis results indicate that the final scale, with 15 questions, has a structure of three first-order factors (capacity, work procedures and participation strategies), which explain 66% of the variance, with a factor of second-order with a hierarchical omega of 0.89. This structure is corroborated by a confirmatory factor analysis. Concurrent validity is observed with the school self-esteem subscale of Coopersmith's Self-Esteem Inventory. (AU)

Cobertura de material de osteosíntesis interno expuesto en fracturas de pierna. Serie de casos / Cover of internal osteosynthesis material exposed in leg fractures: a series of cases

Introducción: Debido a factores intrínsecos y extrínsecos al paciente, las fracturas expuestas de las piernas son comunes y a menudo presentan lesiones de tejidos blandos complejas. Casos: Presentamos siete casos de pacientes masculinos, de los cuales seis sufrieron accidentes de tránsito y uno como secuela de herida por arma de fuego. Un paciente sufrió fractura en tercio proximal, cubierto con colgajo muscular de gemelo medial; cuatro en tercio medio, de los cuales en tres se usaron colgajos musculares hemisóleo y uno con colgajo fasciocutáneo sural inverso y por último dos de tercio distal que se cubrieron con colgajo sural. Discusión: En dos casos hubo necrosis parcial de colgajos que no requirieron cirugías complementarias. La consolidación de fracturas, en aquellas con tiempo de exposición corto, fue buena, mientras que en las de tiempo prolongado fue necesario recambio de material de fijación interna. En fracturas de pierna con material de fijación interna expuesto, se debe considerar tiempo menor a 15 días y conservar este material, siempre y cuando dispongan un protocolo de antibioticoterapia, limpieza quirúrgica y cobertura adecuada.

Introduction: Due to intrinsic and extrinsic factors to the patient, exposed leg fractures are common, and they are often accompanied by complex soft tissue injuries. Case report: We present seven cases of male patients, six injured in road traffic accidents and one with a gun shot trauma sequel. One had a fracture in the proximal third and coverage was made with medial gastrocnemius muscle flap; four had lesions in the middle third, three were treated with hemisoleus muscle flap and one with a reverse sural fasciocutaneous flap. The last two patients had compromised the distal third of their legs, both were covered with sural flap. Discusion: Two cases had partial flap necrosis but they did not require another surgery. Regarding fractures consolidation, outcome depended on exposure time, having better outcomes those with shorter times. Those with longer times required more often internal bone fixation procedures. Conclusions: In case of leg fractures with internal fixation material, exposed time should be taken into account. Patients with lap times shorter than 15 days could keep the material, as long as, an antibiotic prophylaxis scheme is followed. Otherwise, fixation material replacement is warranted.

Evaluación de la restrictividad de dispositivos residenciales para personas con un diagnóstico psiquiátrico en el modelo de Salud Mental Comunitaria en Chile / Assessment of the Restrictiveness of Supported Housing Services for People with Psychiatric Diagnosis in the Model of Community Mental Health in Chile

Los hogares y residencias protegidas son elementos centrales de la red asistencial que atiende a personas con un diagnóstico de trastorno mental severo, dentro del modelo de salud mental comunitaria. Este modelo tiene como uno de sus propósitos centrales estimular la autonomía y participación social de los usuarios. Se evaluó la restrictividad presente en estos dispositivos y factores asociados a su predicción. Se evaluaron 21 servicios residenciales mediante la escala de prácticas restrictivas, que se aplicó a un cuidador por lugar. Se observó que estos dispositivos poseen un nivel de restrictividad que limita la capacidad de los residentes para tomar decisiones en aspectos de su vida. Esta situación dificulta el empoderamiento y la participación de las personas en la comunidad.

Supported housing services are key elements of the healthcare network that serves people with a diagnosis of severe mental illness, within the community mental health model. This model has as a central purpose to stimulate both autonomy and social participation of users. The restrictiveness present in these centers and factors associated to their prediction was assessed. A total of 21 residential services were assessed by means of the scale of restrictive practices applied to one caregiver per place. It was observed that these services have a level of restrictiveness that limits the ability to make decisions of the residents respect to their lives. This situation hinders both empowerment and participation of people in their communities.

Análisis psicométrico y adaptación de la Escala de Distancia Social (DS) en una muestra chilena / Psychometric analysis and adaptation of the Social Distance Scale (DS) in a Chilean sample

Antecedentes El estigma es uno de los obstáculos principales para la integración social de las personas con trastornos mentales. Objetivo Estudiar las propiedades psicométricas y adaptar la Escala de Distancia Social de Link (DS) en una muestra chilena. Ésta evalúa las actitudes públicas hacia personas con trastornos mentales mediante una viñeta seguida de un grupo de preguntas. Método Se tomaron dos muestras por conveniencia: la primera estuvo compuesta por 399 personas y la segunda por 350. La confiabilidad se evaluó por medio del coeficiente alfa de Cronbach. Para valorar su estructura factorial, se realizó un análisis factorial exploratorio con la primera muestra y uno confirmatorio con la segunda. Finalmente, se utilizó el coeficiente de correlación de Pearson para estudiar la validez concurrente con la Escala de Orientación a la Dominancia Social. Resultados Los resultados indican que el instrumento final posee dos factores "cercanía e interacción social", compuesto por tres reactivos, e "intimidad y confianza", compuesto por dos. A pesar de que las muestras tenían distinto nivel educativo, los índices de ajuste del modelo obtenido en el análisis factorial confirmatorio, así como la consistencia interna del instrumento, fueron adecuados. Discusión y conclusión La existencia de dos factores puede estar relacionada con el crecimiento del modelo de salud mental comunitaria en Chile, lo que ha impactado en la cantidad de dispositivos sanitarios y por tanto en la cercanía que se tiene sobre el tema. Los resultados obtenidos avalan la posibilidad de usar este instrumento en distintos grupos sociales.

Background Stigma is one of the major impairments to social integration of people with mental disorders. The present research was aimed to study the psychometric properties and adapt the Link's Social Distance Scale (SD) in a sample from Chile. This scale assessed the public attitudes toward people with mental disorders by means of a vignette, followed by a set of questions. Method A total of two samples by convenience were taken. The first sample consisted of 399 people and the second of 350. Reliability was assessed by means of the Cronbach's alpha coefficient. In order to validate its structure, an exploratory factor analysis of the first sample was conducted. Like waise, a confirmatory analysis was conducted with the second sample. Finally, the Pearson correlation coefficient was used to study the concurrent validity of the Orientation Scale to Social Dominance. Results Results indicate that the final instrument has two factors "proximity and social interaction," composed by three items, and "intimacy and confidence," composed by two. Despite the fact that the samples had different educational level, the adjustment indixes obtained from the confirmatory analyses, as well as the internal consistency of the instrument, were appropriate. Discussion and conclusion The existence of two factors can be related to the growth of the community mental health model in Chile. This has produced an impact on the amount of community centers and, therefore on the closeness on the subject. The results obtained support the possibility of using this instrument in different social groups.

Creencias docentes y uso de Nuevas Tecnologías de la Información y Comunicación en profesores de cinco establecimientos chilenos de educación básica y media / Teacher beliefs and use of New Technologies of Information and Communication in professors from five elementary and secondary Chilean schools

Mediante una encuesta se estudió la relación entre cinco tipos de creencias docentes -constructivismo, creencias en la efectividad de la tecnologías en educación, autoeficacia docente, autoeficacia computacional y autoeficacia de enseñanza con computadores- y la frecuencia y tipos de uso de computadores de 112 profesores de cinco establecimientos chilenos que brindan educación básica y media. Usando análisis de correlación, se obtuvo que la autoeficacia computacional, la autoeficacia de enseñanza con computadores y las creencias en la efectividad de la tecnología, presentan mayor efecto en el uso de computadores que la autoeficacia docente y el constructivismo.

This study explore the relation between five types of teacher's beliefs -constructivism, teacher self-efficacy, computer self-efficacy, self-efficacy for teaching with computers and beliefs about technology's effectiveness on education - and the frequency and variety of use for computer's instructional purposes. A questionnaire was completed by 112 teachers from five Chilean schools. Using correlation analysis, it was found that computer self-efficacy, self-efficacy for teaching with computers and beliefs about technology's effectiveness on education show greater effects on frequency and variety of use of technologies for instructional purposes over teacher self-efficacy, and constructivism.

Manejo paliativo del cáncer de vesícula biliar irresecable o metastásico: Conclusiones del Consenso Latinoamericano de Manejo del Cáncer de Vesícula Biliar / Palliative treatment for locally advanced or metastatic gallbladder cancer: conclusions of the Latin American Consensus meeting for the management of gallbladder cancer

Gallbladder cancer is a rare disease in Western developed countries, but it is a highly prevalent and lethal disease in Chile and other countries in Latin America. No randomized controlled trials have been performed in gallbladder cancer to establish standard treatments. We therefore performed the first Latin American consensus meeting for the management of gallbladder cancer. In this article we present the conclusions of the panel of experts for the palliative treatment of unresectable or metastatic gallbladder cancer based on a review of the literature, the discussion of the participating experts and the opinion of the assistants. The topics reviewed included: 1.- Gallbladder Cancer and Cholangiocarcinoma -are they the same disease?; 2. - Palliative Chemotherapy: Indications, Drugs and Schedules; 3. - Palliative Radiotherapy; 4.- Palliative Surgery; 5.-Management of Malignant Biliary Obstruction.

Divertículo duodenal em colangiografia endoscópica - CPRE: estudo retrospectivo / Duodenal diverticulum in endoscopic colangiograpy - ERCP: retrospective trial

Os divertículos duodenais se manifestam com relativa frequência durante os procedimentos de colangiografia endoscópica (CPRE), e são superados apenas pelos divertículos do cólon. Sua provável origem seria decorrente da debilidade da parede duodenal na área de fusão entre o pâncreas ventral e dorsal durante o período embrionário. Tais divertículos, localizados na região periampular, dificultam a canulação da via biliar quando são de grande tamanho. Nessa revisão, foram analisados os vídeos e informes de 2.641 CPREs, realizados entre janeiro de 2005 a abril de 2007, em clínica de terapia endoscópica. Foi traçado o perfil social dos pacientes, patologias associadas e estabelecida a taxa de sucesso do procedimento. O baixo índice de insucesso (apenas 1,02%) não reflete a dificuldade de canulação, sendo necessário, em algumas vezes, técnicas alternativas para canulação profunda da via biliar principal.

Duodenal diverticulum are present with relative frequency during Endoscopic Colangiograpy (ERCP). They are surpassed just by large intestine diverticulum. Their probable ethiology would be due to duodenal wall weakness at fusion place between ventral and dorsal pancreas in embryo. These diverticulum, at periampular region, make bile duct cannulating difficult when they are large. Videos and comments of 2641 ERCPs were analysed, performed between january 2005 and april 2007, at endoscopic therapy clinic. Patients social profile was traced, related pathologies and procedure success rate. Low rate of unsuccess (just 1,02%), doesn?t represent difficulty of cannulating, been necessary sometimes, alternative techniques for deep cannulating of common bile duct.

Utilidad de la cápsula endoscópica como método diagnóstico en el estudio de patología de intestino delgado / Experience with capsule endoscopy diagnostic tool for the small intestine

Background: Wireless capsule endoscopy (CE) is a relatively new method to evaluate the small intestine. Aim: To evaluate the indications of CE in our center and assess whether specific indications are associated with best results during CE studies. Material and Methods: Retrospective analysis of 69 patients aged 9 to 85 years (36 males) subjected to a CE at our institution between April 2004 and October 2007. Results: The most common indications for CE were overt gastrointestinal bleeding in 43.5 percent of patients, iron deficiency anemia in 39.1 percent, suspicion of a small bowel tumor in 4.3 percent, chronic diarrhea in 4.3 percent and abdominalpain in 2.9 percent. CE was normal in 23.2 percent and was able to find lesions in 76.8 percent of the studies. Gastrointestinal bleeding, followed by iron deficiency anemia were the indications associated with the higher rates of positive findings during CE. Conclusions: Gastrointestinal bleeding and iron deficiency anemia were the indications that obtained the best diagnostic y ield for CE.