Efficacy of Hair Total Mercury Content as a Biomarker of Methylmercury Exposure to Communities in the Area of Artisanal and Small-Scale Gold Mining in Madre de Dios, Peru.

Total mercury content (THg) in hair is an accepted biomarker for chronic dietary methylmercury (MeHg) exposure. In artisanal and small-scale gold mining (ASGM) communities, the validity of this biomarker is questioned because of the potential for contamination from inorganic mercury. As mining communities may have both inorganic and organic mercury exposures, the efficacy of the hair-THg biomarker needs to be evaluated, particularly as nations begin population exposure assessments under their commitments to the Minamata Convention. We sought to validate the efficacy of hair THg for public health monitoring of MeHg exposures for populations living in ASGM communities. We quantified both THg and MeHg contents in hair from a representative subset of participants (N = 287) in a large, population-level mercury exposure assessment in the ASGM region in Madre de Dios (MDD), Peru. We compared population MeHg-THg correlations and %MeHg values with demographic variables including community location, sex, occupation, and nativity. We observed that hair MeHg-THg correlations were high (r > 0.7) for all communities, regardless of location or nativity. Specifically, for individuals within ASGM communities, 81% (121 of 150 total) had hair THg predominantly in the form of MeHg (i.e., >66% of THg) and reflective of dietary exposure to mercury. Furthermore, for individuals with hair THg exceeding the U.S. EPA threshold (1.0 µg/g), 88 out of 106 (83%) had MeHg as the predominant form. As a result, had urine THg solely been used for mercury exposure monitoring, approximately 59% of the ASGM population would have been misclassified as having low mercury exposure. Our results support the use of hair THg for monitoring of MeHg exposure of populations in ASGM settings where alternative biomarkers of MeHg exposure are not feasible.

A population-based mercury exposure assessment near an artisanal and small-scale gold mining site in the Peruvian Amazon.

Human exposure to mercury is a leading public health problem. Artisanal and small-scale gold mining (ASGM) is a major source of global mercury emissions. Although occupational mercury exposure to miners (via mercury vapor inhalation) is known, chronic mercury exposure to nearby residents that are not miners (via mercury-contaminated fish consumption) is poorly characterized. We conducted a population-based mercury exposure assessment in 23 communities (19 rural, 4 urban) around the Amarakaeri Communal Reserve, which is bordered on the east by heavy ASGM activity. We measured total mercury in hair (N = 2083) and blood (N = 476) from March-June 2015 and performed follow-up measurements (N = 723 hair and N = 290 blood) from February-April 2016. Mercury exposure risk was highest in communities classified as indigenous, or native, regardless of proximity to mining activity. Residence in a native community (vs. non-native) was associated with mercury levels 1.9 times higher in hair (median native 3.5 ppm vs. median non-native 1.4 ppm total mercury) and 1.6 times higher in blood (median native 7.4 ng/mL vs median non-native 3.2 ng/mL total mercury). Unexpectedly, proximity to mining was not associated with exposure risk. These findings challenge common assumptions about mercury exposure patterns and emphasize the importance of population-representative studies to identify high risk sub-populations.

Elevated Hair Mercury Levels Are Associated With Neurodevelopmental Deficits in Children Living Near Artisanal and Small-Scale Gold Mining in Peru.

Children living near artisanal and small-scale gold mining (ASGM) are at risk of exposure to mercury, a neurotoxicant. It is not certain whether such exposures are harming development, as they occur in underresourced contexts entwined with other stressors, such as malnutrition and enteric infection. This study sought to investigate the association between hair-mercury levels and visual-motor, cognitive, and physical development among children living near ASGM in the Peruvian Amazon. Total hair-mercury levels were measured in 164 children ages 5-12 living in Madre de Dios, Peru. Primary outcomes included Visual-Motor Integration assessed via the Beery-VMI Developmental Test, General Cognitive Ability assessed via the Batería-III Woodcock-Munoz (Spanish-language Woodcock-Johnson Tests of Cognitive Abilities), and Physical Health assessed via anthropometry/hemoglobin counts. Mean (SD) hair-mercury level was 2.06 (2.43) µg/g. Fifty-four children (32.9%) had hair-mercury levels above the World Health Organization reference level of 2.0 µg/g. After controlling for sex, child age, maternal education, and family socioeconomic status, each one unit increase in log hair-mercury level was associated with a 1.01 unit decrease in Visual-Motor Integration (95%CI: -2.06, 0.05, p = 0.061), a 2.59 unit decrease in General Cognitive Ability (95%CI: -4.52, -0.66, p = 0.012), and a 2.43 unit decrease in Physical Health (95%CI: -5.34, 0.49, p = 0.096). After adjustment for covariates, children with hair-mercury levels exceeding the World Health Organization reference level scored 4.68 IQ points lower in Cognitive Ability than their peers. Mercury exposures related to ASGM may be harming child development in the Peruvian Amazon. Children in this region may benefit from intervention to reach their full developmental potential.

Problemas a los que se enfrenta el personal de enfermería en el cuidado paliativo / Problems faced by nursing staff in palliative care

INTRODUCCIÓN: Los cuidados paliativos comprenden una nueva atención de un equipo multidisciplinar, cumpliendo con la intención de mejorar la calidad de vida de los pacientes y su familia. OBJETIVO: analizar los estudios que revelen los problemas a los que se enfrenta el personal de enfermería que se encarga del cuidado paliativo. MÉTODO: Estudio de revisión bibliométrica y narrativa, se buscaron 75 artículos, de los cuales se seleccionaron 50, ya que cumplían con los criterios de inclusión. Se descartaron 25 artículos puesto que eran de revisión, publicados antes del 2015 y su tema específico no trataba del rol de la enfermería en cuidados paliativos. Se realizó una búsqueda bibliográfica en las bases de datos ProQuest, SCIelo, Google Académico, Scopus, HINARI y PubMed. Con análisis documental bajo los criterios ocupacionales de percepción y de sentimientos a considerar por enfermería bajo la teoría de Cornelia M. Ruland. RESULTADOS: los problemas encontrados fueron sentimientos negativos que repercuten en los profesionales de enfermería como consecuencia del entorno donde se están brindando los cuidados paliativos. El riesgo de padecer el síndrome de burnout es más frecuente cuando experimentan situaciones de impotencia y de frustración emocional. CONCLUSIÓN: Se puede verificar que la teoría de Cornelia M. Ruland, es importante puesto que los conocimientos del personal de enfermería son necesarios al momento de brindar un cuidado paliativo, ayudando así a mejorar la calidad de vida del paciente, brindando un cuidado integral que fortalece una atención holística para cada paciente de forma individualizada.

INTRODUCTION: Palliative care includes new care from a multidisciplinary team, fulfilling the intention of improving the quality of life of patients and their families. OBJECTIVE: to analyze the studies that reveal the problems faced by nursing personnel who are in charge of palliative care. METHOD: Bibliometric and narrative review study, 75 articles were searched, of which 50 were selected, as they met the inclusion criteria. 25 articles were discarded since they were review articles, published before 2015 and their specific topic did not deal with the role of nursing in palliative care. A bibliographic search was performed in the ProQuest, SCIelo, Google Academic, Scopus, HINARI and PubMed databases. With documentary analysis under the occupational criteria of perception and feelings to be considered by the nurse under the theory of Cornelia M. RESULTS: Some of the problems found. They were negative feelings that affect nursing professionals because of the environment where palliative care is being provided. The risk of suffering from burnout syndrome is more frequent when they experience situations of impotence and emotional frustration. CONCLUSION: In conclusion and according to the articles found, it can be verified that the theory of Cornelia M. Ruland, It is important since the knowledge of the nursing staff is necessary when providing palliative care, thus helping to improve the quality of life of the patient, providing comprehensive care that strengthens holistic care for each patient individually

[National action plan for the emergence of invasive meningococcal disease in Chile, 2012-2013]. / Plan de acción nacional frente a la emergencia de la cepa W-135 responsable de enfermedad meningocócica invasora en Chile, 2012-2013.

Invasive meningococcal disease is challenging for public health, mainly when it manifests with sudden changes in incidence, serogroups and hypervirulent clones that spread in the population, causing great alarm due to its sequelae and often fatal course, a situation that occurred in Chile, starting at week 26 of the year 2012. To face this scenario, an organization of multidisciplinary teams was required, called W-135 Action Plan in Chile, which included sanitary alerts, education, reinforcement of the epidemiological surveillance of suspicious cases, immediate diagnosis through state-of-the-art techniques, blocking of contacts, communication plans, and, from the 42nd week, ON the vaccination campaign was started for children aged from 9-months-old to less than 5 years of age. The vaccination strategy had a great impact on the decrease in incidence (1.3 to 0.1/100,000) and case fatality rate in the vaccinated population (23% to 0%), with a high safety profile, leading to its subsequent inclusion in the national immunization program. The ability to develop molecular, clinical and epidemiological studies allowed us to better understand the situation, supporting public health policy decisions for its control. The W-135 Action Plan implemented by the Ministry of Health in Chile, to manage the outbreak of meningococcal disease by Neisseria meningitidis serogroup W, demonstrated that the coordination of these efforts, through an organized Action Plan, allows the implementation of campaigns at the national level achieving high coverage of risk populations in short periods of time, generating a positive impact on the health of the population.

Plan de acción nacional frente a la emergencia de la cepa W-135 responsable de enfermedad meningocócica invasora en Chile, 2012-2013 / National action plan for the emergence of invasive meningococcal disease in Chile, 2012-2013

Invasive meningococcal disease is challenging for public health, mainly when it manifests with sudden changes in incidence, serogroups and hypervirulent clones that spread in the population, causing great alarm due to its sequelae and often fatal course, a situation that occurred in Chile, starting at week 26 of the year 2012. To face this scenario, an organization of multidisciplinary teams was required, called W-135 Action Plan in Chile, which included sanitary alerts, education, reinforcement of the epidemiological surveillance of suspicious cases, immediate diagnosis through state-of-the-art techniques, blocking of contacts, communication plans, and, from the 42nd week, ON the vaccination campaign was started for children aged from 9-months-old to less than 5 years of age. The vaccination strategy had a great impact on the decrease in incidence (1.3 to 0.1/100,000) and case fatality rate in the vaccinated population (23% to 0%), with a high safety profile, leading to its subsequent inclusion in the national immunization program. The ability to develop molecular, clinical and epidemiological studies allowed us to better understand the situation, supporting public health policy decisions for its control. The W-135 Action Plan implemented by the Ministry of Health in Chile, to manage the outbreak of meningococcal disease by Neisseria meningitidis serogroup W, demonstrated that the coordination of these efforts, through an organized Action Plan, allows the implementation of campaigns at the national level achieving high coverage of risk populations in short periods of time, generating a positive impact on the health of the population.

Spatial, Temporal, and Dietary Variables Associated with Elevated Mercury Exposure in Peruvian Riverine Communities Upstream and Downstream of Artisanal and Small-Scale Gold Mining.

Artisanal and small-scale gold mining (ASGM) is a primary contributor to global mercury and its rapid expansion raises concern for human exposure. Non-occupational exposure risks are presumed to be strongly tied to environmental contamination; however, the relationship between environmental and human mercury exposure, how exposure has changed over time, and risk factors beyond fish consumption are not well understood in ASGM settings. In Peruvian riverine communities (n = 12), where ASGM has increased 4-6 fold over the past decade, we provide a large-scale assessment of the connection between environmental and human mercury exposure by comparing total mercury contents in human hair (2-cm segment, n = 231) to locally caught fish tissue, analyzing temporal exposure in women of child bearing age (WCBA, 15-49 years, n = 46) over one year, and evaluating general mercury exposure risks including fish and non-fish dietary items through household surveys and linear mixed models. Calculations of an individual's oral reference dose using the total mercury content in locally-sourced fish underestimated the observed mercury exposure for individuals in many communities. This discrepancy was particularly evident in communities upstream of ASGM, where mercury levels in river fish, water, and sediment measurements from a previous study were low, yet hair mercury was chronically elevated. Hair from 86% of individuals and 77% of children exceeded a USEPA (U.S. Environmental Protection Agency) provisional level (1.2 µg/g) that could result in child developmental impairment. Chronically elevated mercury exposure was observed in the temporal analysis in WCBA. If the most recent exposure exceeded the USEPA level, there was a 97% probability that the individual exceeded that level 8-10 months of the previous year. Frequent household consumption of some fruits (tomato, banana) and grains (quinoa) was significantly associated with 29-75% reductions in hair mercury. Collectively, these data demonstrate that communities located hundreds of kilometers from ASGM are vulnerable to chronically elevated mercury exposure. Furthermore, unexpected associations with fish mercury contents and non-fish dietary intake highlight the need for more in-depth analyses of exposure regimes to identify the most vulnerable populations and to establish potential interventions.

Hair Mercury Level is Associated with Anemia and Micronutrient Status in Children Living Near Artisanal and Small-Scale Gold Mining in the Peruvian Amazon.

Anemia has been widely studied in global health contexts because of severe nutritional deficiency, and more recently, inflammatory status, but chemical exposures are rarely considered. Until recently, "anemia" was used synonymously with "iron deficiency anemia (IDA)" in global health settings. However, only 50% of anemia cases worldwide are IDA. Environmental toxicology studies of anemia risk have generally focused on populations in developed countries, albeit with high exposure to environmental toxicants, such as lead or cadmium. In the developing world, toxicant exposures commonly coexist with other risk factors for anemia. In particular, artisanal and small-scale gold mining (ASGM) communities are at risk for dietary methylmercury exposure through contaminated fish consumption, and for anemia due to food insecurity and infectious and chronic diseases. Here, we report analysis of total hair mercury content, hemoglobin, and serum micronutrient levels in children < 12 years of age (N = 83) near ASGM in the Peruvian Amazon. Forty-nine percent (N = 29/59) of those aged < 5 years were anemic (< 11 g/dL) and 52% (N = 12/23) of those aged 5-11 years (< 11.5 g/dL). Few children were stunted, wasted, or micronutrient deficient. Median total hair mercury was 1.18 µg/g (range: 0.06-9.70 µg/g). We found an inverse association between total mercury and hemoglobin (ß = -0.12 g/dL, P = 0.06) that persisted (ß = -0.14 g/dL, P = 0.04) after adjusting for age, sex, anthropometrics, and vitamin B12 in multivariate regression. This study provides preliminary evidence that methylmercury exposure is associated with anemia, which is especially relevant to children living near ASGM.

Functional disability, sagittal alignment and pelvic balance in lumbar spondylolisthesis / Incapacidade funcional, alinhamento sagital e equilíbrio pélvico em espondilolistese lombar / Discapacidad funcional, alineación sagital y balance pélvico en espondilolistesis lumbar

ABSTRACT Objectives: To demonstrate the recovery of lumbar sagittal pelvic alignment and sagittal pelvic balance after surgical reduction of lumbar spondylolisthesis and establish the benefits of the surgery for reduction and fixation of the lumbar spondylolisthesis with 360o circumferential arthrodesis for 2 surgical approaches by clinical and functional evaluation. Method: Eight patients with lumbar spondylolisthesis treated with surgical reduction and fixation of listhesis and segmental circumferential fusion with two surgical approaches were reviewed. They were evaluated before and after treatment with Oswestry, Visual Analogue for pain and Odom scales, performing radiographic measurement of lumbar sagittal alignment and pelvic sagittal balance with the technique of pelvic radius. Results: Oswestry scales and EVA reported improvement of symptoms after treatment in 8 cases; the Odom scale had six outstanding cases reported. The lumbar sagittal alignment presented a lumbosacral lordosis angle and a lumbopelvic lordosis angle reduced in 4 cases and increased in 4 other cases; pelvic sagittal balance increased the pelvic angle in 4 cases and decreased in 3 cases and the sacral translation of the hip axis to the promontory increased in 6 cases. Conclusion: The surgical procedure evaluated proved to be useful by modifying the lumbar sagittal alignment and the pelvic balance, besides reducing the symptoms, enabling the patient to have mobility and movement and the consequent satisfaction with the surgery.

RESUMO Objetivos: Demonstrar a recuperação do alinhamento pélvico sagital lombar e do equilíbrio pélvico sagital após a redução e fixação cirúrgica da espondilolistese lombar e estabelecer os benefícios do procedimento cirúrgico de redução e fixação da espondilolistese lombar com artrodese circunferencial 360° por dois acessos cirúrgicos por avaliação clínico-funcional. Método: Foram revisados 8 pacientes com espondilolistese lombar tratados com redução cirúrgica e fixação da listese e artrodese segmentar circunferencial por dois acessos cirúrgicos. Eles foram avaliados antes e após o tratamento pelas escalas de Oswestry, visual analógica para dor e de Odom, efetuando-se a medida radiográfica do alinhamento sagital lombar e do equilíbrio pélvico sagital com a técnica do raio pélvico. Resultados: As escalas de Oswestry e EVA relataram melhora dos sintomas após o tratamento em 8 casos, a escala de Odom teve 6 casos excelentes relatados. O alinhamento sagital lombar apresentou ângulo de lordose lombossacral e de lordose lombopélvica reduzidos em 4 casos e aumentados em 4 restantes; o equilíbrio sagital pélvico aumentou o ângulo pélvico em 4 casos e diminuiu em 3 casos e a translação sacral do eixo do quadril até o promontório aumentou em 6 casos. Conclusão: O procedimento cirúrgico avaliado comprova sua utilidade ao modificar o alinhamento sagital lombar e o equilíbrio pélvico e ao reduzir os sintomas, possibilitando que o paciente tenha mobilidade e movimento e a consequente satisfação com a cirurgia.

RESUMEN Objetivos: Demostrar la recuperación de la alineación sagital lumbar y del balance pélvico sagital tras la reducción quirúrgica de la espondilolistesis lumbar y establecer los beneficios del procedimiento quirúrgico de reducción y fijación de la espondilolistesis lumbar con artrodesis circunferencial de 360° por dos vías de abordaje mediante la evaluación clínico-funcional. Métodos: Se revisaron 8 pacientes con espondilolistesis lumbar tratados con reducción y fijación quirúrgica de la listesis y artrodesis circunferencial segmentaria por dos vías de abordaje. Se evaluaron antes y después del tratamiento con las escalas Oswestry, Visual Analógica del dolor y Odom, efectuando la medición radiográfica de la alineación sagital lumbar y del balance pélvico sagital con la técnica del radio pelviano. Resultados: Las escalas de Oswestry y EVA reportaron mejoría de la sintomatología después del tratamiento en los 8 casos; la escala Odom reporto 6 casos excelentes. La alineación sagital lumbar reportó los ángulos de lordosis lumbosacra y de lordosis lumbopélvica disminuidos en 4 casos y aumentados en 4 restantes; el balance pélvico sagital aumentó el ángulo pélvico en 4 casos y disminuyó en 3 casos; la traslación sacra del eje de las caderas al promontorio aumentó en 6 casos. Conclusión: El procedimiento quirúrgico evaluado demuestra su utilidad al modificar la alineación lumbar y el balance pélvico sagital y reducir la sintomatología, lo que permite la movilidad y el desplazamiento del paciente y la consecuente satisfacción con la cirugía.

Imaginarios racistas frente al triunfo del indio en Bolivia / Racist imaginaries about triumph of natives in Bolivia

En este trabajo se hace un breve análisis psicosocial del imaginario racista en la historia reciente de Bolivia, retomando la memoria histórica de la sistemática exclusión de lo indígena, que bajo el imaginario de la superioridad de la identidad blanca y de la racionalidad científica occidental, excluyó a los pueblos originarios del poder civil y político desde la fundación de Bolivia como país independiente en 1825. Imaginario que se ha exacerbado desde el triunfo histórico del presidente indígena, Evo Morales.

Guía de buenas prácticas del desempeño en los servicios de ITS, VIH y SIDA, atención médica periódica y tuberculosis / Guide to Good Practice in Performance STI services, HIV and AIDS, tuberculosis and routine medical care

La presnte publicación describe la metodología de mejora del desempeño en los servicios de salud, identificando las brechas entre el desempeño alcanzado y el deseado , sustentado en el conocimiento de las causas en la implementación de soluciones específicas(AU)

Guía de buenas prácticas del desempeño en los servicios de ITS, VIH y SIDA, atención médica periódica y tuberculosis / Guide to Good Practice in Performance STI services, HIV and AIDS, tuberculosis and routine medical care

La presnte publicación describe la metodología de mejora del desempeño en los servicios de salud, identificando las brechas entre el desempeño alcanzado y el deseado , sustentado en el conocimiento de las causas en la implementación de soluciones específicas

Arboviral etiologies of acute febrile illnesses in Western South America, 2000-2007.

BACKGROUND: Arthropod-borne viruses (arboviruses) are among the most common agents of human febrile illness worldwide and the most important emerging pathogens, causing multiple notable epidemics of human disease over recent decades. Despite the public health relevance, little is know about the geographic distribution, relative impact, and risk factors for arbovirus infection in many regions of the world. Our objectives were to describe the arboviruses associated with acute undifferentiated febrile illness in participating clinics in four countries in South America and to provide detailed epidemiological analysis of arbovirus infection in Iquitos, Peru, where more extensive monitoring was conducted. METHODOLOGY/FINDINGS: A clinic-based syndromic surveillance system was implemented in 13 locations in Ecuador, Peru, Bolivia, and Paraguay. Serum samples and demographic information were collected from febrile participants reporting to local health clinics or hospitals. Acute-phase sera were tested for viral infection by immunofluorescence assay or RT-PCR, while acute- and convalescent-phase sera were tested for pathogen-specific IgM by ELISA. Between May 2000 and December 2007, 20,880 participants were included in the study, with evidence for recent arbovirus infection detected for 6,793 (32.5%). Dengue viruses (Flavivirus) were the most common arbovirus infections, totaling 26.0% of febrile episodes, with DENV-3 as the most common serotype. Alphavirus (Venezuelan equine encephalitis virus [VEEV] and Mayaro virus [MAYV]) and Orthobunyavirus (Oropouche virus [OROV], Group C viruses, and Guaroa virus) infections were both observed in approximately 3% of febrile episodes. In Iquitos, risk factors for VEEV and MAYV infection included being male and reporting to a rural (vs urban) clinic. In contrast, OROV infection was similar between sexes and type of clinic. CONCLUSIONS/SIGNIFICANCE: Our data provide a better understanding of the geographic range of arboviruses in South America and highlight the diversity of pathogens in circulation. These arboviruses are currently significant causes of human illness in endemic regions but also have potential for further expansion. Our data provide a basis for analyzing changes in their ecology and epidemiology.

Síndrome de automutilación en adolescentes: análisis comparativo de comorbilidad / Self-mutilation syndrome in adolescents: comparative analysis of comorbidity

Objetivos. Estudiar en un grupo de pacientes adolescentes que presentan un Síndrome de Automutilación (SAM) su comorbilidad con Trastornos Psiquiátricos, ideación e intento de suicidio, y comparar ésta con otro grupo que no presenta dicho síndrome.Pacientes y método. Se tomó una muestra intencionada, pareada por rangos etarios, sexo y diagnostico, de 47 pacientes con SAM, entre 13 y 21 años de edad y como grupo control, 47 pacientes sin SAM. Ambos grupos de nivel socio-económico alto y medio-alto. Se diagnosticaron según criterios DSM-IV, realizando análisis comparativo de dos proporciones y prueba de Chi cuadrado. Resultados. Los pacientes que se automutilan presentan una mayor frecuencia significativa de: Trastornos del Animo 85.1 porciento; Psicosis 36,2 porciento y Trastornos del Desarrollo de la Personalidad 74.7 porciento. Además, se observa una comorbilidad con la terna diagnóstica compuesta por: Trastornos del Animo, de Personalidad y Abuso de Sustancias: 29.8 porciento. Si bien la ideación Suicida es significativamente mayor en el grupo en estudio (61.7 porciento), no hay diferencia significativa en cuanto al número de intentos de suicidio.Conclusiones. En el diagnóstico y tratamiento del SAM se debe tener presente la comorbilidad y no tratar solamente la conducta de autodaño, por otro lado, frente a Trastornos Psiquiátricos como los aquí mencionados, se debe considerar, en los adolescentes, la posibilidad de estar frente a un SAM, lo que requerirá de un especial tratamiento.

Objectives: To study a group of adolescent patients who present self-mutilation syndrome (SAM), their comorbidity with Psychiatric Disorders, suicidal behaviors (thoughts and attempts) and to compare it with a control group without SAM.Subjects and Methods: Two groups were chosen and paired by age, sex and diagnosis, with 47 patients with SAM ages 13 to 21 and as a control group, 47 patients without SAM. They were diagnosed according to DSM-IV criteria, making a comparative analysis and Chi-squared test. Results. Patients with SAM present a higher and significant frequency of: Mood Disorder 85.1 percent; Psychosis 36.2 percent and Developmental Disorders of Personality 74.4 percent. They also present a higher and significant frequency of coexisting disorders such as: Mood, Personality and Abuse of Substances: 29.8 percent. Although suicidal thoughts are significantly more common in the study group (61, 7 percent), there is no major difference regarding the number of suicide attempts. Conclusions: When diagnosing and treating SAM, one must not only treat the self harm disorder but also keep in mind comorbidity. On the other hand, when it comes to Psychiatric Disorders like the ones mentioned above, one must consider, in adolescents, the possibility of the presence SAM, which will require a specific treatment.

Síndrome de automutilación en adolescentes: Análisis comparativo de comorbilidad / SELF-MUTILATION SYNDROME IN ADOLESCENTS: COMPARATIVE ANALYSIS OF COMORBIDITY

Objetivos. Estudiar en un grupo de pacientes adolescentes que presentan un Síndrome de Automutilación (SAM) su comorbilidad con Trastornos Psiquiátricos, ideación e intento de suicidio, y comparar ésta con otro grupo que no presenta dicho síndrome. Pacientes y método. Se tomó una muestra intencionada, pareada por rangos etarios, sexo y diagnóstico, de 47 pacientes con SAM, entre 13 y 21 años de edad y como grupo control, 47 pacientes sin SAM. Ambos grupos de nivel socio-económico alto y medio-alto. Se diagnosticaron según criterios DSM-IV, realizando análisis comparativo de dos proporciones y prueba de Chi cuadrado. Resultados. Los pacientes que se automutilan presentan una mayor frecuencia significativa de: Trastornos del Animo 85.1%; Psicosis 36,2% y Trastornos del Desarrollo de la Personalidad 74.7%. Además, se observa una comorbilidad con la terna diagnóstica compuesta por: Trastornos del Animo, de Personalidad y Abuso de Sustancias: 29.8%. Si bien la Ideación Suicida es significativamente mayor en el grupo en estudio ( 61.7%), no hay diferencia significativa en cuanto al número de intentos de suicidio. Conclusiones. En el diagnóstico y tratamiento del SAM se debe tener presente la comorbilidad y no tratar solamente la conducta de autodaño, por otro lado, frente a Trastornos Psiquiátricos como los aquí mencionados, se debe considerar, en los adolescentes, la posibilidad de estar frente a un SAM, lo que requerirá de un especial tratamiento Palabras Claves: Automutilación, Trastorno Bipolar, Trastorno de Personalidad Borderline, Suicidio, Adolescencia.

Objectives: To study a group of adolescent patients who present self-mutilation syndrome (SAM), their comorbidity with Psychiatric Disorders, suicidal behaviors (thoughts and attempts) and to compare it with a control group without SAM. Subjects and Methods: Two groups were chosen and paired by age, sex and diagnosis, with 47 patients with SAM ages 13 to 21 and as a control group, 47 patients without SAM. They were diagnosed according to DSM-IV criteria, making a comparative analysis and Chi-squared test. Results. Patients with SAM present a higher and significant frequency of: Mood Disorder 85.1%; Psychosis 36.2% and Developmental Disorders of Personality 74.4%. They also present a higher and significant frequency of coexisting disorders such as: Mood, Personality and Abuse of Substances: 29.8%. Although suicidal thoughts are significantly more common in the study group (61, 7%), there is no major difference regarding the number of suicide attempts. Conclusions: When diagnosing and treating SAM, one must not only treat the self harm disorder but also keep in mind comorbidity. On the other hand, when it comes to Psychiatric Disorders like the ones mentioned above, one must consider, in adolescents, the possibility of the presence SAM, which will require a specific treatment. Key Words: Self-mutilation, Bipolar Disorder, Borderline Personality Disorder, Suicide, Adolescence.

Variables psicosociales en cefalea infantil / Psychosocial variables in child headache

La cefalea es un motivo frecuente de consulta en niños y adolescentes. Los factores psicológicos influyen en la evolución sintomática y han sido abordados desde distintos puntos de vista según los diversos modelos teóricos. Para realizar diagnóstico de cefalea se debe objetivar evolución, frecuencia, intensidad, horario y duración, localización, características del dolor, síntomas asociados, factores desencadenantes, antecedentes familiares y antecedentes personales. El objetivo de este estudio fue evaluar las variables psicológicas y sociales en pacientes que consultan en la Unidad de Cefalea del Servicio de Neurología Infantil del Hospital San Juan de Dios. Los pacientes fueron evaluados mediante una encuesta diseñada por el equipo, que incluyó las variables psicológicas a estudiar: características personales, disfunción y conflictos familiares, violencia intrafamiliar y problemas en el ámbito escolar. Se caracterizó el nivel socioeconómico mediante escala de Graffar. Los pacientes con cefalea evaluados se presentaron con mayor frecuencia en sexo femenino. Se encontró frecuentemente alteración de las variables psicológicas estudiadas. Al plantear el tratamiento, hay diversas modalidades de intervención, así se realizó manejo familiar y/o individual. La inclusión de variables psicosociales, parecen ser útiles tanto en la evaluación como en el posterior diseño de estrategias de intervención que apoyen el tratamiento de estos pacientes.

Headache is a frequent symptom in children and adolescents. Psychological variables affect the clinical evolution and they have been approached from different theoretical models. Headache diagnosis requires specifying course, frequency, intensity, duration, localization, associated symptoms, family and personal history. The aims of this study were to evaluate the psychological and social variables in outpatients consulting the Headache Unit in Neurology Pediatric Service of Hospital San Juan de Dios. The patients were assessed with a structured questionnaire designed for this purpose and socioeconomic status was evaluated with Graffar scale. The patients of our sample were mainly females. The psychological variables were frequently present in all patients. There are different treatments for this kind of pathology; we chose family and/or individual interventions depending on the case. This approach seems to be useful both to proper assessment and treatment strategies for these patients.

El inventario de organización de la personalidad (IPO): sus características y aplicaciones / The inventory of personality organization (IPO): its characteristics and applications

La adaptación y validación de instrumentos de medición psicológica de la personalidad para ser aplicado a grandes muestras es una tarea de relevancia para la planificación de intervenciones psicosociales. El ôInventario de Organización de la Personalidadõ (IPO) es un instrumento que evalúa estructura de personalidad sobre la base de la teoría psicoanalítica de Kernberg. Se describe el proceso de adaptación, las características formales y psicométricas del instrumento, junto con los resultados de las pruebas de confiabilidad y validez factorial de su versión para Chile. Los resultados muestran valores de confiabilidad y validez similares al instrumento original. Se discute el valor del instrumento como herramienta diagnóstica y la importancia de adaptar instrumentos de esta naturaleza en Chile.

Síndrome del hemisferio derecho en niños: una entidad clínica a definir / Right hemisphere syndrome in children: a clinical entity to be defined

El síndrome hemisférico derecho es una entidad diagnóstica inicialmente planteada en adultos, secundario a lesiones adquiridas a este nivel. La literatura describe un cuadro clínico similar en niños, como resultado de un trastorno del desarrollo que puede ser de origen genético o adquirido por noxas perinatales. Las características clínicas en que se basa esta entidad se relacionan básicamente con trastornos en la interacción social, síntomas conductuales, alteraciones pragmáticas del lenguaje, signos físicos de disfunción hemicuerpo izquierdo y hallazgos específicos en pruebas neuropsicológicas (WISC discordante, alteraciones visoespaciales, discalculia). También se ha descrito el hallazgo de parientes con síntomas similares. Las formas clínicas de este cuadro en niños no están claramente estandarizadas, con pruebas que sean universalmente aceptadas. Se presenta una serie de 3 casos con trastornos de conducta cuya evaluación clínica cumpliría con los criterios diagnósticos planteados. Se comentan los hallazgos de la literatura, y se describen las perspectivas terapéuticas que en la actualidad existen