Genome-wide mapping of brain phenotypes in extended pedigrees with strong genetic loading for bipolar disorder.

Bipolar disorder is a highly heritable illness, associated with alterations of brain structure. As such, identification of genes influencing inter-individual differences in brain morphology may help elucidate the underlying pathophysiology of bipolar disorder (BP). To identify quantitative trait loci (QTL) that contribute to phenotypic variance of brain structure, structural neuroimages were acquired from family members (n = 527) of extended pedigrees heavily loaded for bipolar disorder ascertained from genetically isolated populations in Latin America. Genome-wide linkage and association analysis were conducted on the subset of heritable brain traits that showed significant evidence of association with bipolar disorder (n = 24) to map QTL influencing regional measures of brain volume and cortical thickness. Two chromosomal regions showed significant evidence of linkage; a QTL on chromosome 1p influencing corpus callosum volume and a region on chromosome 7p linked to cortical volume. Association analysis within the two QTLs identified three SNPs correlated with the brain measures.

Genetic analysis of activity, brain and behavioral associations in extended families with heavy genetic loading for bipolar disorder.

BACKGROUND: Disturbed sleep and activity are prominent features of bipolar disorder type I (BP-I). However, the relationship of sleep and activity characteristics to brain structure and behavior in euthymic BP-I patients and their non-BP-I relatives is unknown. Additionally, underlying genetic relationships between these traits have not been investigated. METHODS: Relationships between sleep and activity phenotypes, assessed using actigraphy, with structural neuroimaging (brain) and cognitive and temperament (behavior) phenotypes were investigated in 558 euthymic individuals from multi-generational pedigrees including at least one member with BP-I. Genetic correlations between actigraphy-brain and actigraphy-behavior associations were assessed, and bivariate linkage analysis was conducted for trait pairs with evidence of shared genetic influences. RESULTS: More physical activity and longer awake time were significantly associated with increased brain volumes and cortical thickness, better performance on neurocognitive measures of long-term memory and executive function, and less extreme scores on measures of temperament (impulsivity, cyclothymia). These associations did not differ between BP-I patients and their non-BP-I relatives. For nine activity-brain or activity-behavior pairs there was evidence for shared genetic influence (genetic correlations); of these pairs, a suggestive bivariate quantitative trait locus on chromosome 7 for wake duration and verbal working memory was identified. CONCLUSIONS: Our findings indicate that increased physical activity and more adequate sleep are associated with increased brain size, better cognitive function and more stable temperament in BP-I patients and their non-BP-I relatives. Additionally, we found evidence for pleiotropy of several actigraphy-behavior and actigraphy-brain phenotypes, suggesting a shared genetic basis for these traits.

Genetic contributions to circadian activity rhythm and sleep pattern phenotypes in pedigrees segregating for severe bipolar disorder.

Abnormalities in sleep and circadian rhythms are central features of bipolar disorder (BP), often persisting between episodes. We report here, to our knowledge, the first systematic analysis of circadian rhythm activity in pedigrees segregating severe BP (BP-I). By analyzing actigraphy data obtained from members of 26 Costa Rican and Colombian pedigrees [136 euthymic (i.e., interepisode) BP-I individuals and 422 non-BP-I relatives], we delineated 73 phenotypes, of which 49 demonstrated significant heritability and 13 showed significant trait-like association with BP-I. All BP-I-associated traits related to activity level, with BP-I individuals consistently demonstrating lower activity levels than their non-BP-I relatives. We analyzed all 49 heritable phenotypes using genetic linkage analysis, with special emphasis on phenotypes judged to have the strongest impact on the biology underlying BP. We identified a locus for interdaily stability of activity, at a threshold exceeding genome-wide significance, on chromosome 12pter, a region that also showed pleiotropic linkage to two additional activity phenotypes.

Brain structure-function associations in multi-generational families genetically enriched for bipolar disorder.

Recent theories regarding the pathophysiology of bipolar disorder suggest contributions of both neurodevelopmental and neurodegenerative processes. While structural neuroimaging studies indicate disease-associated neuroanatomical alterations, the behavioural correlates of these alterations have not been well characterized. Here, we investigated multi-generational families genetically enriched for bipolar disorder to: (i) characterize neurobehavioural correlates of neuroanatomical measures implicated in the pathophysiology of bipolar disorder; (ii) identify brain-behaviour associations that differ between diagnostic groups; (iii) identify neurocognitive traits that show evidence of accelerated ageing specifically in subjects with bipolar disorder; and (iv) identify brain-behaviour correlations that differ across the age span. Structural neuroimages and multi-dimensional assessments of temperament and neurocognition were acquired from 527 (153 bipolar disorder and 374 non-bipolar disorder) adults aged 18-87 years in 26 families with heavy genetic loading for bipolar disorder. We used linear regression models to identify significant brain-behaviour associations and test whether brain-behaviour relationships differed: (i) between diagnostic groups; and (ii) as a function of age. We found that total cortical and ventricular volume had the greatest number of significant behavioural associations, and included correlations with measures from multiple cognitive domains, particularly declarative and working memory and executive function. Cortical thickness measures, in contrast, showed more specific associations with declarative memory, letter fluency and processing speed tasks. While the majority of brain-behaviour relationships were similar across diagnostic groups, increased cortical thickness in ventrolateral prefrontal and parietal cortical regions was associated with better declarative memory only in bipolar disorder subjects, and not in non-bipolar disorder family members. Additionally, while age had a relatively strong impact on all neurocognitive traits, the effects of age on cognition did not differ between diagnostic groups. Most brain-behaviour associations were also similar across the age range, with the exception of cortical and ventricular volume and lingual gyrus thickness, which showed weak correlations with verbal fluency and inhibitory control at younger ages that increased in magnitude in older subjects, regardless of diagnosis. Findings indicate that neuroanatomical traits potentially impacted by bipolar disorder are significantly associated with multiple neurobehavioural domains. Structure-function relationships are generally preserved across diagnostic groups, with the notable exception of ventrolateral prefrontal and parietal association cortex, volumetric increases in which may be associated with cognitive resilience specifically in individuals with bipolar disorder. Although age impacted all neurobehavioural traits, we did not find any evidence of accelerated cognitive decline specific to bipolar disorder subjects. Regardless of diagnosis, greater global brain volume may represent a protective factor for the effects of ageing on executive functioning.

Contribution of common and rare variants to bipolar disorder susceptibility in extended pedigrees from population isolates.

Current evidence from case/control studies indicates that genetic risk for psychiatric disorders derives primarily from numerous common variants, each with a small phenotypic impact. The literature describing apparent segregation of bipolar disorder (BP) in numerous multigenerational pedigrees suggests that, in such families, large-effect inherited variants might play a greater role. To identify roles of rare and common variants on BP, we conducted genetic analyses in 26 Colombia and Costa Rica pedigrees ascertained for bipolar disorder 1 (BP1), the most severe and heritable form of BP. In these pedigrees, we performed microarray SNP genotyping of 838 individuals and high-coverage whole-genome sequencing of 449 individuals. We compared polygenic risk scores (PRS), estimated using the latest BP1 genome-wide association study (GWAS) summary statistics, between BP1 individuals and related controls. We also evaluated whether BP1 individuals had a higher burden of rare deleterious single-nucleotide variants (SNVs) and rare copy number variants (CNVs) in a set of genes related to BP1. We found that compared with unaffected relatives, BP1 individuals had higher PRS estimated from BP1 GWAS statistics (P = 0.001 ~ 0.007) and displayed modest increase in burdens of rare deleterious SNVs (P = 0.047) and rare CNVs (P = 0.002 ~ 0.033) in genes related to BP1. We did not observe rare variants segregating in the pedigrees. These results suggest that small-to-moderate effect rare and common variants are more likely to contribute to BP1 risk in these extended pedigrees than a few large-effect rare variants.

Genetic studies of neuropsychiatric disorders in Costa Rica: a model for the use of isolated populations.

The importance of genetics in understanding the etiology of mental illness has become increasingly clear in recent years, as more evidence has mounted that almost all neuropsychiatric disorders have a genetic component. It has also become clear, however, that these disorders are etiologically complex, and multiple genetic and environmental factors contribute to their makeup. So far, traditional linkage mapping studies have not definitively identified specific disease genes for neuropsychiatric disorders, although some potential candidates have been identified via these methods (e.g. the dysbindin gene in schizophrenia; Straub et al., 2002; Schwab et al., 2003). For this reason, alternative approaches are being attempted, including studies in genetically isolated populations. Because isolated populations have a high degree of genetic homogeneity, their use may simplify the process of identifying disease genes in disorders where multiple genes may play a role. Several areas of Latin America contain genetically isolated populations that are well suited for the study of neuropsychiatric disorders. Genetic studies of several major psychiatric illnesses, including bipolar disorder, major depression, schizophrenia, Tourette Syndrome, alcohol dependence, attention deficit hyperactivity disorder, and obsessive-compulsive disorder, are currently underway in these regions. In this paper we highlight the studies currently being conducted by our groups in the Central Valley of Costa Rica to illustrate the potential advantages of this population for genetic studies.

The adolescent behavioral repertoire: its latent structure in the PACARDO region of Latin America.

In this study, the authors probed the latent structure of the adolescent behavioral repertoire (ABR) and estimated its sociodemographic correlates. The authors drew a nationally representative sample of 12,797 school-attending youth from the 7 countries in the PACARDO region of Latin America: Panama, Guatemala, El Salvador, Honduras, Nicaragua, Costa Rica, and the Dominican Republic. On the basis of the Behavioral Repertoire Self Report scale (Johanson, Duffy, and Anthony, 1996), the authors identified 5 primary dimensions, including religious behaviors, socializing, sports, home-based activities, and gender socialization activities. The authors found that the levels of involvement in these dimensions of the ABR varied across sociodemographic characteristics. The observed multidimensional structure of the ABR sets the stage for future research on adolescent health in relation to these behaviors and activities.

Multisystem component phenotypes of bipolar disorder for genetic investigations of extended pedigrees.

IMPORTANCE: Genetic factors contribute to risk for bipolar disorder (BP), but its pathogenesis remains poorly understood. A focus on measuring multisystem quantitative traits that may be components of BP psychopathology may enable genetic dissection of this complex disorder, and investigation of extended pedigrees from genetically isolated populations may facilitate the detection of specific genetic variants that affect BP as well as its component phenotypes. OBJECTIVE: To identify quantitative neurocognitive, temperament-related, and neuroanatomical phenotypes that appear heritable and associated with severe BP (bipolar I disorder [BP-I]) and therefore suitable for genetic linkage and association studies aimed at identifying variants contributing to BP-I risk. DESIGN, SETTING, AND PARTICIPANTS: Multigenerational pedigree study in 2 closely related, genetically isolated populations: the Central Valley of Costa Rica and Antioquia, Colombia. A total of 738 individuals, all from Central Valley of Costa Rica and Antioquia pedigrees, participated; among them, 181 have BP-I. MAIN OUTCOMES AND MEASURES: Familial aggregation (heritability) and association with BP-I of 169 quantitative neurocognitive, temperament, magnetic resonance imaging, and diffusion tensor imaging phenotypes. RESULTS: Of 169 phenotypes investigated, 126 (75%) were significantly heritable and 53 (31%) were associated with BP-I. About one-quarter of the phenotypes, including measures from each phenotype domain, were both heritable and associated with BP-I. Neuroimaging phenotypes, particularly cortical thickness in prefrontal and temporal regions as well as volume and microstructural integrity of the corpus callosum, represented the most promising candidate traits for genetic mapping related to BP based on strong heritability and association with disease. Analyses of phenotypic and genetic covariation identified substantial correlations among the traits, at least some of which share a common underlying genetic architecture. CONCLUSIONS AND RELEVANCE: To our knowledge, this is the most extensive investigation of BP-relevant component phenotypes to date. Our results identify brain and behavioral quantitative traits that appear to be genetically influenced and show a pattern of BP-I association within families that is consistent with expectations from case-control studies. Together, these phenotypes provide a basis for identifying loci contributing to BP-I risk and for genetic dissection of the disorder.

Fenomenología trascendental y scientia trascendens: dos versiones de la intencionalidad / Fenomenologia transcendental e scientia trascendens: duas versões da intencionalidade / Transcendental phenomenlogy and scientia trascendens: two conceptions of the intentionality

Este trabajo confronta dos versiones de la intencionalidad, de Duns Escoto y de Edmund Husserl. Esta confrontación permite establecer en qué medida la filosofía de Duns Escoto, la scientia trascendens, enriquece la concepción fenomenológica de la intencionalidad, y permite determinar si la filosofía de Escoto contiene una 'fenomenología de la verdad'. En el desarrollo del trabajo se muestra que, a pesar de algunas convergencias importantes con respecto a la intencionalidad, Escoto y Husserl tienen dos concepciones muy distintas del fenómeno o de la presencia; para el primero el objeto intencional se ofrece mediante las especies inteligibles, para el segundo a través de la fenomenalización. La investigación muestra que el mayor punto de divergencia está en la concepción del ser: para Escoto ser y verdad van de la mano, con independencia de los actos intencionales. Para Husserl, el sentido del ser surge de la actividad intencional de la conciencia, trascendental, determinada por los horizontes de orden temporal, mundano, intersubjetivo. Finalmente, Escoto plantea preguntas de orden metafísico, que llevan a reflexionar sobre los límites de esta disciplina.

This essay compares intentionality in Duns Scotus and Edmund Husserl. Such comparison allows to consider up to which point Scotus's philosophy, the scientia transcendens, enriches the phenomenological concept of intentionality and allows to determine whether such philosophy contains a "phenomenology of truth". It is shown that, despite some important convergencies respect of intentionality, Scotus and Husserl have two very different conceptions of the phaenomenon or the presence; for the first one, the intentional object is offered through the intelligible species, whereas for the second this is done through phaenomenization. This research shows that the main point of divergence is the conception of being: for Scotus, being and truth go together, independantly from intentional acts. For Husserl, the meaning of being arises from the intentional activity of the transcendental conscience, determined by intersubjective, worldly, temporal horizons. Finally, Scotus states questions of metaphysical character, which lead to think about the limits of this discipline.

Este trabalho confronta duas versões de intencionalidade, de Duns Escoto e de Edmund Husserl. Esta confrontação permite estabelecer em que medida a filosofía de Duns Escoto, a scientia trascendens, enriquece a concepção fenomenológica de intencionalidade, e permite determinar se a filosofía de Escoto contém uma "fenomenología da verdade". No desenvolvimento do trabalho mostra-se que, apesar de algumas convergências importantes em relação à intencionalidade, Escoto e Husserl têm duas concepções muito diferentes do fenômeno ou da presença; para o primeiro, o objeto intencional é oferecido através de espécies inteligíveis; para o segundo, através da fenomenalização. Pesquisas mostram que o maior ponto de divergência está na concepção do ser: para Escoto, o ser e a verdade andam de mãos dadas, independentemente de atos intencionais. Para Husserl, a sensação de ser surge da atividade intencional da consciência, transcendental, determinada por horizontes de ordem temporal, mundana e intersubjetiva. Finalmente, Escoto coloca questões de ordem metafísica, que levam a refletir sobre os limites dessa disciplina.

Drogas en Costa Rica: características y desafíos / Drugs in Costa Rica: characteristics and challenges

Objetivo: Evaluación de las características de las publicaciones sobre drogas realizadas en Costa Rica entre 1966 y 2010. Materiales y Métodos: Análisis bibliométrico de los trabajos compilados en la serie “Investigaciones sobre Alcoholismo y Farmacodependencia” que publica el Instituto sobre Alcoholismo y Farmacodependencia de Costa Rica de publicación quinquenal. Dicha serie se construyó a partir de una hoja de registro con diversas características de interés, tras realizarse una consulta de los catálogos y bases de datos de las bibliotecas y centros de documentación de diferentes instituciones. Resultados: Se estudiaron 491publicaciones. Una tercera parte se publicó en revistas científicas en tanto las publicaciones monográficas y los libros ocuparon, respectivamente, un 33 y un 6 % del total. Cerca de una tercera parte de los trabajos son investigaciones epidemiológicas y la droga mayormente investigada fue el alcohol, en ámbitos poblacionales que comprendieron las evaluaciones en la población general, los sujetos en calidad de pacientes y el sector infancia y juventud. Discusión: Se destaca el papel que ha correspondido a las ciencias sociales en el terreno del conocimiento sobre drogas, la importancia y necesidad de una mayor presencia femenina en la producción de dichos conocimientos y la exploración del fenómeno mediante alternativas que supongan un mayor énfasis tanto en el paradigma cualitativo como en el experimental y cuasi experimental para el abordaje de las complejidades que el tema exige.

Objective: This study analyses the characteristics of the publications on drugs carried out in Costa Rica during the period 1966 - 2010. Methods: Bibliometric analysis of the publications compiled in the serial named “Research publications on drug abuse and drug dependence” which is published by the Costa Rican’s National Institute on Alcoholism and Drug Dependence since 1990. Suchserial has been created using an instrument which allows gathering some bibliometric characteristics of interest in libraries’ catalogues and data bases located in different local institutions. Results: 491 publications have been studied, one third of these publications were published in scientific journals while 33% and 6% were published as monographs and books. About one third of the publications correspond to epidemiologic research. The drug mostly explored was alcohol, which has been studied in the general population as well as in drug affected subjects and in youth and childhood. Discussion: The roll of social sciences on drugs’ knowledge field, the importance and need of a growing feminine participation and the use of qualitative paradigms as well as experimental and quasi experimental research are pointed out and their relevance discussed.

Results of a SNP genome screen in a large Costa Rican pedigree segregating for severe bipolar disorder.

We have ascertained in the Central Valley of Costa Rica a new kindred (CR201) segregating for severe bipolar disorder (BP-I). The family was identified by tracing genealogical connections among eight persons initially independently ascertained for a genome wide association study of BP-I. For the genome screen in CR201, we trimmed the family down to 168 persons (82 of whom are genotyped), containing 25 individuals with a best-estimate diagnosis of BP-I. A total of 4,690 SNP markers were genotyped. Analysis of the data was hampered by the size and complexity of the pedigree, which prohibited using exact multipoint methods on the entire kindred. Two-point parametric linkage analysis, using a conservative model of transmission, produced a maximum LOD score of 2.78 on chromosome 6, and a total of 39 loci with LOD scores >1.0. Multipoint parametric and non-parametric linkage analysis was performed separately on four sections of CR201, and interesting (nominal P-value from either analysis <0.01), although not statistically significant, regions were highlighted on chromosomes 1, 2, 3, 12, 16, 19, and 22, in at least one section of the pedigree, or when considering all sections together. The difficulties of analyzing genome wide SNP data for complex disorders in large, potentially informative, kindreds are discussed.

Convergent linkage evidence from two Latin-American population isolates supports the presence of a susceptibility locus for bipolar disorder in 5q31-34.

We performed a whole genome microsatellite marker scan in six multiplex families with bipolar (BP) mood disorder ascertained in Antioquia, a historically isolated population from North West Colombia. These families were characterized clinically using the approach employed in independent ongoing studies of BP in the closely related population of the Central Valley of Costa Rica. The most consistent linkage results from parametric and non-parametric analyses of the Colombian scan involved markers on 5q31-33, a region implicated by the previous studies of BP in Costa Rica. Because of these concordant results, a follow-up study with additional markers was undertaken in an expanded set of Colombian and Costa Rican families; this provided a genome-wide significant evidence of linkage of BPI to a candidate region of approximately 10 cM in 5q31-33 (maximum non-parametric linkage score=4.395, P<0.00004). Interestingly, this region has been implicated in several previous genetic studies of schizophrenia and psychosis, including disease association with variants of the enthoprotin and gamma-aminobutyric acid receptor genes.

The PACARDO research project: youthful drug involvement in Central America and the Dominican Republic.

OBJECTIVE: To estimate the occurrence and school-level clustering of drug involvement among school-attending adolescent youths in each of seven countries in Latin America, drawing upon evidence from the PACARDO research project, a multinational collaborative epidemiological research study. METHODS: During 1999-2000, anonymous self-administered questionnaires on drug involvement and related behaviors were administered to a cross-sectional, nationally representative sample that included a total of 12,797 students in the following seven countries: Costa Rica (n = 1,702), the Dominican Republic (n = 2,023), El Salvador (n = 1,628), Guatemala (n = 2,530), Honduras (n = 1,752), Nicaragua (n = , 419), and Panama (n = 1,743). (The PACARDO name concatenates PA for Panamá, CA for Centroamérica, and RDO for República Dominicana). Estimates for exposure opportunity and actual use of alcohol, tobacco, inhalants, marijuana, cocaine (crack/coca paste), amphetamines and methamphetamines, tranquilizers, ecstasy, and heroin were assessed via responses about questions on age of first chance to try each drug, and first use. Logistic regression models accounting for the complex survey design were used to estimate the associations of interest. RESULTS: Cumulative occurrence estimates for alcohol, tobacco, inhalants, marijuana, and illegal drug use for the overall sample were, respectively: 52%, 29%, 5%, 4%, and 5%. In comparison to females, males were more likely to use alcohol, tobacco, inhalants, marijuana, and illegal drugs; the odds ratio estimates were 1.3, 2.1, 1.6, 4.1, and 3.2, respectively. School-level clustering was noted in all countries for alcohol and tobacco use; it was also noted in Costa Rica, El Salvador, Guatemala, and Panama for illegal drug use. CONCLUSIONS: This report sheds new light on adolescent drug experiences in Panama, the five Spanish-heritage countries of Central America, and the Dominican Republic, and presents the first estimates of school-level clustering of youthful drug involvement in these seven countries. Placed in relation to school survey findings from North America and Europe, these estimates indicate lower levels of drug involvement in these seven countries of the Americas. For example, in the United States of America 70% of surveyed youths had tried alcohol and 59% had smoked tobacco. By comparison, in these seven countries, only 51% have tried alcohol and only 29% have smoked tobacco. Future research will help to clarify explanations for the observed variations across different countries of the world. In the meantime, strengthening of school-based and other prevention efforts in the seven-country PACARDO area may help these countries slow the spread of youthful drug involvement, reduce school-level clustering, and avoid the periodic epidemics of illegal drug use that have been experienced in North America.

El consumo de tabaco en la población joven costarricense: hallazgos de la encuesta mundial sobre tabaco en jóvenes (G.Y.T.S. 1999) / The consumption of the tobacco in the Costa Rican young population: findings of the world-wide survey on tobacco in young people (G.Y.T.S. 1999)

En este artículo se presentan los principales hallazgos relativos al consumo de tabaco en una muestra representativa de estudiantes costarricenses de 7º, 8º y 9º año. La recolección de los datos se efectuó en 1999, mediante un instrumento estandarizado por la Organización Mundial de la Salud (OMS) y el Centro para el Control de las Enfermedades y Prevención de Atlanta (CDC) para administración multinacional. Este permite obtener información sobre prevalencia, acceso/disponiblilidad y precio, fumado pasivo, cesación del fumado, medios de comunicación, publicidad y currículum escolar. Se utilizó un diseño muestral por conglomerados en dos etapas. En la primera de éstas se seleccionaron los colegios, con probabilidad proporcional al tamaño de la matrícula. En la segunda, las aulas se escogieron aleatoriamente y todos los alumnos fueron elegibles para participar en el estudio. Los resultados revelan niveles muy altos de consumo de tabaco, ausencia de diferencias entre hombres y mujeres, exposición a fumado pasivo y también una exposición significativa a la publicidad inductora del consumo. Adicionalmente, se destacan algunos aspectos positivos presentes en el conglomerado en estudio, como el hecho de que la mayor parte de los estudiantes conocen los efectos negativos del fumado y la mayoría de los fumadores activos desean dejar de fumar, entre otros.

The PACARDO research project: youthful drug involvement in Central America and the Dominican Republic

OBJETIVO: Estimar el grado en que el consumo de drogas se produce y muestra una concentración en el nivel escolar entre adolescentes que asisten a la escuela en siete países de América Latina. Los datos presentados provienen del proyecto de investigación PACARDO, estudio epidemiológico conjunto multinacional. MÉTODOS: En el período de 1999­2000, se aplicaron cuestionarios anónimos autoadministrados sobre el consumo de drogas y conductas afines a una muestra transversal, representativa de la población nacional, que se compuso de un total de 12 797 estudiantes en los siguientes siete países: Costa Rica (n> 1 702), El Salvador (n> 1 628), Guatemala (n> 2 530), Honduras (n> 1 752), Nicaragua (n> 1 419), República Dominicana (n> 2 023) y Panamá (n> 1 743). (El nombre de PACARDO combina la PA de Panamá, la CA de Centroamérica y la RDO de República Dominicana). Se calcularon las oportunidades de exposición y el consumo de alcohol, tabaco, sustancias inhaladas, marijuana, cocaína (crack/pasta de cocaína), anfetaminas y metaanfetaminas, tranquilizantes, éxtasis y heroína sobre la base de las respuestas dadas a preguntas acerca de la edad en que se tuvo la oportunidad de probar cada una de las drogas, y en que se probó cada una de ellas, por primera vez. Para estimar las asociaciones de interés se aplicaron modelos de regresión logística con arreglo a la complejidad de la encuesta. RESULTADOS: Las siguientes fueron las frecuencias estimadas acumulativas del consumo de alcohol, tabaco, sustancias inhaladas, marijuana y drogas, respectivamente, en toda la muestra: 52%, 29%, 5%, 4% y 5%. Comparados con las mujeres, los varones fueron más propensos a consumir alcohol, tabaco, sustancias inhaladas, marijuana y drogas; las razones de posibilidades estimadas fueron, respectivamente, 1,3; 2,1; 1,6; 4,1 y 3,2. En todos los países se observó una concentración del consumo de alcohol y tabaco en el nivel escolar; el consumo ilegal de drogas también mostró una concentración escolar en Costa Rica, El Salvador, Guatemala y Panamá. CONCLUSIONES: Este informe arroja nueva luz sobre las experiencias de los adolescentes con la droga en Panamá, en los cinco países centroamericanos de tradición española, y en la República Dominicana. En él se presentan las primeras estimaciones del grado en que se concentra en las escuelas el consumo de drogas entre la juventud de estos siete países. Cuando se examinan a la luz de los resultados de encuestas escolares...

Intervención psicosocial en la internación por alcoholismo / Psychosocial intervention in hospitalization due to alcoholism

El presente artículo presenta un estudio de tipo descriptivo, basado sobre un seguimiento, de uno año de duración, llevado a cabo con una muestra de 72 pacientes atendidos en el Instituto sobre Alcoholismo y Fármacodependencia de San José, Costa Rica. Se recabó la información mediante un cuestionario de 59 preguntas respecto de: aspectos sociodemográficos, pautas de ingesta de alcohol/abstención, relaciones interpersonales, de familia y laborales, autodiagnóstico y evaluación del programa de tratamiento. Se impartió tratamiento psicosocial a todos los pacientes, durante las tres semanas de internación. A causa de los cambios sustanciales encontrados en las áreas arriba mencinadas, los resultados indican la presencia de una importante mejoría: puede dicirse, entonces, que se han complido los objetivos del tratamiento

El consumo de drogas en la mujer costarricense. Evolución de cinco años / Drug consumption of Costarican women. Its five year evolution

En este artículo se analizan los resultados obtenidos mediante la encuesta nacional sobre consumo de drogas, llevada a cabo por el Instituto sobre Alcoholismo y Farmacodependencia de Costa Rica en 1995. En virtud de que se trata de una réplica del estudio nacional efectuado en 1990, en el presente se efectúan comparaciones con los hallazgos inciales, en especial los relativos a las proporciones de prevalencia para todas las drogas y sobre los niveles de ingestión de alcohol. Se destacan, entre otros hallazgos, las variaciones que han sufrido los patrones de consumo de drogas en las mujeres con edades entre 12 y 70 años y algunas observaciones de interés en relación con modificaciones trascendentales en la ingestión de alcohol