A cross-sectional study on the characteristics and factors associated with the clinical course of child and adolescent patients hospitalized in a public child and adolescent psychiatric unit of Chile. / Estudio transversal de las características y factores asociados a la evolución clínica de pacientes hospitalizados en una unidad de psiquiatría infanto-juvenil pública en Chile.

INTRODUCTION: Patients of the Short-stay Child and Adolescent Unit of the Del Salvador Psychiatric Hospital (Valparaíso, Chile) exhibit different clinical and social characteristics compared to literature reports of other national centers, although published data are scarce. OBJECTIVES: To describe the operation of the Unit, the socio-familial and clinical characteristics of its patients and analyze factors associated with their clinical evolution. METHODS: We performed a cross-sectional study to describe the patients hospitalized over a three-year period. Variables were registered in an anonymized database. Clinical evolution was evaluated over the year following hospital discharge. RESULTS: The Unit's model of care can be described as involving biomedical, psychodynamic, and ecological components. We included 98 patients, of which 70.4% were male, and the average age was 11.5 ± 2.3 years. 82.6% were of low socioeconomic status, and 35.7% did not attend school; 98.9% presented family dysfunction, and 91.8% of parents had a history of psychopathology. The most frequent reason for admission was the risk of harm to self or others. The most frequent discharge diagnoses were behavioral, depressive, and personality development disorders. The average length of stay was 41.8 ± 31.1 days. The most commonly used pharmacological agents were antipsychotics and mood stabilizers. Regarding clinical evolution in the first year post-discharge, 47% were evaluated as positive, 27% regular, and 26% unsatisfactory. The factor associated with an unsatisfactory clinical course was having had in-patient antidepressants. Re-admission during the first year post-discharge was associated with comorbid substance use disorder. Treatment noncompliance was associated with a history of behavioral disorder at hospital discharge and having parents with a history of suicide or consummated suicide. CONCLUSIONS: The patient profile is one of low socioeconomic status, severe psychopathology, maladaptive behavior, family dysfunction, and parental psychopathology. Substance use disorder is also associated with readmission.

INTRODUCCIÓN: La Unidad de Corta Estadía Infanto-juvenil del Hospital Psiquiátrico del Salvador (Valparaíso, Chile) y sus pacientes poseen características clínicas y sociales diferentes a las reportadas por la escasa literatura nacional al respecto. OBJETIVOS: Describir el funcionamiento la unidad, las características sociofamiliares y clínicas de sus pacientes y analizar los factores asociados a su evolución clínica. MÉTODOS: Estudio transversal que describió el universo de pacientes hospitalizados durante tres años. Las variables se recogieron desde una base de datos anonimizada. Se evaluó la evolución clínica dentro del año posterior al egreso hospitalario. RESULTADOS: El modelo de atención de la unidad presenta los componentes biomédico, psicodinámico y ecológico. Se analizaron 98 pacientes, 70,4% hombres, con edad promedio de 11,5 ± 2,3 años. Un 82,6% perteneció al nivel socioeconómico bajo y 35,7% estaba desescolarizado; 98,9% presentó disfunción familiar y 91,8% de los padres portaba alguna psicopatología. Los motivos de ingreso más frecuente fueron riesgo de hetero y autoagresión. Los diagnósticos de egreso más frecuente fueron trastornos de conducta, depresivos y del desarrollo de la personalidad. El tiempo de estadía promedio fue de 41,8 ± 31,1 días. Los fármacos más utilizados fueron antipsicóticos y estabilizadores del ánimo. Un 47% tuvo una buena evolución clínica, 27% regular y 26% insatisfactoria. El único factor que se asoció a esta última fue haber tenido prescrito un antidepresivo durante la hospitalización. El factor que consistentemente se vinculó al reingreso a lo largo de un año, fue el haber presentado trastorno por consumo de sustancias. El abandono a tratamiento se relacionó con haber presentado un trastorno de conducta al egreso hospitalario y a tener padres con antecedente de suicidio o suicidio consumado. CONCLUSIONES: El perfil de pacientes de esta unidad corresponde a pacientes de nivel socioeconómico bajo, psicopatología severa, conducta desadaptativa, disfunción familiar y frecuente psicopatología parental. El trastorno por consumo de sustancias es un factor significativamente asociado al reingreso hospitalario.

Estudio transversal de las características y factores asociados a la evolución clínica de pacientes hospitalizados en una unidad de psiquiatría infanto-juvenil pública en Chile / A cross-sectional study on the characteristics and factors associated with the clinical course of child and adolescent patients hospitalized in a public child and adolescent psychiatric unit of Chile

INTRODUCCIÓN: La Unidad de Corta Estadía Infanto-juvenil del Hospital Psiquiátrico del Salvador (Valparaíso, Chile) y sus pacientes poseen características clínicas y sociales diferentes a las reportadas por la escasa literatura nacional al respecto. OBJETIVOS: Describir el funcionamiento la unidad, las características sociofamiliares y clínicas de sus pacientes y analizar los factores asociados a su evolución clínica. MÉTODOS: Estudio transversal que describió el universo de pacientes hospitalizados durante tres años. Las variables se recogieron desde una base de datos anonimizada. Se evaluó la evolución clínica dentro del año posterior al egreso hospitalario. RESULTADOS: El modelo de atención de la unidad presenta los componentes biomédico, psicodinámico y ecológico. Se analizaron 98 pacientes, 70,4% hombres, con edad promedio de 11,5 ± 2,3 años. Un 82,6% perteneció al nivel socioeconómico bajo y 35,7% estaba desescolarizado; 98,9% presentó disfunción familiar y 91,8% de los padres portaba alguna psicopatología. Los motivos de ingreso más frecuente fueron riesgo de hetero y autoagresión. Los diagnósticos de egreso más frecuente fueron trastornos de conducta, depresivos y del desarrollo de la personalidad. El tiempo de estadía promedio fue de 41,8 ± 31,1 días. Los fármacos más utilizados fueron antipsicóticos y estabilizadores del ánimo. Un 47% tuvo una buena evolución clínica, 27% regular y 26% insatisfactoria. El único factor que se asoció a esta última fue haber tenido prescrito un antidepresivo durante la hospitalización. El factor que consistentemente se vinculó al reingreso a lo largo de un año, fue el haber presentado trastorno por consumo de sustancias. El abandono a tratamiento se relacionó con haber presentado un trastorno de conducta al egreso hospitalario y a tener padres con antecedente de suicidio o suicidio consumado. CONCLUSIONES: El perfil de pacientes de esta unidad corresponde a pacientes de nivel socioeconómico bajo, psicopatología severa, conducta desadaptativa, disfunción familiar y frecuente psicopatología parental. El trastorno por consumo de sustancias es un factor significativamente asociado al reingreso hospitalario.

INTRODUCTION: Patients of the Short-stay Child and Adolescent Unit of the Del Salvador Psychiatric Hospital (Valparaíso, Chile) exhibit different clinical and social characteristics compared to literature reports of other national centers, although published data are scarce. OBJECTIVES: To describe the operation of the Unit, the socio-familial and clinical characteristics of its patients and analyze factors associated with their clinical evolution. METHODS: We performed a cross-sectional study to describe the patients hospitalized over a three-year period. Variables were registered in an anonymized database. Clinical evolution was evaluated over the year following hospital discharge. RESULTS: The Unit's model of care can be described as involving biomedical, psychodynamic, and ecological components. We included 98 patients, of which 70.4% were male, and the average age was 11.5 ± 2.3 years. 82.6% were of low socioeconomic status, and 35.7% did not attend school; 98.9% presented family dysfunction, and 91.8% of parents had a history of psychopathology. The most frequent reason for admission was the risk of harm to self or others. The most frequent discharge diagnoses were behavioral, depressive, and personality development disorders. The average length of stay was 41.8 ± 31.1 days. The most commonly used pharmacological agents were antipsychotics and mood stabilizers. Regarding clinical evolution in the first year post-discharge, 47% were evaluated as positive, 27% regular, and 26% unsatisfactory. The factor associated with an unsatisfactory clinical course was having had in-patient antidepressants. Re-admission during the first year post-discharge was associated with comorbid substance use disorder. Treatment noncompliance was associated with a history of behavioral disorder at hospital discharge and having parents with a history of suicide or consummated suicide. CONCLUSIONS: The patient profile is one of low socioeconomic status, severe psychopathology, maladaptive behavior, family dysfunction, and parental psychopathology. Substance use disorder is also associated with readmission.

Linguistic Analysis as a Method for Assessing Symptoms After Sexual Trauma Among Female Adolescent Psychiatric Inpatients.

Using a sample of female psychiatric inpatient adolescents, the current study aimed to extend this literature to an adolescent sample for the first time by examining if linguistic markers and their subcategories (cognitive process words, pronoun use, and somatosensory detail) in a trauma account are related to trauma symptomology and recovery during inpatient care. Results indicated that greater use of body words and fewer insight words were related to increased trauma symptoms at admission. In addition, use of fewer cognitive process words at admission predicted greater symptom change at discharge, extending previous research findings to an adolescent sample. Findings suggest that linguistic analysis may be an important component of adolescent trauma symptom assessment and treatment monitoring.

Latino community health workers and the promotion of sexual and reproductive health.

Community health worker (CHW) programs have existed for over 50 years across the world. However, only recently has research evidence documented their effectiveness. Research is still needed to identify issues related to implementation and sustainability of CHW programs. This article explores the role and challenges of U.S. Latino CHWs trained to deliver a comprehensive sexual and reproductive health educational intervention to Latino families. We conducted a semistructured interview with a purposive convenience sample of 19 CHWs. Findings suggest that CHWs occupy roles that go beyond those they were trained for. CHWs serve not only as educators but also as providers of social support, facilitators of access to resources, patient navigators, and civil rights advocates. Lack of clarity of the role of a CHW influenced perceptions of adequacy of compensation, training, and integration into the agency that trained them. Policy facilitating the standardization of the CHW occupational category and role expectations is imperative to ensure successful implementation and sustainability of U.S. CHW programs.

Combined spinal/general anesthesia with postoperative femoral nerve block for total knee replacement in a patient with familial hyperkalemic periodic paralysis: a case report.

Familial hyperkalemic periodic paralysis (HYPP) is a rare genetic disorder in which the sodium channels in skeletal muscle cells have altered structure and function. Small elevations in serum potassium lead to inactivation of sodium channels, causing episodic weakness or paralysis. Exposure to cold, anesthesia, fasting, emotional stress, potassium ingestion, and rest after exercise can stimulate an attack. This case report describes a 65-year-old man with HYPP who was admitted for a right total knee arthroplasty. He had a history of arteriosclerotic heart disease and stenting 8 years earlier, previous inferior wall myocardial infarction with ejection fraction of 65%, anxiety, degenerative joint disease, well-controlled type 2 diabetes mellitus, and a body mass index of 53.3 kg/m2. A combined spinal/general anesthetic with a femoral nerve block for postoperative pain control was chosen. Careful attention was given to monitoring and maintenance of core temperature, use of insulin and glucose to maintain normokalemia, and carbohydrate loading the night before surgery. The patient recovered from the anesthetic without complication and had pain relief for approximately 22 hours postoperatively because of the femoral nerve block. The patient was without weakness or paralysis related to HYPP in the postanesthesia care unit or throughout his hospitalization.