Trastornos de la conducta alimentaria: alteraciones cardiovasculares al ingreso y evolución a 3 meses / Female adolescents with eating disordes: cardiac abnormalities

Background: Cardiovascular complications can occur in up to 80% of adolescent patients with eating disorders (ED) and account for 30% of their mortality. Aim: To evaluate cardiovascular complications in adolescents with ED and their evolution after refeeding. Patients and Methods: In adolescents with ED admitted to treatment, we assessed the nutritional status, weight loss prior to consultation, presence of bradycardia (BC, defined as heart rate < 60 bpm), we performed an electrocardiogram (ECG) and an echocardiography and measured thyroid hormones. Results: We studied 53 women aged 16.4 ± 2.3 years. Fifteen had a diagnosis of Anorexia Nervosa (AN), seven of Bulimia (BN), eight a not otherwise specified ED (ED-NOS), four a Binge Eating Disorder (BED), sixteen an Atypical Anorexia (AAN) and three an Atypical Bulimia (ABN). Thirty four percent were malnourished and 3.8% overweight. The most common cardiac problem was BC in 51%. In eight of 26 patients in whom an echocardiogram was done, it was abnormal. Six had a decreased ventricular mass, three a pericardial effusion and three valvular involvement. There was a significant association between bradycardia and malnutrition, weight loss and low free triiodothyronine levels. BC was significantly more common in patients with AN, but it also occurred in half of the patients with AAN and in one of three patients with other types of ED. At follow up, bradycardia significantly improved with refeeding. Conclusions: There is an association between all types of ED and bradycardia, as well as anatomical and functional cardiac anomalies.

Riesgo de trastornos alimentarios en adolescentes obesos de la Región Metropolitana / Eating disorders risk among obese adolescents

Background: Preliminary research suggests that eating disorders (ED) are common among overweight teenagers. Missing the diagnosis is a poor prognostic factor. Aim: To quantify the risk of ED and the effects of age, sex and severity of obesity in obese adolescents. Patients and Methods: We studied 99 obese adolescents with a body mass index (BMI) > percentile 95 of CDC-NCHS, 51% females, aged between 11 and 19 years, attending an obesity clinic. The Eating Disorders Inventory-2 (EDI-2) was used to evaluate the risk of ED. A score equal or higher than 110, corresponding to the 85th percentile, was considered as risky. Results: Sixteen percent of studied adolescents had EDI scores > 110. No statistically significant differences were observed by age, sex or severity of obesity. EDI-2 scores in participants with a BMI z score over and under 4 were 93.6 ± 33.9 and 78.2 ± 38.8 respectively (p = 0.02). A high percentage of participants had body dissatisfaction (BD) and drive for thinness. Bulimic symptoms, inefficacy, fear of maturity, and impulsivity scores were significantly higher among participants with a high risk of developing ED. Conclusions: Obese adolescents have a high risk for ED, regardless of their age and sex. The risk increases along with higher BMI. The routine use of screening tests is fundamental for an early detection of ED.

Intervención de salud mental para niños expuestos al desastre en la comunidad de Iloca: experiencia de la Unidad de Psiquiatría Infantil de Clínica Alemana / Mental health intervention for children exposed to disaster in the Iloca community

Se explica los pasos seguidos para realizar una intervención en Salud Mental en la población de la zona costera de la I. Municipalidad de Licantén de la VII región de Chile posterior al terremoto/maremoto del 27 de Febrero del 2010 en la zona centro sur de Chile, por parte de la Unidad de Psiquiatría Infantil del Departamento de Pediatría de Clínica Alemana. Se destaca la importancia de la evaluación de la situación local, del trabajo en equipo, de la coordinación entre diversas entidades y la necesidad de generar (en los agentes de salud local y en la población) credibilidad, confianza y percepción de pertinencia de las acciones del equipo externo. Se muestra una intervención planificada con recursos mixtos privados, públicos y trabajo voluntario de profesionales. Se valoran también la capacidad de flexibilidad en la programación inicial, la constancia en las acciones y el plantear desde el inicio estrategias a corto, mediano y largo plazo.

Matonaje escolar: bullying / Bullying

Revisión bibliográfica extensa de literatura nacional e internacional acerca del fenómeno del bullying. Se analiza la definición y descripción del problema desde una mirada amplia y sistémica, considerando el contexto en el que ocurre: la violencia social. Se revisa la prevalencia de la violencia entre pares a nivel internacional y un acercamiento a las cifras disponibles en escolares chilenos, junto con una actualización de la información acerca de los distintos actores involucrados en la dinámica bullying: agresores, víctimas, víctimas/agresores y testigos, describiendo sus características psicológicas, familiares, psicopatología y consecuencias tanto para los niños y adolescentes como para la sociedad en general. Se revisan las estrategias de prevención e intervención sobre el bullying y la violencia en general desde una mirada sistémica y científica crítica. Se sintetizan los aspectos generales y específicos de prevención (primaria, secundaria y terciaria), de acuerdo a la etapa del ciclo vital y se analiza el rol que cumple el clínico, la familia y la escuela en detectar y prevenir la violencia entre pares. Nos focalizamos en las estrategias de intervención escolar y se realiza una exhaustiva revisión de los programas escolares de prevención secundaria que han sido implementados en otros países, y que tienen efectividad comprobada científicamente.

The following paper is an extensive bibliographic review of the bullying phenomenon in international and national literature. We analyze the definition and description of bullying within its broader context: social violence. The national and international reports of the prevalence of violence within peers are presented, along with an update of the information available on the actors involved in the dynamics of bullying: aggressors (bullies), victims, bully-victims and witnesses, describing their psychological features, family characteristics, psychopathology and the consequences for the children, adolescents, and society in general. We critically reviewed the existing information on prevention and intervention strategies for bullying with a systemic and scientific outlook. Some aspects of prevention are synthesized (general and specific primary, secondary and tertiary prevention), according to the developmental stage of those involved. We analyze the role that clinicians, family and school play in preventing and detecting violence against peers. We focused on school-level interventions and a thorough description is made of the school programs for secondary prevention that have been implemented in developed countries and their effectiveness verified by scientific studies. Finally, we discuss that bullying has become a serious mental health problem for our children and adolescents as a new form of social violence. It has severe consequences for the development of our youngsters and must be recognized and evaluated in its real dimension by the multiple social actors involved. It is very important to evaluate this problem in the broader context in which it presents It self and to focus on prevention and intervention strategies according to the developmental stages of childhood and adolescence, the families involved and the scientific evidence available.

Evaluación del uso de video juego en escolares de la Región Metropolitana / Evaluation of the use of video game in school children of Metropolitan Region

Introducción: Los video juegos (VJ) producen alteraciones fisiológicas y conductuales a corto plazo. Un 10-15 por ciento de los jugadores desarrollan conductas adictivas. Objetivo: describir el uso de los VJ en población escolar de la región metropolitana, analizar variables individuales y familiares, determinando asociación entre el uso de los VJ y factores de riesgo para adicción. Diseño: Estudio prospectivo descriptivo. Autoaplicación de encuesta con criterios de Tejeiro para adicción a VJ y Apgar familiar. Se utilizó stata 8.1. Resultados: 363 niños encuestados entre 9 y 16 años. Los varones cumplen más criterios para adicción a VJ (p<0.05). Se diferenciaron 2 grupos, bajo riesgo (52.03 por ciento) y alto riesgo de adicción a VJ (47.97 por ciento). Mayor riesgo de adicción en niños insertos en familias disfuncionales con mala supervisión parental y que juegan más de una hora de lunes a viernes. Conclusiones: Se observa asociación entre mayores puntajes en la escala de adicción a VJ con sexo masculino, disfunción familiar, menor supervisión parenteral, menor rendimiento escolar y mayor número de horas dedicadas al uso de video juegos. Es fundamental ampliar la muestra para determinar si los criterios pueden ser aplicados ala población general.

Introduction: video games produce physiologic and conductual abnormalities in short terms. 10 to 15 percent of the video game players develop addictive conducts. Objetive: To describe the use of the video games in the school age population in the metropolitan region and analyze individual and family variables, to determine an association between tha use of video games and the presence of risk factors for addiction. Design: Prospective descriptive study consistent in the selfaplication questionnaire based on Tejeiros addiction to video game criteria and family Apgar. Stata 8.1 was used. Results: The questionnaire was aplicated to 363 children between 9 and 16 years old. Men fulfill more video game addiction criteria. (p < 0.05). Two groups were determined, low risk (52,03 percent) and high risk for videogame addiction was found in children with family malfunction and poor parental supervision that played video games for more than one four from monday to friday. Conclusions: There is an association between high score in the video game addiction scale, male gender, family malfunction, low parental supervision, low scholastic yield and greater number of hours dedicated to video games. It is fundamental to extend the sample, to determine whether the criteria can be applied to the general population.