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Introducción: Existe escasez de instrumentos especialmente desarrollados para estudiar el apego durante la adolescencia en nuestro país. El objetivo de esta investigación fue adaptar y validar a la población chilena el AAQ (Adolescent Attachment Questionnaire). Pacientes y Método: Estudio de tipo transversal, efectuado en 199 adolescentes de entre 11 y 19 años. El AAAQ como cuestionario de autorreporte consistió en 9 ítems, distribuidos en 3 escalas de forma equitativa: a) disponibilidad; b) cooperación en la relación y c) señales de enojo y angustia. Los ítems se respondieron a través de la escala Lickert. El AAAQ originalmente fue validado en una muestra compuesta por 824 adolescentes, de los cuales 691 correspondía a población no clínica y 133 correspondían a población clínica, demostrando satisfactoria confiabilidad interna. Para la elaboración de la versión en español del cuestionario se utilizó el procedimiento de traducción-retraducción, evaluándose posteriormente la validez semántica, de contenido, de constructo y confiabilidad del mismo. Resultados: Los resultados muestran una adecuada consistencia interna del instrumento con valores de alfa de Cronbach entre 0,52 y 0,74. Además se replica la estructura factorial de la versión en inglés del AAQ. Finalmente, se entregan normas provisorias para la interpretación de los resultados que consideran diferencias de edad para una de las 3 escalas. Conclusiones: se concluye que el instrumento resulta adecuado para su uso, en cuanto es un cuestionario autoaplicado que resulta muy breve y demuestra características psicométricas similares a la versión original en inglés.

There are not enough specially developed tools to study attachment during adolescence in our country. The objective of this research is to adapt and validate the AAQ (Adolescent Attachment Questionnaire) for the Chilean population.A cross-sectional study was conducted in 199 adolescents between 11 and 19 years old. The AAQ is a self-report questionnaire consisting of 9 items, three scales of three statements each: a) Availability scale; b) Goal corrected Partnership scale and c) Angry distress scale. The items were answered with Likert-type responses. The AAAQ was originally validated in a sample of 824 adolescents, 691 of which corresponded to non-clinical population and 133 corresponded to clinical population, demonstrating satisfactory internal reliability. To create the spanish version of the questionnaire, a translation-retranslation procedure was used evaluating semantic, content, construct and reliability validity.The results showed adequate internal consistency of the instrument with Cronbach alpha's values between 0.52 and 0.74. Also, the factorial structure of the AAQ English version was replicated. Finally, temporary rules for the interpretation of results that consider age differences for one of the 3 scales are presented.It is concluded that the instrument is suitable for use because it is a short self-administered questionnaire that shows similar psychometric characteristics to the original English version.

The objective of this study is to compare the declared licit and illicit drug consumption, between paired methodology (MP) and self assessed questionnaire (CAR). We suggest that understatement of illicit drug use will be minimized with the use of peer methodology, and that licit drug understatement will not be affected using peer methodology. The population of this study is composed by male school students ranging between middle and high School. The sample reached to 301 students. The results obtained regarding illicit drug consumption in the year, tend to be higher using MP compared with the CAR. Similarly, last month consumption reached a higher prevalence using MP than using CAR. There are no significant differences in both samples, during both periods. Nevertheless, in the last 12 months, illicit drug consumption doubled the CAR report in comparison to MP. Regarding drug consumption in the last 30 days, the results also showed that CAR underestimated half of the rate stated using MP. Illicit drug consumption is significantly higher using MP, than CAR, in both periods that were studied. Illicit consumption rates of in the past year and in the last month are significantly higher using MP, particularly with Marihuana. There are no statistical differences in the same periods, regarding licit drug consumption rate, as alcohol and tobacco.

El problema del consumo de drogas es una preocupación mundial fundamentalmente en términos de prevención. El objetivo de esta investigación fue identificar factores predictores del inicio en el consumo de drogas lícitas en escolares de 4° a 7° básico. Se encuestaron 234 participantes de dos comunas de Santiago, mediante la metodología de pares (Rodríguez & Hernández, 2005). Los resultados muestran que si bien el consumo en el último mes parece estar disminuyendo, el consumo escolar está en aumento y a una edad más temprana, lo que predice un aumento del consumo futuro. Los principales factores de riesgo asociados al uso de drogas licitas en la muestra serían no vivir con alguno de sus padres y la participación en peleas callejeras. Dentro de los factores protectores, el género femenino presenta menor riesgo de inicio en la edad escolar.

Background: It is possible that men consume a higher amount of legal and illegal drugs than women. This can be assessed using the peer methodology, that is an adaptation of the privileged access interviewers (PAI) method and allows to identify populations in which there may be a tendency to under state a phenomenon (hidden populations) Aim: To compare the consumption of legal and illegal drugs by gender. Material and methods: Drug consumption was assessed using a peer methodology in university students between 18 and 26 years of age. Results: A random sample of 56 women (mean age 21.6 years) and 86 men (mean age 21.5 years), was studied. Women tended to report a higher proportion of tobacco consumption than men. Both genders had a similar consumption behavior of alcohol, total legal drugs, marihuana, cocaine, ecstasies and total illegal drugs. Among subjects that recognized the consumption of legal drugs, men have a higher proportion of illicit drug use and women have a higher proportion of smoking. Men have a higher awareness of the damages caused by drug consumption. Conclusions: The results in these small population sample do not support the hypothesis that men have a higher frequency and proportion of illicit drug consumption (Rev Med Chile 2007; 135: 449-56). (Key words: Alcohol drinking; Cannabis; Gender identity; Street drugs; Tobacco)

In Chile, cocaine base paste (CBP) is the illegal substance that produces the highest rate of addiction. Nonetheless, a marginal number of users receive treatment each year.To compare the consumption patterns and risk behavior of CBP and cocaine hydrochloride (CH) users who do not attend rehabilitation services.In a prospective research design, through a study methodology called Privileged Access Interview of hidden populations, 28 surveyors recruited 231 CBP users (group 1) and 236 CH users (group 2). The Risk Behavior Questionnaire was applied in four communities of Metropolitan Santiago, that have the highest prevalence of PBC and CH use.CBP users showed higher schools drop-out and unemployment rates. Subjects of both groups were predominantly polysubstance and polyaddicted users. The severity of addiction to CBP of group 1 was significantly higher than the severity of addiction to CH of group 2 (5.5 versus 5.1: p0.001). CBP users showed significantly higher rates of sexual risk behaviors, antisocial behavior, self infliction of injuries, suicide attempt and child neglect.A higher vulnerability was shown for users of CBP than those of CH. Attention is drawn to the need for developing community interventions in order to alter substance abuse and the risk behavior of these vulnerable groups.

Background: In Chile, cocaine base paste (CBP) is the illegal substance that produces the highest rate of addiction. Nonetheless, a marginal number of users receive treatment each year. Aim: To compare the consumption patterns and risk behavior of CBP and cocaine hydrochloride (CH) users who do not attend rehabilitation services. Material and Methods: In a prospective research design, through a study methodology called Privileged Access Interview of hidden populations, 28 surveyors recruited 231 CBP users (group 1) and 236 CH users (group 2). The Risk Behavior Questionnaire was applied in four communities of Metropolitan Santiago, that have the highest prevalence of PBC and CH use. Results: CBP users showed higher schools drop-out and unemployment rates. Subjects of both groups were predominantly polysubstance and polyaddicted users. The severity of addiction to CBP of group 1 was significantly higher than the severity of addiction to CH of group 2 (5.5 versus 5.1: p

At the present time the assessment of results of treatment of Chagas disease is mainly parasitological. Anti Trypanosoma cruzi IgGs remain positive practically lifelong and electrocardiographic tracings are not usually used as criteria of improvement. Aim: To determine, in a long term follow up, if electrocardiographic evolution is associated with the persistence of the parasite in treated patients with chronic Chagas disease. Material and methods: Thirty patients with chronic Chagas disease that participated in a randomized trial of treatment with itraconazole or allopurinol, were studied. Seven years after treatment, patients were classified in group I if they had a positive xenodiagnosis test, polymerase chain reaction and hybridization in blood or in group II if they had negative tests. A 12 lead electrocardiogram (EKG) was performed each year to all patients. Results: Seventeen patients were classified in group I and 13 in group II. At baseline 10 patients in group I and 8 in group II had a normal EKG. Six years after treatment 13 patients in group I and 10 in group II had a normal tracing. Of those with a normal tracing at baseline, only one patient in each group presented alterations after six years. A regression of abnormal tracings was observed in four and three patients of groups I and II respectively. Conclusions: There is no association between the persistence of the parasite in treated patients with Chagas disease and the evolution of electrocardiographic tracings (Rev Méd Chile 2005; 133: 1153-60)

Introducción. Se revisan los estudios de diagnósticos psiquiátricos en niño sescolares de población general. Objetivos. Estudiar la prevalencia de desórdenes psiquiátricos, comorbilidad, discapacidad y condiciones asociadas en niños de dos cohortes de 7 colegios del Area Occidente de Santiago. Explorar las diferentes causas de discapacidad. Evaluar las continuidades y cambios en la psicopatología. Sujetos y método. Becados de Psiquiatría efectuaron una evaluación psiquiátrica y diagnóstico multiaxial CIE-10 en 162 niños en 1 básico y 210 niños en 6 básico. Resultados. La prevalencia de desórdenes psiquiátricos fue 45,7%, reduciéndose a 15,7% al asociar con discapacidad en 6 básico. 39,4% de los niños con discapacidad y diagnóstico psiquiátrico presenta comorbilidad. La comorbilidad se asocia a la discapacidad. Al analizar sólo los 38 niños con discapacidad; 33 de ellos tienen diagnóstico psiquiátrico, 3 presentan además un desorden del desarrollo y todos están sometidos a situaciones psicosociales anormales. Conclusiones. Es necesario ajustar la prevalencia agregando los criterios de discapacidad para diferenciar a aquellos niños que requieren atención especializada. Tanto los desórdenes psiquiátricos, como los trastornos de desarrollo y las situaciones psicosociales anormales contribuyen a causar discapacidad. El registro de los seis ejes de la clasificación CIE-10 permite al clínico entender mejor esta multicausalidad. Introduction. Studies of psychiatric diagnoses in schoolchildren from the general population are reviewed. Objectives. To study the prevalence of psychiatric disorders, comorbidity, impairment and associated conditions in two cohorts of schoolchildren from seven West Santiago schools. To explore multiple causes of impairment. To assess continuities and changes in psychopathology. Subjects and Method. Psychiatric fellows performed evaluations according to ICD-10 multiaxial diagnostic criteria in 162 first graders and 210 sixth graders. Results. Prevalence of psychiatric disorders was 45,7%; the figure dropped to 15,7% when associated with impairment among 6th graders. 39,4% of the children with psychiatric diagnosis and impairment have comorbidity. Comorbidity is associated with impairment. In a sample of 38 children with impairment, 33 have a psychiatric diagnosis, 3 have additional learning disorders, and all of them are living under abnormal psychosocial situations. Conclusions. It is necessary to adjust prevalence by adding impairment criteria in order to differentiate children that need specialized treatment. Psychiatric disorders as well as comorbidity, learning disorders and abnormal psychosocial situations contribute to impairment. A review of the six ICD-10 axes helps the clinician's comprehension of multiple causes.

Introducción. Existe controversia en el algoritmo de estudio de obstrucción de la vía biliar (VB). La colangiopacreatografía endoscópica retrógrada (ERCP) ha sido el examen de referencia. La colangioresonancia (CPRM) es un examen no invasivo con buena correlación entre observadores al evaluar la VB, pero aún cuestionada en nuestro medio por su mayor costo. El US convencional focalizado detecta dilatación de VB y disminuye los costos del algoritmo de estudio, seleccionando los pacientes que debieran referirse a otros métodos de estudio más costosos o invasivos (CPRM-ERCP). Objetivo. Comparar la validez, valores predictivos y cambios de probabilidad post-test de CPRM y US focalizado a la VB, en el estudio de pacientes con ictericia o sospecha de obstrucción biliar. Materiales y métodos. Se realizó un ensayo clínico pareado ciego. La muestra la constituyeron pacientes con sospecha de patología obstructiva de la VB a los cuales se les solicitó CPRM entre Enero-Julio 2003. Se les realizó US 24 hr antes o después de la CPRM por ecografistas de diferente experiencia. La CPRM se realizó con protocolos estándar, se registró el uso de Gadolinio y secuencias adicionales. El estándar dorado lo constituyeron la cirugía, la ERCP, seguimiento de al menos 30 días y revisión de informes de Anatomía Patológica. Se clasificó el riesgo de obstrucción de la VB en alto, moderado o bajo. Análisis. Se construyeron tablas de contingencia de 2x2 para estimar los valores del test: Sensibilidad (S), Especificidad (E), Valores predictivos positivo (VPP) y negativo (VPN), Likelihood ratios (LR) y probabilidades pre y post test. Resultados. Muestra constituida por 76 pacientes de los cuales 64 han completado el seguimiento. En el grupo de Alto riesgo en 21 pacientes se comprobó obstrucción, en 1 de los de moderado, en ninguno de los de bajo riesgo y en 2 de los no clasificados. La prevalencia de obstrucción (probabilidad pre-test) fue de 24/64 (37.5%). El US encontró dilatación de la VB en el 50% de los pacientes y la CPRM en el 48%. La principal causa de obstrucción fue la coledocolitiasis (25%), siendo las neoplasias la segunda. Para el diagnóstico de obstrucción de la vía biliar de cualquier causa el US mostró una S de 58.33%, la cual aumentó a 70% cuando el ecografista era experimentado, una E de 82.5%, VPP de 66.67% y VPN de 76.74% y LR(+) de 3.3 con una probabilidad post-test de 55%, un LR(-) de 0.49 con una probabilidad post-test de 20%. La CPRM para este mismo diagnóstico presentó una S de 95.83% y una E de 87.5%, así como un VPP de 82.14% y VPN de 97.22%; un LR(+) de 7.7 lo que lleva a una probabilidad post-test de 80% y un LR(-) de 0.05, con una probabilidad post-test de 3%. Para coledocolitiasis los VP(+) y VP(-) fueron, respectivamente, 53.33% y 83.67% para el US, y 70% y 95.45% para la CPRM. Conclusiones. CPRM posee sensibilidad, valores predictivos y LR(s) mejores que ultrasonido focal en la detección de obstrucción de la vía biliar. Ambos métodos poseen valores cercanos de Especificidad y de detección de dilatación de los conductos biliares. En el algoritmo de estudio de un paciente con sospecha de obstrucción de la vía biliar usar US en serie y luego CPRM cuando no se diagnostica la causa de obstrucción, sería la alternativa actual, probablemente más costo-efectiva en el estudio de estos pacientes. Between January and July, 2003, a single blinded matched trial was done to assess focalized biliary ultrasound (US) and MR cholangiography (MRCP) compared with ERCP or surgery as reference standard in patients with suspected biliary obstruction. Focalized US was performed 24 hrs before/after MRCP. Patients were triage according symptoms, signs and laboratory in high, intermediate and low risk for obstruction. Radiologists sonographers were divided in low and highly experienced. None of the radiologist who reported either US or MRCP was aware to the other test results. Sensitivity, Specificity, PPV and NPV, (LR) Likelihood Ratios and pre and post-test odds for positive and negative test were estimated. We analized 64 out of 76 sampled patients, the prevalence of obstruction was 37 % (24 out of 64 patients). US found biliary tree dilated in 50% and MRCP in 48% of the patients. Main cause of obstruction was common bile duct stones in (16) 25%. and tumors were the second more common cause. US shown a Sensitivity (S) 58.3% when a non experienced radiologist perform the exam, and 70% when an experienced radiologist doest it. Specificity (Sp) 82,5%, PPV 66.7% and NPV 76.7%. RMCP Shown S 95.8%, Sp 87.5%, PPV 82.1%, NPV 97.2% For common bile duct stones US shown a PPV 53.3% and NPV 83.6% on the other hand MRCP a PPV 70% and NPV 95.4%. MRCP perform better than focalized US in overall patients with high risk of obstruction (37.5%), detecting the cause of obstruction but using aditional sequences rising the examination time and costs. With a positive ultrasound and LR(+) 3.3 pre-test odds rise from 0.37/37% to a post-test odds of 0.55/55% and with negative test result and LR(-) 0.49 pre-test odds 0.37/37% will decrease to post-test odds of 0.2/20%. With MRCP a positive test with LR(+) 7.7 initial pre-test odds 0.37/37.5% to post-test odds of 0.8/ 80% and with a negative test result LR(-) 0.05 pretest odds 0.37/37% will decrease to post-test odds of 0.03%. Ultrasound performed by experienced sonographers has a Specificity and NPV over 80%, and perform similar to MRCP for detecting biliary tree dilatation the best predictor of obstruction. In patients with low pre-test odds (low risk) of obstruction, to use focalized US and then MRCP, when the cause of obstruction is not diagnosed could be the more cost/efective initial alternative in this patients. This data must be confirmed with further studies with cost/effectivenes analysis.

Objetivo: estimar la prevalencia lápsica de maltrato en niños y adolescentes menores de 15 años de una comuna suburbana de Santiago metropolitano. Material y método: pesquisa de maltrato entre 42 148 niños asistentes a las escuelas públicas, 81 796 beneficiarios de los servicios públicos de salud y 230 casos mensuales de denuncias judiciales que afectan a niños en la comuna de Puente Alto, Chile, a partir de la información registrada durante tres meses en escuelas, consultorios, servicios de urgencia, policía y juzgados, como parte de un estudio más amplio sobre el problema. Se calculó prevalencia lápsica corregida por sector, usando como numerador los casos, los controles que cambiaron a casos y las sospechas y, como denominador, la población potencialmente atendida por el correspondiente servicio en esa comunidad. Resultados: Se obtuvo una muestra de 245 casos y sospechas fundadas de maltrato y 394 controles. Se calculó una tasa de 23,1% de maltrato en educación, 25,3% en salud y 27,1% en justicia. Conclusión: a pesar de los muy posibles sesgos el procedimiento de pesquisa empleado puede ofrecer una aproximación útil a la magnitud del problema de maltrato en la comunidad estudiada Abuse among chilean children and adolescents. Part I: Prevalence estimation Objective: to estimate lapsic prevalence of abuse to children up to 15 years of age in one county at Santiago, Chile as a part of a wider study. Material and methods: abuse cases and matched controls were identified along a three month period from the records of comunity educational, health, police and justice facilities. Lapsic prevalence was estimated from cases among potential users, the later being 42 148 for schools, 81 796 for health services and 230 cases reported per month at selected police stations and justice courts. Results: confirmed and suspected abuse cases amounted to 245 children and controls were 349. Abuse rates among the study population were estimated as 23.1% obtained from school information, 25.3% from heath records and 27.1% from judicial data. Conclusion: in spite of its obvious biasses this method may give useful information on child abuse in other communities of this country

Cried, and serolog'C studies rot Chagas disease end for electrocardiographyc evidence of myocardicl cb^ormality were oerfonned every four mon'hs clong a one year period to 1 1 5 school male end female chilcrer (ages 9 "o 8, mecn 13.7 years), 55 infected and 60 non infected by rypa;'osarr.a cruzi, from Combarbala, at the IVth (Coauimboi Regio-, Oie. All suD^ecIs were symptom free and ri'ia serologic status (either positive or negative indirect inminohuorescense.. indirect hemaglutination and EIJSA recctions rot trypanosomiasisl did not change in anyone of them along the whole study period, nevertherless ther electrocardiographyc records snowec evidence included for chagasic cardio-nyopathy by PAHQ criteria in 22 (40%) of infected children Most frequent electrocardiograohvc abnormal'ties in these patients were prolonged QT interval and "ncomplete right buncle b'anch block. Elecrroccraiographyc signs hat were not considered among PAHO criteria for suspectec chagasic cofdiorr.yopathy were de'ecled ii 7.3% and 6.7% of infected and non infec:ed children respectively. Ninety one percent o chagasic patients wth sig^s of sugeslng soecif'c carciomyopathy had at least one ncrnal elect'ocardiocram scnetime along the fcllovy-up period. This las: finding was not seen in patients considerec to have ccrdiopathy of ano'her ethiclogy.

Cell-mediated immune response was evaluated by multitest for cutaneous delayed hypersensitivity with seven recall antigens and a glycerol diluent control in children with recurrent infections. Fifty patients, aged 4.9 years mean (range 1 to 14 years), were selected by a score based on frequency, localization, severity and etiology of infectious episodes (Hosking)13. Results were confronted with those obtained from 21 healthy children aged 4.4 years mean (range 1 to 4 years, p; ns). Patients had lower number of positive reactions (2.06 vs 3.95) and lower sum up diameter of all positive indurations (7.29 vs 13.69) than controls (p < 0.01). Responses to tetanic, diphteric, tuberculin and Proteus mirabitis antigens were significantly lower in patients versus controls (magnitudes). Anergy was detected in 20% of patients. Diminished cellular immune response in children with recurrent infections may be adquired and transient. This alteration may worsen their pathological conditions or it mat be the consequence of multiple infectious episodes.