[Serum lipid levels in a group of cocaine dependent subjects in recent abstinence]. / Descripción de los hallazgos en el perfil lipídico y proteico de pacientes dependientes a cocaína, en abstinencia reciente.

BACKGROUND: Chronic cocaine users develop multiple potentially lethal ischemic vascular complications associated with accelerated atherosclerosis. AIM: To assess biochemical and lipid profiles among cocaine dependent subjects in recent abstinence. MATERIAL AND METHODS: A blood sample to measure blood count, biochemical and lipid profiles was obtained from 78 patients aged 19 to 53 years (78% males) who complied with DSM-IV criteria for cocaine dependency. Laboratory results were compared with a group of normal subjects. RESULTS: All cases had positive urinary cocaine, with a mean consumption lapse of 7.6 years. The frequency of smoking was higher in cases. Dependent males had higher body mass index than controls. Compared to controls, dependent females had significantly higher triglyceride (TG) levels and lower HDL cholesterol. Therefore the relation total/HDL cholesterol was higher (p = 0.0365). Dependent males had higher TG levels than their normal counterparts. Dependent subjects consuming cocaine base-paste had higher TG levels. Total proteins, albumin, urea and blood urea nitrogen were lower in dependent subjects. Among males, serum creatinine was lower and blood urea was positively correlated with the daily amount of cocaine use (p = 0.03). After a month of strict abstinence, lipid profile was repeated in 27 patients and remained unchanged. CONCLUSIONS: Chronic cocaine use was associated with higher TG in both genders and lower HDL cholesterol in women when compared with a group of healthy counterparts.

Platelet activation in chronic cocaine users: effect of short term abstinence.

Cocaine abuse increases the risk of cardiac and cerebrovascular events, such as myocardial infarction and ischemic stroke. The underlying mechanisms leading to these complications are not fully understood although intravascular thrombus formation has been observed. The aim of this study was to investigate the existence of platelet activation and the effect of short-term abstinence in chronic cocaine consumers. We studied 23 cocaine dependent individuals (aged 20-54 years) who met DSM-IV criteria for cocaine dependence and 20 controls. Samples were obtained at baseline, within 72 h of last drug exposure and after 4 weeks of controlled abstinence. Monocyte-platelet aggregates (MPA) were measured by flow cytometry. Plasma levels of soluble CD40L (sCD40L), Neutrophil-Activating Peptide-2 (NAP-2) and regulated on activation normal T cells expressed and secreted (RANTES) were determined by ELISA. Levels of MPA, sCD40L, NAP-2 and RANTES were significantly higher (all p < 0.05) in cocaine addicts compared to controls at baseline. All the parameters returned to values similar to the control group after 4-weeks' abstinence. Levels of sCD40L and RANTES were associated with an index of intensity of drug consumption (p < 0.02). Our results demonstrate that cocaine use induces platelet activation which is a prominent finding after recent consumption. The persistence over time of this condition may contribute not only to acute thrombotic complications but also to the development of early-onset atherosclerotic process observed in cocaine abusers.

Changes in regional cerebral blood flow are associated with endothelial dysfunction markers in cocaine-dependent patients under recent abstinence.

OBJECTIVES: Cocaine is a known risk factor for several vascular ischemic events. The underlying mechanisms leading to the complications are not fully understood, although thrombus formation and accelerated atherosclerosis are prominent findings. Evidence of endothelial dysfunction (ED), a key phenomenon in the pathogenesis of atherogenesis, has been demonstrated in cocaine-dependent individuals. Abnormal regional cerebral blood flow (rCBF) is a common finding among chronic cocaine users. The aim of this study was to evaluate whether brain perfusion changes were associated with ED markers in cocaine-dependent individuals. METHODS: Circulating endothelial cells (CECs), soluble intercellular cell adhesion molecule, and the chemokine regulated on activation normal T cells expressed and secreted were measured in 27 DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition) cocaine-dependents patients. Regional cerebral blood flow was assessed using single-photon emission computed tomography at baseline (after recent cocaine consumption) and after 4 weeks of strict abstinence under standard benzodiazepine or antipsychotic therapy. We used statistical parametric mapping analysis to evaluate the covariates. RESULTS: Endothelial cell damage/activation markers were significantly higher in cocaine-dependent individuals after recent consumption and were reduced after 1-month abstinence (P < 0.05). Global rCBF exhibited no significant difference between baseline and after abstinence. When regional perfusion was analyzed in association with ED covariates, significant differences were observed in bilateral cortical areas, including the limbic lobes. CONCLUSIONS: We demonstrated an association between systemic ED markers and rCBF in cocaine-dependent patients. These findings suggest that vascular injury may play a role in the pathogenesis of abnormal rCBF.

Increased number of circulating endothelial cells and plasma markers of endothelial damage in chronic cocaine users.

BACKGROUND: Cocaine use has been related with the development of accelerated atherosclerosis and with an increased risk of cardiac and cerebrovascular events, such as myocardial infarction, sudden cardiac death, and ischemic stroke. The underlying mechanisms leading to these complications are not fully understood, although thrombus formation and altered vascular function are prominent findings. OBJECTIVES: Our aim was to evaluate markers of endothelial dysfunction in chronic cocaine consumers before and after drug withdrawal. PATIENTS/METHODS: We determined circulating endothelial cells (CECs) and plasma levels of stromal cell-derived factor-1 (SDF-1), monocyte chemotactic protein-1(MCP-1), soluble intracellular adhesion molecule (sICAM), high-sensitivity C reactive protein (hsCRP) and endothelin-1(ET-1), in DSM-IV cocaine addicts at baseline and after one month of cocaine abstinence. RESULTS: Cocaine users showed a strikingly higher numbers of CEC (62.35 ± 18.4 vs 8.25 ± 13.8 CEC/mL) and significantly elevated plasma levels for all the markers evaluated as compared to the control group. After cocaine withdrawal, patients improved SDF-1, ET-1, hsCRP and sICAM levels. However, CEC number and MCP-1 plasma levels remained significantly elevated. All the results were adjusted for blood levels of cholesterol and triglycerides and for smoking habit. CONCLUSIONS: Our results demonstrated that chronic cocaine consumption alters several functions of the endothelium towards a pro-thrombotic condition and that some of those functions remain abnormal even after short-term drug withdrawal. These observations support the notion that endothelial dysfunction may play a key role in the pathogenesis of ischemic vascular disease observed in cocaine abusers.

Descripción de los hallazgos en el perfil lipídico y proteico de pacientes dependientes a cocaína, en abstinencia reciente / Serum lipid levels in a group of cocaine dependent subjects in recent abstinence

Background: Chronic cocaine users develop multiple potentially lethal ischemic vascular complications associated with accelerated atherosclerosis. Aim: To assess biochemical and lipid profiles among cocaine dependent subjects in recent abstinence. Material and Methods: A blood sample to measure blood count, biochemical and lipid profiles was obtained from 78 patients aged 19 to 53 years (78% males) who complied with DSM-IV criteria for cocaine dependency. Laboratory results were compared with a group of normal subjects. Results: All cases had positive urinary cocaine, with a mean consumption lapse of 7.6 years. The frequency of smoking was higher in cases. Dependent males had higher body mass index than controls. Compared to controls, dependent females had significantly higher triglyceride (TG) levels and lower HDL cholesterol. Therefore the relation total/HDL cholesterol was higher (p = 0.0365). Dependent males had higher TG levels than their normal counterparts. Dependent subjects consuming cocaine base-paste had higher TG levels. Total proteins, albumin, urea and blood urea nitrogen were lower in dependent subjects. Among males, serum creatinine was lower and blood urea was positively correlated with the daily amount of cocaine use (p = 0.03). After a month of strict abstinence, lipid profile was repeated in 27 patients and remained unchanged. Conclusions: Chronic cocaine use was associated with higher TG in both genders and lower HDL cholesterol in women when compared with a group of healthy counterparts.

[Effect of angiotensin II synthesis inhibition on alcohol consumption]. / Efecto de la inhibición de la síntesis de angiotensina II en el consumo de alcohol.

BACKGROUND: Central renin-angiotensin system modulates alcohol intake and inhibition of angiotensin converting enzyme reduces ethanol consumption in rats, and may be potentially useful in the treatment of alcoholism. AIM: To study the effect of captopril on alcohol intake, both in humans and animals . MATERIAL AND METHODS: In a double-blind, placebo-controlled clinical study, 15 alcoholics who met DSM-IV criteria were randomized to receive captopril 100 mg/day or placebo for 12 weeks. In the experimental study, daily consumption of ethanol (10% v/v), water and solid food was assessed in 12 male Wistar rats before and after the intraperitoneal administration of captopril 50 mg/kg/day. RESULTS: In alcoholics, mean weekly standard alcoholic drink consumption was not different during captopril treatment or placebo. However, both groups had a significantly lower intake than during baseline. Days of abstinence increased and days of drunkeness decreased in the group receiving captopril, when compared with baseline but not with placebo. Craving was significantly reduced by captopril when compared with placebo. In rats, captopril reduced not only alcohol consumption but also water and food intake. CONCLUSIONS: Captopril decreases alcohol intake in rats and this effect is not specific for ethanol. Captopril did not alter alcohol consumption in alcoholics when compared with placebo but reduced craving.

Cuantificación paramétrica de los cambios en la perfusión cerebral producidos por abstinencia y con activación neurocognitiva en dependientes de cocaína / Changes in cerebral perfusion caused by abstinence in cocaine-dependent patients

Introducción. Los sujetos dependientes de cocaína pueden presentar deterioro neurocognitivo y alteraciones conductuales con importantes implicancias sociales. En esos pacientes se han demostrado diversas anormalidades en la perfusión cerebral, especialmente en la corteza prefrontal. Esta región cortical está relacionada con funciones ejecutivas y con el control de impulsos. El Wisconsin Card Sorting Test (WCST) fue diseñado específicamente para activar la corteza prefrontal. Objetivo. En sujetos dependientes de cocaína, cuantificar cambios en la perfusion cerebral basal y post activación con WCST inducidos por la detoxificación. Método. Se estudió a 23 pacientes entre 24 y 49 años de edad (19 hombres) que cumplían criterios DSM-IV para dependencia de cocaína y con consumo reciente demostrado. En todos ellos se obtuvo SPECT de perfusión cerebral en condiciones de reposo al ingreso y tras 4 semanas de hospitalización con abstinencia controlada. En 19 sujetos se realizó además SPECT cerebral con activación usando WCST, al inicio y al final de la hospitalización. Para comparar estas cuatro condiciones se utilizó Statistical Parametric Mapping (SPM). Resultados. Al comparar la perfusión en condiciones de reposo inicial y al mes de abstinencia se observó mejoría significativa de múltiples áreas corticales especialmente en región parieto-occipital bilateral y corteza prefrontal izquierda.El análisis grupal no demostró activación de corteza prefrontal con WCST al ingreso a la terapia de detoxificación. Luego de 4 semanas de abstinencia estricta, se observó significativa activación post WCST de corteza prefrontal dorsolateral izquierda.Conclusiones. Un mes de abstinencia estricta de cocaína produce mejoría de la perfusión cerebral en pacientes dependientes. Post consumo reciente, no se demuestra activación a nivel prefrontal con el estímulo del WCST, la cual se observa luego de abstinencia, lo que indica mejoría neurocognitiva...

Introduction. Cocaine-dependent subjects might have socially disruptive behavior. Several regional cerebral blood flow (rCBF) abnormalities have been described in these patients, mainly in the prefrontal cortex, area related to executive functions and impulse control. Wisconsin Card Sorting Test (WCST) was specifically designed to activate this cortical area. Aim. To quantify rCBF and to assess prefrontal activation pre and post detoxification on cocaine-dependant subjects. Methods. We studied 23 patients who met DSM-IV criteria for cocaine dependency ranging from 24 - 49 years old (19 males), all with positive urine cocaine test. Baseline 99mTc-ECD brain perfusion SPECT was performed at admission and after 4 weeks of controlled in-hospital abstinence; in 19 patients SPECT was acquired also after WCST activation. Statistical Parametric Mapping (SPM) was used to compare SPECT studies on these 4 conditions. Results. rCBF of bilateral parieto-occipital area, left prefrontal cortex and multiple small cortical region improved after 4 weeks of cocaine detoxification. The group analysis did not show significant prefrontal cortex activation induced by WCST on admission. After 4 weeks of strict cocaine abstinence, WCST was able to induce left dorsolateral prefrontal cortex activation. Conclusions. A month of strict cocaine abstinence improved brain perfusion in dependant patients. After recent consumption, there was no prefrontal activation when using WCST, but this was observed after abstinence, supporting neurocognitive improvement. These findings may have clinical implications as potential predictors of therapy response.

Daño endotelial y activación del sistema hemostático asociado al uso crónico de cocaína: estudios ex vivo e in vitro / Endothelial damage and activation of the haemostatic system associated to chronic use of cocaine: an ex vivo and in vitro study

Antecedentes: Usuarios crónicos de cocaína tienen riesgo aumentado de presentar infarto de miocardio, angina,muerte súbita y accidentes cerebrovasculares. Aunque la patogenia del daño vascular es mayormente desconocida, se ha encontrado arterioesclerosis prematura y formación de trombos intravasculares. Objetivo: Demostrar evidencia de daño endotelial y activación del sistema hemostático en usuarios crónicos de cocaína. Métodos: Un grupo de 23 pacientes con criterios de dependencia a cocaína DSM-IV; 19 hombres (edad promedio 32 a), con exposición a la droga dentro de 72 h del estudio. Disfunción endotelial se evaluó por enumeración de las células endoteliales circulantes (CEC) y nivel de sICAM . Para activación del sistema hemostático se incluyó: complejos trombina-antitrombina (TAT) y generación de trombina; NAP-2 y RANTES para activación plaquetaria. In vitro, CE en cultivo (HUVEC), se expusieron a plasma de consumidores o controles. Se midió factor von Willebrand (FVW) en el medio y expresión de FvW y factor tisular (FT) sobre las CE. Adhesión plaquetaria estática se evaluó por microscopía. Resultados: En usuarios de cocaína, con respecto a controles, las CEC estaban significativamente elevadas...

Background: chronic cocaine users have an increased risk of developing myocardial infarction, angina, suddendeath and stroke. Although the pathogenesis of this effect is not completely known, premature atheromatosis and intravascular thrombosis appear to be involved.Aim: to provide evidence for the presence of endothelial damage and activation of the haemostatic system in chronic cocaine users. Methods: 23 subjects (19males, overall mean age 32) with DSM-IV criteria for cocaine dependency and exposure to the drug within 72 hours were studied. Endothelial dysfunction was determined by circulating endothelial cell counts (CEC) and sICAM levels. Thrombin-antithrombin complexes (TAT) and thrombin generation were used to characterize haemostatic status. In vitro, platelet activation was studied by NAP-2 and RANTES. EC in culture (HUVEC) were exposed to plasma from cocaine users and controls. Von Willebrand factor was measured in the culture media as well as its expression along with that of tissue factor in EC. Platelet adhesion was evaluated by microscopy. Results: Compared to controls, EC were significantly increased in cocaine users...

Brain perfusion abnormalities associated to drug abuse in recent abstinent patients using SPECT 99m Tc-ethylen-cysteinate-dimer (ECD)

Several substances may produce brain perfusion abnormalities in drug-dependent patients. Their mechanism is unclear and several causes might be involved, especially vasospasm in cocaine consumption. Goal: To characterize residual brain perfusion abnormalities in substance-dependent population. We analyzed brain perfusion in 100 dependant patients (DSM-IV criteria) following a month of strict in-hospital abstinence (age:35 +/- 2y.o.; 86 percent men); 55 percent corresponded to poly-drug dependents, mainly to cocaine, alcohol and cannabis; 44 percent mono-drug users, mostly to alcohol. Results: Single Photon Emission Computed Tomography (SPECT) with 99mTc-ethylen-cysteinate-dimer (ECD) was abnormal in 54 percent of the cases, with bilateral cortical hypo-perfusion in 89 percent, focal in 54 percent and diffuse in 46 percent of them, with moderate or severe intensity in 61 percent. The abnormal perfusion group’s age was 38 +/- 12 versus 31 +/- 10 years in the normal SPECT group (P=0.005) with a consumption period of 16 +/- 11 versus 11 +/- 8 years, respectively (P=0.043). Only 29 percent of women had abnormal perfusion versus 58 percent of men (P=0.047). Abnormal brain perfusion in 64 percent of mono and 45 percent in poly-drug dependents (P=0.07). Psychometric tests performed in 25 patients demonstrated association between perfusion defects and cognitive abnormalities. Relative risk for abnormal psychometric test was 2.5 [95 percent;CI=1.1-5.6] for abnormal SPECT. Conclusion: Dependent population after a month of abstinence persists with cortical brain perfusion abnormalities, associated to age, sex and type of drug consumption.

Efecto de la inhibición de la síntesis de angiotensina II en el consumo de alcohol / Effect of angiotensin II synthesis inhibition on alcohol consumption

Background: Central reninangiotensin system modulates alcohol intake and inhibition of angiotensin converting enzyme reduces ethanol consumption in rats, and may be potentially useful in the treatment of alcoholism. Aim: To study the effect of captopríl on alcohol intake, both in humans and animals . Material and methods: In a double-blind, placebo-controlled clinical study, 15 alcoholics who met DSM-IV criíteria were randomized to receive captopril 100 mg/day or placebo for 12 weeks. In the experimental study, daily consumption of ethanol (10 percent v/v), water and solid food was assessed in 12 male Wistar rats before and after the intraperítoneal administration of captopríl 50 mg/kg/day. Results: In alcoholics, mean weekly standard alcoholic drínk consumption was not different during captopríl treatment or placebo. However, both groups had a signiñcantly lower intake than duríng baseline. Days of abstinence increased and days of drunkeness decreased in the group receiving captopril, when compared with baseline but not with placebo. Craving was significantly reduced by captopríl when compared with placebo. In rats, captopríl reduced not only alcohol consumption but also water and food intake. Conclusions: Captopríl decreases alcohol intake in rats and this effect is not speciñc for ethanol. Captopril did not alter alcohol consumption in alcoholics when compared with placebo but reduced craving.

Epidemiología del hábito de beber en adolescentes / Epidemiology of drinking habits among adolescents

Los autores estudian el Alcoholismo y otros hábitos de beber en la población adolescente de 15 a 19 años, utilizando el diagnóstico clínico a través de una entrevista individual. La tasa de alcoholismo es alta y alcanza a un 9,2%, siendo más frecuente el tipo Normotimizante. La tasa de alcohólicos adolescentes es semejante a la de adultos y ancianos, ello indicaría que la enfermedad se estableceria en etapas tempranas de la vida, hipótesis a comprobar en un estudio de seguimiento. La enfermedad afecta más a los hombres, siendo la razón alcoholismo femenino/masculino de 1/4, más estrecha que en la población general, lo que podría señalar un cambio en el hábito de bebet en las adolescentes mujeres. El estrato social con más alcohólicos es el bajo, encontrando una proporción del 20.8%. El alcoholismo es más frecuente a menor nivel escolar y entre jóvenes que no están estudiando. Se puede establecer un perfil epidemiológico de los adolescentes de más alto riesgo de enfermar, este es: adolescente hombre, de estrato social bajo, de escasa escolaridad, que no estudia y no trabaja. Pensamos que las acciones de prevención debieran dirigirse principalmente a esta edad y en toda la comunidad

Depressión compensada por polifarmacodependencia a substancias de uso habitual (café, cigarrillos, comida) / Compensated depressión by plypharmacodependency of substances of habitual use (coffee, cigarettes, meal)

Un grupo de 20 pacientes, 19 de ellos mujeres, consultaron privadamente y fueron investigados durante meses o años, utilizando el método clínico fenomenológico. Se distinguía un grupo formado por mujeres que trabajaban y dependían del café y cigarrillos, que les provocaban efectos tales como: relajación, tranquilización, sedación de la ansiedad o angustia, animación, activación, supresión de la fatiga, etc. En cambio, el grupo de las dueñas de casa consumían la comida de forma patológica, resultando sorpresivo constatar que tembién experimentaban con el alimento, efectos psicofarmacológicos, especialmente sedar la ansiedad y la angustia, entretenerse o animarse. Simultáneamente abusaban del fumar. En ambos grupos predominaban claramente las mujeres de edad madura. Como estas substancias les provocaban: alteraciones conductuales en su forma de vida, necesitándolas compulsivamente, dependencia psíquica, síntomas de privación (café y cigarrillos), es correcto denominarlas fármacodependencias. Además fue interesante encontrar que compensaban parcialmente los síntomas de una depresión o subdepresión endógena o reactiva y que por esta razón cursaba enmascarándose. Se trata entonces de polifarmacodependencias compensatorias de estos depresivos, que respondieron favorablemente al tratamiento de la enfermedad básica

Aplicación diagnóstica de la CIE-10-1990 a un grupo de alcohólicos de la Clínica Psiquiátrica, 1991-1992 / Diagnostic applications of the ICD-10-1990 to an alcoholics group of the Clinica Psiquiátrica, 1991-1992

Es un estudio clínico que presenta la experiencia de los autores al utilizar la CIE-10-1990, en un grupo de 40 alcohólicos de ambos sexos, según las pautas diagnósticas de esta clasificación. Se analiza el grado de eficacia de cada uno de los 9 criterios propuestos en las pautas, encontrando que varios de ellos están siempre presentes, y que otros tienen alta prevalencia. Se consigna que existe en el grupo de enfermos, una alta frecuencia de asociación con patologías mentales concomitantes, lo que se desglosa. Concluímos que la mayoría de los criterios estudiados, fueron de gran eficacia para el diagnóstico del concepto genérico de dependencia alcohólica, siempre que al pesquisarlos el investigador no se limite a preguntar por cada uno de ellos, sino que realice un estudio clínico acucioso del paciente. Además carecen de finura semiológica que permita discriminar en subtipos de alcohólicos, con las implicaciones terapéuticas que esto conlleva. Contrasta la buena capacidad clasificatoria de las pautas propuestas, con sus limitaciones para coger compleja realidad clínica de esta patología

Ninfomanía sintomática a síndrome de tensión premenstrual (SPM) / Symptomatic nymphomania to premenstrual tension syndrome

Se relata la historia de una ninfómana con apetito sexual patológico, que la condujo a la promiscuidad y al quiebre de su matrimonio. Describimos las características de su cuadro clínico, apetito sexual y de las lesiones ginecológicas que padecía, las que tratadas contribuyeron decisivamente a la recuperación de su enfermedad. Se comparan: el apetito sexual anómalo de la enferma, con el de alcohol de los alcohólicos y el de comida de los obesos. También este caso clínico con otros relatados en la literatura médica. Se muestra su evolución después de 2 años de su hospitalización, su recuperación ginecológica, psiquiátrica, de su vida familiar y social. Sugerimos que en casos de este tipo, se profundice en el estudio semiológico del cuadro clínico psiquiátrico y en la búsqueda de patología ginecológica

Síndrome de stress estudiado en un grupo de enfermeras universitarias / Stress syndrome studied a group of university nurses

El trabajo presenta la experiencia obtenida al estudiar con el método clínico fenomenológico, un grupo de Enfermeras Universitarias del Hospital José Joaquín Aguirre. Trabajaban en Servicios de atención a pacientes muy graves, por lo que estaban sometidas permanentemente a estímulos tensionales de diversas naturaleza. Se describen las características clínicas de las Reacciones de Estrés que presentaban, y su evolución posterior adaptándose a la situación; o bien evolucionando hacia el agotamiento. En este caso se configuraba una entidad clínica cuya sintomatología precisamos y que denominamos Estado Patológico. Respecto a su origen mostramos como frustraciones sostenidas provenientes de su vida familiar eran el principal motivo estresor, por lo general unidas a esfuerzos laborales escesivos y enajenantes; todo lo que se facilitaba por las características de su personalidad, propia de la formación recibida y de la época actual. Si desde el punto de vista psicológico los rasgos del carácter ern inestables, todo se agravaba. Proponemos algunas indicaciones inmediatas y orientaciones psicoterápicas medidas que implican la maduración de la persona y reordenar su vida en forma más salutífera

La apetencia patologica del comer: estudio epidemiológico / Pathological disorder of eating: a epidemiological study

El trabajo desarrolla la hipótesis que en un grupo importante de la población adulta, se produce una perturbación patológica en el comer, que en la muestra estudiada alcanza al 13,3%, lo que lo señala como problema médico importante. Al relacioanr este comer patológico y el normal, con algunas variables que se refieren al modo de hacerlo, es importante destacar que hai diferencias estadísticamente significativas en cuanto a la velocidad de íngestión, degustación, compañía y sensación posterior a la ingestión. En cuanto al comer patológico, y variables biosociodemográficas, se descubren interesantes relaciones. El sexo es determinante en la tasa, de modo que en las mujeres es el doble que en los varones. La edad influye, puesto que al aumentar, la tasa también se incrementa considerablemente. También varía la tasa, según el estado civil. Curiosamente, en cambio, aparece sin importancia el somatotipo, el estrato socioeconómico y el nivel educativo de la población