Estudio descriptivo de mortalidad en sobrevivientes de tortura y prisión política en el período de la dictadura militar en Chile, 1973-1990

Background: Studies on the long-term consequences of torture in survivors in Chile have only addressed the consequences for mental health, leaving aside the physical consequences. Aim: To report the causes of death in the universe of victims of the Chilean civic-military dictatorship recognized by the Reports of the National Commission for Political Prison and Torture (CNPPT) and the Advisory Commission for the qualification of Disappeared Detainees, Politically Executed individuals and Victims of Political Prison and Torture. Material and Methods: The causes of death, age at the time of death, sex, political context of death and opportunity of repair up to June 2016 are described in 38,254 victims of the Chilean civic-military dictatorship. Results: Of the universe of 38,254 victims, 9,152 (23.9%) died until June 2016. The median age at death was 68 years. The main causes of death were malignant tumors in 28%, cardiovascular diseases in 27%, respiratory diseases in 10%, digestive diseases in 9% and external causes in 8%. Conclusions: These results can inform prevention and treatment strategies for victims of the Chilean dictatorship.

Implementing the protocol of a pilot randomized controlled trial for the recovery-oriented intervention to people with psychoses in two Latin American cities / Implementação de um protocolo para um estudo piloto randomizado e controlado sobre uma intervenção voltada para a recuperação em pessoas com psicoses em duas cidades latino-americanas / Implementando un protocolo para una prueba piloto controlada aleatorizada en una intervención orientada a la recuperación de personas con psicosis en dos ciudades latinoamericanas

Several Latin American countries have made remarkable strides towards offering community mental health care for people with psychoses. Nonetheless, mental health clinics generally have a very limited outreach in the community, tending to have weaker links to primary health care; rarely engaging patients in providing care; and usually not providing recovery-oriented services. This paper describes a pilot randomized controlled trial (RCT) of Critical Time Intervention-Task Shifting (CTI-TS) aimed at addressing such limitations. The pilot RCT was conducted in Santiago (Chile) and Rio de Janeiro (Brazil). We included 110 people with psychosis in the study, who were recruited at the time of entry into community mental health clinics. Trial participants were randomly divided into CTI-TS intervention and usual care. Those allocated to the intervention group received usual care and, in addition, CTI-TS services over a 9-month period. Primary outcomes include quality of life (WHO Quality of Life Scale - Brief Version) and unmet needs (Camberwell Assessment of Needs) at the 18-month follow-up. Primary outcomes at 18 months will be analyzed by Generalized Estimating Equations (GEE), with observations clustered within sites. We will use three-level multilevel models to examine time trends on the primary outcomes. Similar procedures will be used for analyzing secondary outcomes. Our hope is that this trial provides a foundation for planning a large-scale multi-site RCT to establish the efficacy of recovery-oriented interventions such as CTI-TS in Latin America.

Diversos países latino-americanos já alcançaram avanços notáveis na oferta de assistência em saúde mental para pessoas com psicoses. No entanto, as clínicas de saúde mental geralmente realizam atividades de extensão muito limitadas dentro das comunidades, tendem a ter vínculos fracos com a assistência primária, raramente envolvem os próprios pacientes nos cuidados e poucas vezes prestam serviços orientados para a recuperação. O artigo descreve um estudo piloto randomizado e controlado sobre a Critical Time Intervention-Task Shifting (CTI-TS), que teve como objetivo analisar essas limitações. O estudo piloto foi realizado em Santiago (Chile) e no Rio de Janeiro (Brasil). Teve como meta a inclusão de 110 pessoas com psicose, recrutadas no momento da entrada em clínicas comunitárias de saúde mental. Os participantes foram randomizados para o CTI-TS ou para os cuidados usuais. Aqueles alocados ao grupo da intervenção receberam os cuidados usuais e os serviços de CTI-TS ao longo de 9 meses. Os desfechos primários incluíram a qualidade de vida (WHO Quality of Life Scale - Brief Version) e as necessidades não atendidas (Camberwell Assessment of Needs) no acompanhamento aos 18 meses. Os desfechos primários aos 18 meses serão analisados com a técnica de Equações de Estimação Generalizadas (GEE), com as observações agrupadas dentro dos locais do estudo. Serão utilizados modelos em três níveis para examinar as tendências temporais nos desfechos primários. Procedimentos semelhantes serão utilizados para analisar os resultados secundários. Espera-se que o estudo forneça uma base para planejar um estudo randomizado e controlado em grande escala e em múltiplos locais para estabelecer a eficácia da intervenção orientada para a recuperação, a exemplo da CTI-TS, na América Latina.

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La salud como derecho en la misión fundacional de la Escuela de Salud Pública de la Facultad de Medicina de la Universidad de Chile: un análisis histórico / Health as a right in the founding mission of the School Of Public Health, School Of Medicine, University Of Chile: a historical analysis / A saúde como direito na missão fundacional da Escola De Saúde Pública Da Faculdade De Medicina Da Universidade de Chile: uma análise histórica

Este trabajo explora el contexto histórico en el cual se origina la Escuela de Salud Pública de la Universidad de Chile (ESP). Se estudia un periodo de tiempo comprendido entre fines del siglo XIX y mediados del siglo XX. En primer lugar, se analizan las posiciones de cuatro actores claves (la élite, los médicos y profesionales de la salud, las capas populares, y el Estado) y sus conflictos. En segundo lugar, se estudia el cambio de paradigma en el rol del Estado frente a los problemas de salud, desde una posición de “Estado subsidiario y gendarme” a una de “Estado asistencial de compromiso”. La ESP surge como producto de estos procesos históricos, para cubrir la necesidad de formar especialistas en el campo de la salud pública, obteniendo un apoyo externo de la Fundación Rockefeller que se resulta fundamental en su inicio. Desde sus inicios tiene un fuerte involucramiento en la vida pública del país, asumiendo la salud de la población como un derecho social.

The historical context in which the School of Public Health of the University of Chile was born is explored in this work. The period studied goes from the end of the 19th century to middle of the 20th Century. In the first place, the position of the four key actors - the elite, doctors and health professionals, popular layers, and the State - and their conflicts are analyzed. In the second place, the change of paradigm in the role of the State regarding health problems, from a position of “Subsidiary Gendarme State” to a new position of “Welfare Committed State” is studied. The School of Public Health was born as a result of these historical processes, to cover the need to train specialists in the field of public health, getting external support from the Rockefeller Foundation which was essential in its beginnings. Since its origin it has been greatly involved in the country´s public life, understanding people´s health as a social right.

Este trabalho analisa o contexto histórico no qual teve origem a Escola de Saúde Pública da Universidade do Chile (ESP). Estuda-se um período de tempo que varia entre finais do século XIX e meados do século XX. Em primeiro lugar, são analisadas as posições dos quatro jogadores-chave (a elite, os médicos e profissionais de saúde, os setores populares, e o Estado) e seus conflitos. Em segundo lugar, analisa-se a mudança de paradigma no papel do Estado a partir dos problemas de saúde, a partir de uma conceição de “Estado subsidiário e gendarme” para uma de “Estado assistencial de compromisso” A ESP surge como resultado desses processos históricos, para atender a necessidade de formação de especialistas no domínio da saúde pública, obtendo um apoio externo da Fundação Rockefeller, que é essencial no início. Desde a sua criação tem uma forte participação na vida pública do país, assumindo a saúde da população como um direito social.

Estudio multicéntrico para la validación de la versión en español del Eating Disorder Diagnostic Scale / Validation of the Spanish version of the Eating Disorders Diagnostic Scale

Background: The Eating Disorders Diagnostic Scale (EDDS) is a self-administered low cost psychometric instrument with excellent levels of temporal reliability and validity. Aim: To adapt and validate the EDDS in Chile. Material and Methods: Thefactorial structure, internal consistency and test-retest reliability ofthe Spanish-language version of the EDDS was analyzed in a sample of1964 university and high school students. The concurrent validity was tested in a sample of 50 primary care patients with ED and 59 controls, comparing its results with those of a structured psychiatric interview (CIDI). Results: The EDDS showed a high internal consistency, moderate test-retest reliability, an appropriate factorial structure (in women) and an excellent convergent validity. Also, the diagnosis of ED obtained with the EDDS is moderately consistent with the structured psychiatric interview. Conclusions: The Spanish-language version of the EDDS showed a satisfactory psychometric behavior and a good capacity for detecting ED, according to the DSM criterion.

Evaluación de psicopatología en adultos víctimas de prisión política y tortura durante su infancia y adolescencia / Evaluation of psychopathology in adult victims of political imprisonment and torture during their adolescence and childhood

Objetivo: Evaluar la presencia de indicadores de psicopatología en adultos que fueron prisioneros políticos en infancia y/o adolescencia durante la dictadura militar chilena. Material y método: Estudio de casos y controles en que se compararon indicadores de trastornos mentales en tres grupos: A) adultos con antecedente de tortura en infancia y/o adolescencia sin reparación psicosocial, B) adultos con antecedentes de tortura con reparación psicosocial y C) adultos que han vivido su infancia y/o adolescencia durante la dictadura, sin antecedentes de tortura. Se utilizo una muestra no aleatoria de 60 personas. Se midieron indicadores de depresión, ansiedad (estado/rasgo), trastorno de estrés postraumático (TEPT) y trastorno de personalidad con escala especificas. Resultados: Existen diferencias significativas en los indicadores de trastornos mentales estudiados entre aquellos adultos que tienen antecedentes de tortura y los que no. Sin embargo, no existen diferencias significativas entre aquellos que no han recibido reparación psicosocial de los que sí la han recibido. Conclusiones: Existe asociación entre trauma extremo en infancia y/o adolescencia y psicopatología adulta y la posibilidad de cronificarse depende de las variables sociales interactuantes.

Objective: Evaluate the presence of psychopathology indicators in adults who were political prisoners during childhood and/or adolescence, during the Chilean military dictatorship. Materials and methods: Case studies and controls, in which indicators of mental disorders were compared in three groups: A) adults who suffered torture and have not received psychosocial treatment, B) adults who suffered torture who did receive psychosocial treatment, and C) adults whose adolescence and/or childhood took place during the dictatorship, who did not suffer torture. A nonrandom sample of 60 people was used. Indicators of depression, anxiety (state/trait), post traumatic stress syndrome (PTSD) and personality disorder were measured with specific scales. Results: There are significant differences in the indicators of mental disorder studied, between those adults who suffered torture and those that did not. Nevertheless, there are not significant differences between those that received psychosocial treatment and those that did not. Conclusions: There is an association between external trauma in childhood and/or adolescence, and psychopathology in adults, and that the possibility of disorders becoming chronic or not depends on interacting social variables.