Syringoma of vulva: an unusual presentation. Clinical, morphological and immunohistochemical aspects.

The case of a 34-year-old woman, who consulted because she observed the appearance of numerous yellow-white asymptomatic papules on the vulva, is presented. Clinical diagnosis of syringoma of vulva was established. The pathological and immunohistochemical studies confirmed the diagnosis. Vulvar syringoma usually occurs as a multiple flesh-colored or brownish papules on both sides of labia majora of women in their third decade. Its diagnosis should be considered when the patient complaints of vulvar pruritus and/or sweating.

[Mortality from ischemic heart disease in Chile: who, how many, and where]. / Mortalidad por cardiopatía isquémica en Chile: quiénes, cuántos y dónde.

OBJECTIVE: To describe the characteristics of mortality from ischemic heart disease in Chile and its trend over time, and to identify the factors associated with extra-hospital mortality from this pathology between 1997 and 2007. METHODS: A time-series study was conducted using the mortality database of the Department of Health Statistics and Information for 1997 to 2007. Of the total of 917,029 deaths reported in this period, those whose primary cause was ischemic heart disease (ICD-10 codes I20-I25) were selected. Crude and adjusted rates were calculated by age and sex in order to analyze the trend. Mortality characteristics were analyzed by the place of death, evaluating potential factors associated with extra-hospital mortality (death at home or elsewhere outside a hospital or clinic). The factors considered, using binomial regression, were age, rurality, marital status, education, and sex, as well as the effect of the incorporation of acute myocardial infarction into the explicit health guarantees law. RESULTS: During the period in question, 87,342 deaths from ischemic heart disease were reported, 57.7% of which were in males and 59.5% outside the hospital. The age-standardized mortality rate declined from 52.9 to 40.4 per 100,000 population. Factors related to extra-hospital mortality in men were rurality, relative risk (RR) 1.24 (1.21-1.27); age of over 70 years, RR 1.03 (1.01-1.05); and being single, RR 1.10 (1.08-1.12). In women, the respective values were rurality, 1.13 (1.10-1.18); advanced age, 1.31 (1.27-1.36); and being single, 1.07 (1.04-1.09). Passage of the explicit health guarantees law was associated with an increase in the percentage of in-hospital deaths in women, RR 0.95 (0.92-0.97). CONCLUSIONS: Mortality from ischemic heart disease in Chile has declined. The majority of deaths from this cause occur outside hospitals or clinics. The factors associated with extra-hospital mortality in both sexes were advanced age, being single, and rurality.

Impulsivity facets and substance use initiation: A comparison of two models of impulsivity.

Several types of impulsivity have been linked to various substance use outcomes. The UPPS-P framework has received major focus within the field of substance use research. However, this framework is not without limitation. An alternative framework is the Two-Factor Model of impulsivity, which posits that rash impulsivity and reward drive are the central, if not sufficient, domains of impulsivity. Unfortunately, the extant literature is quite limited in terms of work that have directly compared the UPPS-P framework to the Two-Factor Model of impulsivity, particularly in prospective designs focused on the initiation of common, problematic forms of substance use among adolescents (i.e., alcohol and marijuana use). In the current study, the UPPS-P measures were compared to dedicated measures of the Two-Factor Model of impulsivity in a sample of Chilean adolescents who were lifetime abstainers of alcohol or marijuana use at baseline (N = 541) to predict the initiation of use for these substances at a one-year follow-up. Results showed that the Two-Factor Model had superior predictive utility compared to the UPPS-P measures, and only rash impulsivity and reward drive were significant predictors in a multivariate model that simultaneously considered UPPS-P and Two-Factor Model assessments. Overall, the current findings indicate that the Two-Factor Model should be considered to index risk of substance use initiation to guide prevention efforts and highlight the importance of direct comparisons of alternative measurement and theoretical frameworks of impulsivity within the field of substance use research.

Relation between insulin resistance and breast cancer among Chilean women.

PURPOSE: In Chile, diabetes and breast cancer are important public health problems. The association between insulin resistance and breast cancer, however, remains largely unexplored. METHODS: We conducted a case-control study to assess the relationship of insulin resistance (IR) and breast cancer in Chilean premenopausal and postmenopausal women. We compared 170 women, 33 to 86 years old, with incident breast cancer and 170 normal mammography controls, matched by 5-year age interval. Plasmatic insulin and glucose were measured and IR was calculated by the homeostasis model assessment method. Anthropometric measurements and sociodemographic and behavioral data were also collected. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by multivariable conditional logistic regression. RESULTS: IR was independently associated with breast cancer in postmenopausal women (OR = 2.70, 95%CI = 1.10-6.63), but not in premenopausal women (OR = 0.84, 95%CI = 0.20-3.52). Obesity was not associated with breast cancer at any age (OR = 0.68, 95%CI = 0.39-1.20). CONCLUSION: In this sample, IR increased the risk of breast cancer among postmenopausal women.

Hypertension and the risk of breast cancer in Chilean women: a case-control study.

BACKGROUND: Breast cancer is the most common cancer in women worldwide. Although different metabolic factors have been implicated in breast cancer development, the relationship between hypertension and breast cancer has not been elucidated. AIM: To evaluate hypertension as a risk factor for breast cancer in Chilean women of low and middle socio-economic status. METHODS: We conducted an age-matched (1:1) case-control study in 3 hospitals in Santiago, Chile. Breast cancer cases (n=170) were histopathologically confirmed. Controls had been classified as Breast Imaging Reporting and Data System I (negative) or II (benign findings) within 6 months of recruitment. Blood pressure was measured using a mercury sphygmomanometer and standardized procedures. We used 2 hypertension cut-off points: blood pressures of ≥140/90 mmHg and ≥130/85 mmHg. Fasting insulin and glucose levels were assessed, and anthropometric, sociodemographic, and behavioral information were collected. Odds ratios and 95% confidence intervals were estimated for the entire sample and restricted to postmenopausal women using multivariable conditional logistic regression models. RESULTS: Hypertension (≥140/90 mmHg) was significantly higher in cases (37.1%) than controls (17.1%) for the entire sample and in postmenopausal pairs (44.0% compared to 23.8%). In crude and adjusted models, hypertensive women had a 4-fold increased risk of breast cancer (adjusted odds ratio: 4.2; 95% confidence interval: 1.8; 9.6) compared to non-hypertensive women in the entire sample. We found a similar association in the postmenopausal group (adjusted odds ratio: 2.8; 95% confidence interval: 1.1; 7.4). A significant effect was also observed when hypertension was defined as blood pressure of ≥130/85 mmHg. CONCLUSION: A significant association was found between hypertension and breast cancer over the entire sample and when restricted to postmenopausal women. Hypertension is highly prevalent in Latin America and may be a modifiable risk factor for breast cancer; therefore, a small association between hypertension and breast cancer may have broad implications.

Syringoma of vulva: an unusual presentation. Clinical, morphological and immunohistochemnical aspects / Siringoma de vulva / una presentación inusual. Aspectos clínicos, histopatológicos e inmunohistoquímicos

The case of a 34-year-old woman, who consulted because she observed the appearance of numerous yellow-white asymptomatic papules on the vulva, is presented. Clinical diagnosis of syringoma of vulva was established. The pathological and immunohistochemical studies confirmed the diagnosis. Vulvar syringoma usually occurs as a multiple flesh-colored or brownish papules on both sides of labia majora of women in their third decade. Its diagnosis should be considered when the patient complaints of vulvar pruritus and/or sweating.

Se presenta un caso de una paciente de 34 años de edad quien consultó por presentar la aparición de numerosas pápulas de color blanco-amarillentas en la vulva. El diagnóstico clínico de siringoma de vulva fue realizado. Los estudios de patología y de inmunohistoquimica confirmaron el diagnóstico. El siringoma vulvar usualmente se presenta como múltiples pápulas del color de la piel o marrones en ambos labios mayores en mujeres en su tercera década de la vida. Su diagnóstico debe ser considerado en pacientes que se quejan de prurito y/o sudoración vulvar

Size at birth and lipoprotein concentrations in adulthood: two prospective studies in Latin American cities.

BACKGROUND: The relationship between birth weight and plasma lipoproteins is inconsistent. AIMS: To assess the association between birth weight and (1) body mass index (BMI) at birth and (2) lipoproteins in young adults, and also to explore the possible effect of current obesity as a possible effect modifier. METHODS: Two prospective studies based on representative samples of subjects born in the 1970s were carried out in Ribeirão Preto, Brazil (n=2063) and Limache, Chile (n=999). The surveys were carried out between 2001 and 2004. RESULTS: Mean birth weights were 3267 g and 3177 g and mean adult BMIs were 24.3 kg/m2 and 25.8 kg/m2 in the Brazilian and Chilean samples, respectively. Total adult cholesterol was 4.57 mmol/l in Chileans, 0.26 mmol/l higher than in Brazilians (p<0.001). The main finding was an interaction between adult obesity (BMI 30 or over) and birth weight and also BMI at birth and low-density lipoprotein (LDL) and total cholesterol. A birth-weight increment of 1 kg was associated with a decrease in total cholesterol (-0.374 mmol/l, 95% CI -0.567 to -0.181) and LDL (-0.304 mmol/l (-0.479 to -0.129) in obese participants only. These associations persisted after allowing for gestational age in a smaller sample. This finding was consistent in separate analyses in the Brazilian and Chilean samples. No associations were found in relation to high-density lipoprotein and triglyceride concentrations. CONCLUSION: The results suggest that those who were of low birth weight and are obese are more likely to have high cholesterol and LDL concentrations. Thus preventing obesity may be especially rewarding in subjects with a low birth weight.

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

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

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

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

[Social support as a protective factor of recurrence after drug addiction treatment]. / Importancia del apoyo social en la permanencia de la abstinencia del consumo de drogas.

UNLABELLED: Lack of social support can be one of the factors that influences recurrences of drug consumption after treatment of addictions. AIM: To assess the role of social support in maintaining drug abstinence after treatment. MATERIAL AND METHODS: We studied 306 subjects that were treated in drug addiction centers, financed by the National Council for Drug Control (CONACE). At discharge, social and demographic data were recorded and the Medical Outcomes Study (MOS) questionnaire was given to evaluate social support. Subjects that achieved abstinence at the moment of discharge were contacted six months later and interrogated about eventual drug consumption thereafter. RESULTS: One hundred fifty three (76% male, aged 32+/-10 years) of 197 abstinent subjects at discharge, were located six months later. Of these, 108 (71%) were not consuming drugs. On univariate analysis, social support had a protective effect against recurrence of drug consumption (OR-0.98; CI 95%=0.96-0.99). This effect remained significant after adjusting for age, sex, occupational situation, mental health self-assessment, family history of alcohol and drug consumption, type of drug treatment and type of discharge as confounding variables (OR=0.97; CI 95%=0.94-0.99). CONCLUSIONS: These data provide evidence that social support protects against recurrence into drug consumption at least up to six months. Long-term effects should be evaluated.

Mortalidad por cardiopatía isquémica en Chile: quiénes, cuántos y dónde / Mortality from ischemic heart disease in Chile: who, how many, and where

OBJETIVO: Describir las características de la mortalidad por cardiopatía isquémica en Chile y su evolución temporal, e identificar los factores asociados a mortalidad extrahospitalaria por esta patología entre 1997 y 2007. MÉTODOS. Estudio de serie temporal que utiliza las bases de defunciones del Departamento de Estadísticas e Información en Salud entre 1997 y 2007. De un total de 917 029 muertes notificadas, se seleccionaron aquellas cuya causa primaria fue cardiopatía isquémica (códigos I20 a I25 de la CIE-10). Se calcularon tasas crudas y ajustadas por edad y sexo para analizar la tendencia. Se analizaron las características de la mortalidad según el lugar de defunción, evaluando posibles factores asociados a mortalidad extrahospitalaria (casa/habitación u otro lugar), incluidos edad, ruralidad, estado civil, educación y sexo, así como el efecto de la incorporación del infarto agudo al miocardio a la ley de garantías en salud (GES), con regresión binomial. RESULTADOS: Durante el período estudiado se notificaron 87 342 muertes por cardiopatía isquémica, de las cuales 57,7 por ciento eran hombres y 59,5 por ciento ocurrieron fuera del hospital. La tasa de mortalidad ajustada por edad disminuyó de 52,9 a 40,4 por 100 000 habitantes. Los factores asociados a mortalidad extrahospitalaria en hombres fueron ruralidad, riesgo relativo (RR) 1,24 (1,21-1,27); edad mayor a 70 años, RR 1,03 (1,01-1,05); estado civil soltero, RR 1,10 (1,08-1,12), mientras que en las mujeres los valores correspondientes fueron 1,13 (1,10-1,18); 1,31 (1,27-1,36) y 1,07 (1,04-1,09). La adopción de la GES se asoció con un aumento en el porcentaje de muertes intrahospitalarias en mujeres, RR 0,95 (0,92-0,97). CONCLUSIONES: †La mortalidad por cardiopatía isquémica en Chile ha disminuido. El mayor porcentaje de las muertes ocurren fuera de hospitales o clínicas. Los factores asociados a mortalidad extrahospitalaria en ambos sexos fueron edad avanzada, estado civil soltero y ruralidad.

OBJECTIVE: To describe the characteristics of mortality from ischemic heart disease in Chile and its trend over time, and to identify the factors associated with extra-hospital mortality from this pathology between 1997 and 2007. METHODS: A time-series study was conducted using the mortality database of the Department of Health Statistics and Information for 1997 to 2007. Of the total of 917 029 deaths reported in this period, those whose primary cause was ischemic heart disease (ICD-10 codes I20-I25) were selected. Crude and adjusted rates were calculated by age and sex in order to analyze the trend. Mortality characteristics were analyzed by the place of death, evaluating potential factors associated with extra-hospital mortality (death at home or elsewhere outside a hospital or clinic). The factors considered, using binomial regression, were age, rurality, marital status, education, and sex, as well as the effect of the incorporation of acute myocardial infarction into the explicit health guarantees law. RESULTS: During the period in question, 87 342 deaths from ischemic heart disease were reported, 57.7 percent of which were in males and 59.5 percent outside the hospital. The age-standardized mortality rate declined from 52.9 to 40.4 per 100 000 population. Factors related to extra-hospital mortality in men were rurality, relative risk (RR) 1.24 (1.21-1.27); age of over 70 years, RR 1.03 (1.01-1.05); and being single, RR 1.10 (1.08-1.12). In women, the respective values were rurality, 1.13 (1.10-1.18); advanced age, 1.31 (1.27-1.36); and being single, 1.07 (1.04-1.09). Passage of the explicit health guarantees law was associated with an increase in the percentage of in-hospital deaths in women, RR 0.95 (0.92-0.97). CONCLUSIONS: Mortality from ischemic heart disease in Chile has declined. The majority of deaths from this cause occur outside hospitals or clinics. The factors associated with extra-hospital mortality in both sexes were advanced age, being single, and rurality.

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

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

Importancia del apoyo social en la permanencia de la abstinencia del consumo de drogas / Social support as a protective factor of recurrence after drug addiction treatment

Lack of social support can be one of the factors that influences recurrences of drug consumption after treatment of addictions. Aim: To assess the role of social support in maintaining drug abstinence after treatment. Material and methods: We studied 306 subjects that were treated in drug addiction centers, financed by the National Council for Drug Control (CONACE). At discharge, social and demographic data were recorded and the Medical Outcomes Study (MOS) questionnaire was given to evaluate social support. Subjects that achieved abstinence at the moment of discharge were contacted six months later and interrogated about eventual drug consumption thereafter. Results: One hundred fifty three (76 percent male, aged 32 ± 10 years) of 197 abstinent subjects at discharge, were located six months later. Of these, 108 (71 percent) were not consuming drugs. On univariate analysis, social support had a protective effect against recurrence of drug consumption (OR - 0.98; CI 95 percent = 0.96-0.99). This effect remained significant after adjusting for age, sex, occupational situation, mental health self-assessment, family history of alcohol and drug consumption, type of drug treatment and type of discharge as confounding variables (OR = 0.97; CI 95 percent = 0.94-0.99). Conclusions: These data provide evidence that social support protects against recurrence into drug consumption at ¡east up to six months. Long-term effects should be evaluated.