Loss of Health State Utilities Attributable to Obesity.

OBJECTIVES: This study aimed to quantify the association between the loss of health state utilities (LHSU) and obesity, considering different obesity categories. This is relevant to interventions economic evaluations and for public policy decision planning. METHODS: Using data from the Chilean National Health Survey, this study uses linear regression models and counterfactual scenarios to calculate the prevalent burden, population averages, and total sum of LHSU attributable to obesity for the Chilean national level on people older than 15 years, year 2017. Adjustments for socioeconomic status and associated noncommunicable diseases (NCDs) are considered. Calculating the LHSU using these methods enables the approximation of loss of prevalent quality-adjusted life-years (QALYs). RESULTS: The raw obesity LHSU burden was 9.1% (95% uncertainty interval [UI] 5.1-13). When adjustment is considered, the LHSU attributable to obesity reaches 4.6% (95% UI 0.6-8.5) being responsible for 121 045 prevalent QALYs. Socioeconomic status adjusted analysis of higher body mass index (BMI, in kg/m2) categories of obesity shows a dose-response effect for LHSU, being the BMI ≥ 40 category with the highest population average of attributable LHSU (10.1; 95% UI 5.5-14.5, scale 0 [full health] to 100 [dead]). Burden for BMI ≥ 35 categories showed the biggest change after NCD adjustment. CONCLUSIONS: Obesity carries a significant burden of QALY loss. Policy decision-making addressing obesity should focus specially on the BMI ≥ 40 group. NCD comorbidity should be considered for policies addressing the BMI ≥ 35 group.

A Data-Driven Framework for Small Hydroelectric Plant Prognosis Using Tsfresh and Machine Learning Survival Models.

Maintenance in small hydroelectric plants (SHPs) is essential for securing the expansion of clean energy sources and supplying the energy estimated to be required for the coming years. Identifying failures in SHPs before they happen is crucial for allowing better management of asset maintenance, lowering operating costs, and enabling the expansion of renewable energy sources. Most fault prognosis models proposed thus far for hydroelectric generating units are based on signal decomposition and regression models. In the specific case of SHPs, there is a high occurrence of data being censored, since the operation is not consistently steady and can be repeatedly interrupted due to transmission problems or scarcity of water resources. To overcome this, we propose a two-step, data-driven framework for SHP prognosis based on time series feature engineering and survival modeling. We compared two different strategies for feature engineering: one using higher-order statistics and the other using the Tsfresh algorithm. We adjusted three machine learning survival models-CoxNet, survival random forests, and gradient boosting survival analysis-for estimating the concordance index of these approaches. The best model presented a significant concordance index of 77.44%. We further investigated and discussed the importance of the monitored sensors and the feature extraction aggregations. The kurtosis and variance were the most relevant aggregations in the higher-order statistics domain, while the fast Fourier transform and continuous wavelet transform were the most frequent transformations when using Tsfresh. The most important sensors were related to the temperature at several points, such as the bearing generator, oil hydraulic unit, and turbine radial bushing.

[Suicide attempts and self inflicted harm: a one year follow up of risk behaviors among out of treatment cocaine users]. / Intentos de suicidio y heridas auto-inferidas: 12 meses de seguimiento de conductas de riesgo de consumidores de cocaína no consultantes de servicios de rehabilitación.

BACKGROUND: Cocaine users tend to have a higher frequency of risk behaviors. AIM: To compare risk behaviors of out -of -treatment Cocaine Base Paste (CBP) and Cocaine Hydrochloride (CH) users, by means of Privileged Access Interviewing in a one- year prospective study. MATERIAL AND METHODS: Twenty -eight interviewers were trained to recruit and administer a questionnaire on substance use patterns and related risk behaviors. Intentioned sampling was carried out in four municipalities of Santiago, Chile. Subjects who used CBP (group 1) or CH (group 2) at least once in the last month, with primary current use of CBP (group 1) or CH (group 2), and without treatment for substance abuse in the last six months were interviewed. Generalized Estimating Equations (GEE) were employed to compare risk behaviors during follow -up. RESULTS: Four hundred and two of 467 subjects (86.1%) were followed up for one year. CBP users (n = 204) reported greater frequency of self -inflicted injuries (Odds Ratio (OR): 1.97 [95% confidence intervals (CI): 1.07-3.66]) and suicide attempts (OR: 2.68 [95% CI: 1.19-6.01]) than CH users. CONCLUSIONS: CBP users had a greater frequency of self -inflicted injuries and suicide attempts, both life threatening risk behaviors, than CH users. This profile shows the high vulnerability of CBP users and should encourage further research and design of outreach interventions, particularly focused on this group.

Intentos de suicidio y heridas auto-inferidas: 12 meses de seguimiento de conductas de riesgo de consumidores de cocaína no consultantes de servicios de rehabilitación / Suicide attempts and self inflicted harm: a one year follow up of risk behaviors among out of treatment cocaine users

Background: Cocaine users tend to have a higher frequency of risk behaviors. Aim: To compare risk behaviors of out ­of ­treatment Cocaine Base Paste (CBP) and Cocaine Hydrochloride (CH) users, by means of Privileged Access Interviewing in a one­ year prospective study. Material and Methods: Twenty ­eight interviewers were trained to recruit and administer a questionnaire on substance use patterns and related risk behaviors. Intentioned sampling was carried out in four municipalities of Santiago, Chile. Subjects who used CBP (group 1) or CH (group 2) at least once in the last month, with primary current use of CBP (group 1) or CH (group 2), and without treatment for substance abuse in the last six months were interviewed. Generalized Estimating Equations (GEE) were employed to compare risk behaviors during follow ­up. Results: Four hundred and two of 467 subjects (86.1%) were followed up for one year. CBP users (n = 204) reported greater frequency of self ­inflicted injuries (Odds Ratio (OR): 1.97 [95% confidence intervals (CI): 1.07­3.66]) and suicide attempts (OR: 2.68 [95% CI: 1.19­6.01]) than CH users. Conclusions: CBP users had a greater frequency of self ­inflicted injuries and suicide attempts, both life threatening risk behaviors, than CH users. This profile shows the high vulnerability of CBP users and should encourage further research and design of outreach interventions, particularly focused on this group.

A family outreach intervention for engaging young out-of-treatment drug users: pre- versus post-treatment comparison.

Only a small fraction of drug users worldwide enter treatment each year. We evaluated the efficacy of a systemic family outreach intervention (SFOI) for young, untreated drug users, using a quasi-experimental design in which the experimental group (EG) received SFOI and the control group (CG) received traditional outreach work (OW). Both pre- and post-treatment, we administered the Addiction Severity Index-6 (ASI-6), the Family Environment Scale (FES), and tests of parental practices and risky behavior. Post-treatment, there was a fivefold improvement on the ASI-6 and a significant worsening on the conflict sub-scale of the FES in the EG as compared with the CG. SFOI was more efficacious than OW in reducing drug use in the drug user's home environment. The increased conflict in the EG might be explained by parents' increased awareness of abnormal behaviors and implementation of strategies to protect their children.

Validez y confiabilidad de la versión chilena del Alcohol Use Disorders Identification Test (AUDIT) / Assessment of the alcohol use disorders identification test (AUDIT) to detect problem drinkers

Background: AUDIT is a self-reported questionnaire used to detect problem drinkers. It must be translated into Spanish and validated in order to be used in Chile. Aim: To assess the validity of a Chilean version of the AUDIT questionnaire. Material and methods: The English version of the questionnaire was translated into Spanish and adapted to the Chilean cultural environment. Using the Delphi method, an expert group examined the text and then decided on which would be the definitive version. This test was translated to English again and was approved by one of the original authors. It was then applied to 93 subjects aged 37 ± 12 years (60 percent males) consulting at a primary health care center These subjects also answered the Composite International Diagnostic Interview (CIDI), version 2.1 that was used as the gold standard for the diagnosis of hazardous drinking and alcohol dependence. Cronbach alpha and test-retest validity were analyzed. Sensitivity and specificity were determined using receiver operating (ROC) curves. Results: The internal consistency of AUDIT was 0.93, its test re-tests reliability was 0.97 (95 percent confidence intervals 0.96-0.98). Using a cutoff point of 6 for hazardous consumption, its sensitivity and specificity were 83 percent and 88 percent, respectively. The figures for dependence and harmful consumption, using a cutoff point of 9, were 87 percent and 85 percent, respectively. Conclusions: AUDIT is a valid questionnaire to detect problem drinkers.

The Alcohol Use Disorders Identification Test (AUDIT) as a screening instrument for adolescents.

BACKGROUND: The Alcohol Use Disorders Identification Test (AUDIT) is an international screening instrument extensively employed in adult target groups. However, there is scarce information on screening with the AUDIT in adolescent populations. The purpose of this study was to determine the cut-off point for hazardous, harmful, and dependent alcohol use through the validation of the AUDIT in a Chilean adolescent sample. METHODS: The original English version of the AUDIT was translated into Spanish, using the procedure recommended by the World Health Organization. The text was then back-translated and sent to one of the original authors (Thomas Babor), who approved the translation. Students attending public schools in Santiago, Chile, self-administered the AUDIT, and those older than 15 years completed the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM), which served as a gold standard. Between 1 and 4 weeks after the CIDI-SAM, participants answered a second AUDIT. RESULTS: A total of 42 female and 53 male adolescents (mean age: 15.9 [SD=1.2]) completed the AUDIT, with a mean score of 4.3. Reliability according to Cronbach's alpha was 0.83. Test-retest correlation was also satisfactory (intra-class correlation 0.81 [95% CI 0.73-0.87]). Analysis of the receiver operating characteristic (ROC) curve yielded cut-off points for hazardous, harmful, and dependent alcohol use of 3, 5, and 7 points, respectively. CONCLUSIONS: The Chilean version of the AUDIT is a valid and reliable tool for identifying adolescents with hazardous, harmful, and dependent alcohol use. The suggested cut-off points make screening with the AUDIT more accurate for adolescent populations.

[Assessment of the alcohol use disorders identification test (AUDIT) to detect problem drinkers]. / Validez y confiabilidad de la versión chilena del Alcohol Use Disorders Identification Test (AUDIT).

BACKGROUND: AUDIT is a self-reported questionnaire used to detect problem drinkers. It must be translated into Spanish and validated in order to be used in Chile. AIM: To assess the validity of a Chilean version of the AUDIT questionnaire. MATERIAL AND METHODS: The English version of the questionnaire was translated into Spanish and adapted to the Chilean cultural environment. Using the Delphi method, an expert group examined the text and then decided on which would be the definitive version. This test was translated to English again and was approved by one of the original authors. It was then applied to 93 subjects aged 37 +/- 12 years (60% males) consulting at a primary health care center These subjects also answered the Composite International Diagnostic Interview (CIDI), version 2.1 that was used as the gold standard for the diagnosis of hazardous drinking and alcohol dependence. Cronbach alpha and test-retest validity were analyzed. Sensitivity and specificity were determined using receiver operating (ROC) curves. RESULTS: The internal consistency of AUDIT was 0.93, its test re-tests reliability was 0.97 (95% confidence intervals 0.96-0.98). Using a cutoff point of 6 for hazardous consumption, its sensitivity and specificity were 83% and 88%, respectively. The figures for dependence and harmful consumption, using a cutoff point of 9, were 87% and 85%, respectively. CONCLUSIONS: AUDIT is a valid questionnaire to detect problem drinkers.

Disfonía funcional: variables clínicas y terapéuticas / Functional dysphonia: clinical and therapeutic variables

Se ha observado en los últimos años, en el Hospital del Trabajador de Santiago, un incremento en el número de pacientes aquejados de patología funcional de la voz. Con el objetivo de optimizar su tratamiento, se analizaron las características sociodemográficas y clínicas de una muestra de pacientes con disfonía funcional y su posible relación con la respuesta terapéutica. Se estudiaron retrospectivamente 77 pacientes mujeres, con diagnóstico de disfonía funcional, derivadas a la unidad de salud mental del Hospital del Trabajador. El tratamiento fue ambulatorio e incluyó evaluaciones periódicas por otorrinolaringólogo, sesiones de foniatría y, la evaluación y tratamiento de salud mental cuando se estimó necesario. La muestra estuvo constituida en un 87 por ciento por profesores. Presentaron diagnóstico psiquiátrico el 74 por ciento de las pacientes, predominando los trastornos adaptativos y personalidades vulnerables. Los conflictos más frecuentes fueron de origen laboral y familiar. Se discute el rol de variables sociodemográficas y clínicas en el tratamiento y la evolución de la disfonía funcional.

Trastornos invernales del ánimo / Winter mood disorders

La existencia de trastornos del ánimo de recurrencia estacional está plenamente demostrada en el mundo, siendo denominado trastorno afectivo estacional (TAE). En Chile, el TAE no ha sido formlmente descrito. El presente trabajo tiene por objeto estudiar la concordancia clínica y terapéutica de una serie de pacientes con depresiones de recurrencia invernal, con las características de series extrajeras de TAE. Se reclutaron 12 pacientes con depresión mayor actual, que cumplieron con los requisitos internacionales de recurrencia estacional y se estudió su pérfil de síntomas y se evaluó su respuesta a 10 sesiones de fototerapia de acuerdo a un protocolo estandarizado. Se observó una estrecha concordancia de los síntomas y la respuesta a fototerapia con las series extranjeras. Se trata de la primera serie nacional de TAE. Se discute su relevancia clínica