[Paternal-fetal attachment from the maternal perspective]. / Vínculo prenatal paterno desde la perspectiva materna.

INTRODUCTION: The study of Paternal-fetal attachment is a recent research area, which has become relevant due to its correlation with the postnatal paternal bond and its impact on the cognitive and socio-emotional de velopment of the child. OBJECTIVE: to characterize Paternal-fetal attachment, based on maternal pers pective, in puerperal women treated in a public hospital in the Metropolitan Region. SUBJECTS AND METHOD: A cross-sectional observational study was carried out. Hospitalized puerperal women were interviewed by applying a questionnaire with sociodemographic variables of both parents. In addi tion, the Paternal-fetal attachment Scale from the maternal perspective was applied, previously adap ted and validated. A descriptive and association analysis was performed to determine the behavior of the link indicator with respect to the sociodemographic variables. RESULTS: The mean Paternal-fetal attachment score from the maternal perspective was 41.5 (range 10-50), which is significantly higher in cases where parents live together, the couple's relationship is longer than two years, and in plan ned and controlled pregnancies before twelve weeks. There were no differences in the Paternal-fetal attachment score from the maternal perspective in relation to the number of children, nationality, or educational level. DISCUSSION: The Paternal-fetal attachment is mainly determined by characteristics of the parental relationship and not by the individual characteristics of the parents, therefore, the attachment must be seen from the triad.

[Cooccurrence of autism spectrum disorder and gender dysphoria in childhood: Analy sis of the personal identity from a psychodynamic perspective]. / Coocurrencia de trastorno del espectro autista y disforia de género en la infancia: Análisis de la identidad personal desde un enfoque psicodinámico.

INTRODUCTION: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition with alterations in social inte raction and communication, and restricted and repetitive patterns of behavior and interests. Gender Dysphoria (GD) refers to the incongruence between the gender identity and the sex assigned at birth, together with a strong and persistent desire to be of the opposite sex. During global personal identity construction, the development of sexual identity is essential. OBJECTIVE: To analyze an adolescent clinical case of co-occurrence of ASD and GD from a psychodynamic understanding of his identity. CLINICAL CASE: A 15-year-old male diagnosed with ASD and borderline intellectual capacity. He mani fested feminine behaviors and interests in girlish games since preschool age, imitating female figures, and verbalizing the desire to be of the opposite sex. A multidisciplinary evaluation of the patient concluded that he presented a diffuse general identity with ambivalent gender identity. Therefore, he did not fulfill the requirements for hormone therapy. Psychological therapy was suggested to favor grea ter exploration and cognitive flexibility to develop a better-defined gender identity. CONCLUSIONS: In cases as ASD, where identity development is compromised, the affected subject often delays or does not consolidate sexual identity, leading to a diffusion of identity and gender, as in the reported case. The co-occurrence of ASD and GD requires a multidisciplinary evaluation that includes a complete assessment of the patient's global identity before considering any definitive therapeutic orientation regarding gender.

Asociación entre síntomas depresivos del cuidador principal y problemas conductuales en una muestra de preescolares chilenos de 30 a 48 meses de edad / Association between primary caregiver depressive symptoms and behavioral problems in a sample of chilean preschool children age 30 to 48 months

Resumen Introducción: La salud mental del cuidador influye en el desarrollo de los niños; sin embargo, desconocemos si existe una asociación entre síntomas depresivos del cuidador y problemas conductuales en preescolares chilenos. El objetivo fue analizar la asociación entre los síntomas depresivos del cuidador principal y la presencia de problemas conductuales en preescolares usuarios de la red pública de salud chilena. Método: Estudio transversal. Muestreo por conglomerados estratificados bietápico. Muestra de 1.377 preescolares de 2,5-4 años y sus cuidadores principales. Con consentimiento informado se aplicó encuesta sociodemográfica y Child Behavior Checklist 1½-5. Los síntomas depresivos del cuidador se evaluaron mediante Entrevista Diagnóstica Internacional Compuesta abreviada. Resultados: Edad promedio del preescolar 40,95 ± 4,6 meses, 51,3% varones. 97,5% fueron cuidadoras mujeres, edad promedio 31,6 ± 10,2 años y escolaridad 9,5 años. Se encontró problemas conductuales de rango clínico en las tres escalas: total de problemas conductuales 21,4%, conductas internalizantes 23,1% y externalizantes 16,4%. Se encontró sintomatologia depresiva en 9,1% de los cuidadores, la que aumenta a 14,5,% y 16,1% en cuidadores de preescolares con conductas internalizantes y externalizantes respectivamente. En el análisis de regresión logística multinomial ajustando por variables confundentes, la asociación bivariada con los problemas conductuales internalizantes desaparece, sin embargo, se mantiene para el total de problemas conductuales y conductas externalizantes. Conclusiones: La asociación entre síntomas depresivos del cuidador y problemas conductuales en preescolares chilenos es consistente y modulada por otras variables médicas y psicosociales, esto sugiere la importancia de la identificación, prevención e intervención temprana de la díada y su entorno.

Introduction: The mental health of the caregiver influences the development of children; however we do not know if there is an association between depressive symptoms of the caregiver and behavioral problems in Chilean preschoolers. The objective was to analyze the association between primary caregiver depressive symptoms and behavioral problems in preschoolers users of the Chilean public health network. Method: Cross-sectional study. Two-stage stratified cluster sampling. Sample 1377 preschool children 2,5-4 years old and their primary caregivers. In order to assess child behavior, a sociodemographic survey and Child Behavior Checklist ½-5 we applied to each caregiver, under informed consent. Caregiver depressive symptoms were assessed using the International Diagnostic Composite Interview Short Form. Results: Preschool age was 40.95 ± 4.6 months, 51.3% were boys. 97.5% of caregivers were female, (ages 31.6 ± 10.2 yr, average schooling 9.5 years). Behavioral problems of clinical rank were found in the three scales: total behavioral problems 21.4%, internalizing 23.1%, and externalizing behaviors 16.4%. 9.1% of caregivers experienced depressive symptomatology. In preschool children with internalizing behavioral, caregivers showed depressive symptoms in 14,5% of cases, and 16,1% in those with an externalizing behavioral. In multinomial logistic regression analysis adjusted for confounding variables, bivariate association for internalizing behavioral problems was lost, but persisted for total behavioral problems and for externalizing behavioral. Conclusions: The association between caregiver's depressive symptoms and behavioral problems in Chilean preschool children is consistent and modulated by other medical and psychosocial variables, suggesting the importance of identification, prevention and early intervention of the dyad and their environment.

Estrés post-traumático post terremoto 27F en cuidadores de niños preescolares. Factores asociados del cuidador, de la familia y la crianza / Post-traumatic stress disorder after 27/F earthquake in caregivers of preschool children. Factors associated with the caregiver, family and parenting

Objetivos: Describir la frecuencia de estrés postraumático posterior al terremoto de Chile del 27 de febrero de 2010, en cuidadores de niños prescolares y su asociación con el reporte del desarrollo de los niños, como también de las actitudes respecto de la crianza. Metodología: El estudio fue ejecutado seis meses después de acontecido el terremoto. Se realizó un diseño transversal en 1.625 cuidadores de niños entre 30 y 48 meses, que recibían atención en centros de salud públicos. Se evaluó el trastorno mediante la escala auto-administrada de trauma de Davidson. Adicionalmente se midieron las características sociodemográficas, de salud física y mental de los cuidadores, el desarrollo de los niños y crianza. Resultados: La frecuencia del trastorno de estrés postraumático fue de 7,3%. No se encontraron asociaciones significativas entre estrés postraumático en el cuidador y desarrollo infantil. Hubo asociaciones estadísticamente significativas con funcionamiento familiar (p<0,05) y creencias coercitivas respecto de la educación de los niños (p < 0,05), entre otras. Conclusiones: La presencia de este trastorno en el cuidador podría ser un marcador de riesgo para el cuidado infantil, por lo que, resulta fundamental su detección y tratamiento tempranos post desastre mediante un abordaje familiar.

Objectives: To describe the PTSD frequency, following the February 27, 2010 (27-F) earthquake in Chile, in preschool caregivers and its association with child development reports and parenting attitudes. Methodology: The study was carried out six months after the earthquake. A cross-sectional survey design was performed in 1625 caregivers of children between 30 and 48 months old, who received care at public health centers. Disorders were evaluated by the self-administered Davidson trauma scale. Additionally, sociodemographic, physical and mental health of caregivers, child development and parenting characteristics were measured. Results: The frequency of PTSD was 7.3%. There were no significant associations between post-traumatic stress in the caregiver and child development. There were statistically significant associations with family functioning (p < 0.05) and enforced beliefs regarding the education of children (p < 0.05), among others. Conclusions: The presence of this disorder in the caregiver may be a risk marker for child care; therefore, after the disaster and through a familiar approach, detection and early treatment are essential.

Estrés post-traumático post terremoto 27F en cuidadores de niños preescolares: factores asociados del cuidador, de la familia y la crianza / Post-traumatic stress disorder (PTSD) after 27/F earthquake in caregivers of preschool children. Factors associated with the caregiver, family and parenting

Objectives: to describe the PTSD frequency, following the february 27, 2010 (27-F) earthquake in Chile, in preschool caregivers and its association with child development reports and parenting attitudes. Methodology: the study was carried out six months after the earthquake. A cross-sectional survey design was performed in 1625 caregivers of children between 30 and 48 months old, who received care at public health centers. Disorders were evaluated by the self-administered Davidson trauma scale. Additionally, sociodemographic, physical and mental health of caregivers, child development and parenting characteristics were measured. Results: the frequency of PTSD was 7.3 percent. There were no significant associations between post-traumatic stress in the caregiver and child development. There were statistically significant associations with family functioning (p < 0.05) and enforced beliefs regarding the education of children (p < 0.05), among others. Conclusions: the presence of this disorder in the caregiver may be a risk marker for child care; therefore, after the disaster and through a familiar approach, detection and early treatment are essential.

Objetivos: describir la frecuencia de estrés postraumático posterior al terremoto de Chile del 27 de febrero de 2010, en cuidadores de niños prescolares y su asociación con el reporte del desarrollo de los niños, como también de las actitudes respecto de la crianza. Metodología: el estudio fue ejecutado seis meses después de acontecido el terremoto. Se realizó un diseño transversal en 1.625 cuidadores de niños entre 30 y 48 meses, que recibían atención en centros de salud públicos. Se evaluó el trastorno mediante la escala auto-administrada de trauma de Davidson. Adicionalmente se midieron las características sociodemográficas, de salud física y mental de los cuidadores, el desarrollo de los niños y crianza. Resultados: la frecuencia del trastorno de estrés postraumático fue de 7,3 por ciento. No se encontraron asociaciones significativas entre estrés postraumático en el cuidador y desarrollo infantil. Hubo asociaciones estadísticamente significativas con funcionamiento familiar (p<0,05) y creencias coercitivas respecto de la educación de los niños (p < 0,05), entre otras. Conclusiones: la presencia de este trastorno en el cuidador podría ser un marcador de riesgo para el cuidado infantil, por lo que, resulta fundamental su detección y tratamiento tempranos post desastre mediante un abordaje familiar.

[A model for resource allocation in primary health care]. / Modelo de asignación de recursos en atención primaria.

Resource allocation in primary health care is a worldwide issue. In Chile, the state allocates resources to city halls using a mechanism called "per capita". However, each city hall distributes these resources according to the historical expenses of each health center. None of these methods considers the epidemiological and demographic differences in demand. This article proposes a model that allocates resources to health centers in an equitable, efficient and transparent fashion. The model incorporates two types of activities; those that are programmable, whose demand is generated by medical teams and those associated to morbidity, generated by patients. In the first case the health promotion, prevention and control activities are programmed according to the goals proposed by health authorities. In the second case, the utilization rates are calculated for different sociodemographic groups. This model was applied in one of the most populated communities of Metropolitan Santiago and proved to increase efficiency and transparency in resource allocation.

Modelo de asignación de recursos en atención primaria / A model for resource allocation in primary health care

Resource allocation in primary health care is a worldwide issue. In Chile, the state allocates resources to city halls using a mechanism called "per capita". However, each city hall distributes these resources according to the historical expenses of each health center. None of these methods considers the epidemiological and demographic differences in demand. This article proposes a model that allocates resources to health centers in an equitable, efficient and transparent fashion. The model incorporates two types of activities; those that are programmable, whose demand is generated by medical teams and those associated to morbidity, generated by patients. In the first case the health promotion, prevention and control activities are programmed according to the goals proposed by health authorities. In the second case, the utilization rates are calculated for different sociodemographic groups. This model was applied in one of the most populated communities of Metropolitan Santiago and proved to increase efficiency and transparency in resource allocation.

El movimiento de la medicina basada en evidencia de la medicina basada en la evidencia: Alcances conceptuales y teóricos / Evidence based medicine: Theoretical and conceptual issues

Evidence based decision making in medicine is, nowadays, a movement with political and practical implications. This article performs a historical description of evidence based medicine and its underlying conceptual and philosophical premises. An open dialogue to recognize the diverse sources of evidence that modify clinical practice is proposed, to improve decision making in this field.

Costo-efectividad de la promoción de la salud en Chile: experiencia del programa íMirame! / Cost-effectiveness of health promotion in Chile: experience with íMirame! Program

Background : íMirame! program was launched in Chile in 1993, to promote a healthy life style at school age. Aim: To evaluate cost-effectiveness of this program. Material and methods: Fifth and sixth grade school children, from 5 selected municipalities of the Metropolitan Region were studied. The design was a quasi-experiment with an intervention (IP, 1,435 children) and reference population (RP, 1,246 children). Tobacco (T-C) and alcohol (OH-C) consumption were the indicators. A baseline survey was done in 1993 and repeated in 1996 in both groups. The criterion of Net Change was applied to assess effectiveness. For cost evaluation, an institutional perspective was considered. Direct municipal administration and "íMirame!" program costs were analyzed and incremental costs were calculated, using reference municipalities as controls. A univariate sensitivity analysis was done based on the beneficial discount rate and cost discount rate. Cost effectiveness coefficient was calculated. Results: The incremental cost per each boy and girl prevented from OH-C was US$ 112 (103.6-114.3) and US$ 132 (129.9-133.3) respectively. The figures for each boy and girl prevented from T-C was US$ 154 (142.7-157.4) and US$ 130 (122.5-135.2) respectively. The program caused an additional cost per child, for the city hall of US$ 11.7 in two years. Conclusions: It is possible to apply health promotion interventions in schools with a good cost effectiveness in the short run (Rev MÚd Chile 2004; 132: 361-70).

Consumo de alcohol y familia: un estudio descriptivo en adolescentes / Alcohol consumption and family: a descriptive study in adolescents

To study abnormal alcohol ingestion among parents and family dysfunction of pregnant and non pregnant teenagers from 12 to 18 years old consulting in the Teenagers Health Unit of a public hospital outpatient clinic. Their degree of instruction attained, marital status, social behavior, alcohol, drug intake and history of child abuse was recorded. The level of instruction, marital status, alcohol ingestion and work stability of their fathers was also studied. One hundred sixteen pregnant and 60 non pregnant teenagers were studied. The fathers of pregnant girls had a higher level of alcohol consumption, more civil irregularities and a higher level of family dysfunction. Among these girls, a higher frequency of neurological abnormalities and fetal alcohol syndrome was observed. They had also a lower educational level and a higher degree of alcohol and drug use. Alcohol consumption among parents leads to family dysfunction and has adverse physical, intellectual and social consequences in the offspring

Claritromicina versus penicilina en el tratamiento de las faringoamigdalitis por estreptococo beta hemolítico grupo A en niños / Clarithromycin versus penicillin in the treatment of group A streptococcal pharyngitis in children

La penicilina ha sido considerada el antibiótico de elección para tratar las faringoamigdalitis por EBHA. En el último tiempo se han desarrollado drogas alternativas para aquellos pacientes alérgicos a penicilina, que tengan eficacia y erradiquen el agente infeccioso. Con el objeto de probar la eficacia y la erradicación del EBHA en faringoamigdalitis aguda en niños entre 2 y 15 años, se realiza un ensayo clínico randomizado controlado en 43 niños consultantes, con diagnóstico acreditado, ingresados al servicio de urgencia del Hospital Sótero del Río. Se compara el uso de claritromicina 15 mg/K/día en dosis diarias por vía oral con penicilina 250 mg tres veces al día por vía oral. Exito clínico se encontró en 86,4 por ciento de los casos tratados con claritromicina y 85,7 por ciento en los tratados con penicilina cuya diferencia no es significativa. Tampoco se encontró diferencias entre ambas terapias respecto a erradicación bacteriológica con 86,4 por ciento en el caso de los tratados con claritromicina versus un 85,7 por ciento en los tratados con penicilina. No se observaron efectos adversos serios en ambos grupos, Este estudio sugiere que la claritromicina es igualmente efectiva y bien tolerada que penicilina para el tratamiento de faringoamigdalitis aguda por EBHA, pudiendo considerarse un antibiótico de alternativa

Características epidemiológicas de la displasia congénita de caderas en una población chilena / Epidemiologic characteristics of congenital hip dysplasia in a chilean population

Se presentan los resultados de un estudio retrospectivo de 97 casos de displasia congénita de caderas y 100 controles pareados por sexo y peso de nacimiento. Se encontró una relación sexo femenino: sexo masculino 6,5:1, predominio del compromiso bilateral (68%) y diferencias estadísticamente significativas entre casos y controles en los antecedentes familiares de displasia y presentación podálica completa. En 23% de los casos no hubo sospecha clínica previa al diagnóstico radiológico. Los autores plantean la necesidad de aplicar programas de tamizaje de mayor sensibilidad empleando estudios radiológicos y ultrasonográficos, en particular en niños con antecedentes de factores de riesgo