[Medical education and well-being: orientations towards the implementation of a positive teaching]. / Educación médica y bienestar: orientaciones para el desarrollo de una educación médica positiva.

The transition to and through college can affect the mental health of college students. The situation in medical students is particularly worrisome, considering that they have high rates of psychopathology. These mental health problems can be associated with worse academic and professional outcomes and worse patient care. In this scenario, it is relevant to look at how this problem can be addressed considering variables of both mental health and educational systems in medicine. Therefore, initiatives to promote well-being during the career are proposed. The importance of well-being at an institutional level should be defined. Also, the foundations of learning neurosciences from the point of view of well-being should be incorporated. Considering that well-being goes beyond the absence of discomfort, the role of educational environment both in learning and in mental health should be recognized. Proven effective interventions should be incorporated. It must be considered that not every initiative linked to well-being is necessarily positive and that discomfort to a certain extent can be exploited educatively as well. The well-being of medical students is a complex, dynamic and multidimensional issue. These principles are orientations for different actors of the educational process, to define how they will approach this problem in their contexts.

Educación médica y bienestar: orientaciones para el desarrollo de una educación médica positiva / Medical education and well-being: orientations towards the implementation of a positive teaching

The transition to and through college can affect the mental health of college students. The situation in medical students is particularly worrisome, considering that they have high rates of psychopathology. These mental health problems can be associated with worse academic and professional outcomes and worse patient care. In this scenario, it is relevant to look at how this problem can be addressed considering variables of both mental health and educational systems in medicine. Therefore, initiatives to promote well-being during the career are proposed. The importance of well-being at an institutional level should be defined. Also, the foundations of learning neurosciences from the point of view of well-being should be incorporated. Considering that well-being goes beyond the absence of discomfort, the role of educational environment both in learning and in mental health should be recognized. Proven effective interventions should be incorporated. It must be considered that not every initiative linked to well-being is necessarily positive and that discomfort to a certain extent can be exploited educatively as well. The well-being of medical students is a complex, dynamic and multidimensional issue. These principles are orientations for different actors of the educational process, to define how they will approach this problem in their contexts.

Regional Brain Perfusion Is Associated with Endothelial Dysfunction Markers in Major Depressive Disorder.

BACKGROUND: Major depressive disorder (MDD) is an important independent risk factor for cardiovascular disease. Cumulative data suggest that depressive patients exhibit derangement in regional cerebral blood flow (rCBF), although underlying mechanisms remain mostly unknown. Endothelial dysfunction (ED), defined as different forms of abnormal endothelial activity, plays a key role in the pathogenesis of vascular disease. ED is associated with several clinical conditions characterized by high cardiovascular risk. Diverse ED markers have been found in mood disorders. PURPOSE: To evaluate the association between rCBF and peripheral ED markers in MDD patients, at baseline and after selective serotonin receptor inhibitors (SSRIs) therapy. PATIENTS AND METHODS: Twenty-seven untreated unipolar MDD patients in their first episode were evaluated with the Hamilton Depression Rating Scale (HAM-D) and brain perfusion SPECT at baseline and after 2 months of SSRIs. Statistical Parametric Mapping (SPM) was employed to evaluate rCBF; circulating endothelial cells (CECs), plasma soluble intercellular adhesion molecule (sICAM), and high-sensitivity C-reactive protein (hsCRP) were used as independent covariates. RESULTS: Baseline CECs and sICAM were increased in MDD patients compared with matching controls (p = 0.0001) and hsCRP (p = 0.03). HAM-D scores (21 items) and CECs diminished after SSRI therapy in MDD patients (p < 0.0001). There was a significant rCBF decrease, mainly in deep central structures. HAM-D change was associated with rCBF decrease at the left amygdala, right striatum levels, and Brodmann area 25. CEC change was associated with rCBF at deep brain level and sICAM with large rCBF areas at the left caudate and tectum; hsCRP was associated, to a lesser extent, with the left dorsal striatum and mesencephalic tectum. CONCLUSION: ED markers in patients with MDD are associated with significant changes in rCBF which are features of depression. These findings suggest that systemic damage/activation of the endothelium may contribute to the abnormal rCBF observed in MDD patients.

Seasonal variation of sexual abuse in Santiago de Chile.

BACKGROUND: Seasonal variations of sexual crime have been seldom studied in the world. Santiago, a city situated at 33 degrees south latitude with a well defined four season climate, has a reliable forensic registry, providing a good opportunity for the assessment of seasonality in this type of crime. MATERIALS AND METHODS: After studying monthly records of sexual abuse from the registry of the Servicio Médico Legal of Santiago between 1990 and 2001, a ratio of observed to expected monthly frequency was obtained, allowing the assessment of the seasonal character of the phenomenon. RESULTS: A total number of 11,844 cases of sexual abuse were recorded during 12 years of the study. Statistically significant differences could be demonstrated between spring and autumn, with a peak in November and a nadir in June. CONCLUSIONS: A distinct seasonal pattern can be set forth for sexual abuse in Santiago, Chile.

Consumo de psicofármacos en la población general del Gran Santiago, Chile / Use of psychotropic drugs in general population in Santiago, Chile

Objetivo. Describir los patrones de consumo de psicofármacos en la población de Santiago, Chile. Materiales y Método. Estudio transversal de una muestra representativa de la población de 16 a 64 años, residentes en Santiago, Chile. se aplicó una entrevista estructurada que incluyó preguntas acerca del consumo de psicofármacos y la CIS-R, para la detección de trastornos mentales comunes. Resultados: 3.870 personas fueron entrevistadas (52,2 por ciento mujeres, 47,8 por ciento hombres) con un 10 por ciento de rechazo. Un 6,4 por ciento de la población declara haber estado consumiendo algún psicofármaco al momento de la entrevista, especialmente benzodiazepinas (3,8 por ciento. En un modelo de regresión logística múltiple los factores independientes que se relacionaron significativamente al uso de psicofármacos fueron ser mujer, tner más de 24 años y tener un trastorno mental común. Discusión. El uso de psicofármacos en Santiago es comparable al informado en la literatura extranjera. Se confirma que los factores de riesgo má importantes parta estar consumiendo algún psicofármaco son: ser mujer, de edad avanzada y tener algún trastorno mental común.

[Trends in benzodiazepine use in primary care patients]. / Tendencia del uso de benzodiazepinas en una muestra de consultantes en atención primaria.

BACKGROUND: Benzodiazepine use is associated to a risk of abuse of dependency. In Chile benzodiazepine abuse is a public health issue. In an attempt to overcome this problem, several restrictions in their prescription were implemented by the health authority. Despite these measures, inadequate use of benzodiazepines in primary care continues to be frequent. AIM: To study the frequency of benzodiazepine use among primary care patients. MATERIAL AND METHODS: Cross sectional survey done during two days, with seven physicians working in public primary care clinics. They applied a structured questionnaire about psychotropic medication use. RESULTS: One hundred eighty eight subjects aged 46.8 +/- 17.5 years, 66% women, were interviewed. Thirty two percent were consuming a psychotropic drug and 82% of these corresponded to benzodiazepines. General practitioners and psychiatrists prescribed the drug to 75% and 13% of subjects, respectively. A higher frequency of benzodiazepine use was observed in women and in urban areas. CONCLUSIONS: Benzodiazepine use continues to be highly prevalent in primary care patients, in spite of the nationwide implementation of controlled prescriptions.

Síndrome de hombro doloroso / The painful shoulder syndrome

El hombro doloroso es una patología cuyo síntoma principal es el dolor, asociada generalmente a limitación funcional de cualquiera de los distintos movimientos que realiza la articulación. Su prevalencia es alta y es motivo de consulta frecuente para el médico general. Se presenta habitualmente después de la cuarta década de la vida, aunque puede aparecer en edades más precoces, asociada principalmente a traumas y actividad deportiva intensa. Este cuadro clínico puede ser producido por diversas patologías, originadas tanto en las múltiples estructuras anatómicas del hombro, como en ubicaciones fuera de la articulación; a pesar de la complejidad que esto pudiera significar, una anamnesis detallada y un examen físico acucioso, asociado en algunos casos a exámenes complementarios, nos permitirán hacer un diagnóstico adecuado e instaurar precozmente un tratamiento efectivo, que evite las secuelas funcionales y la perpetuación del cuadro