[Suicide attempts and self inflicted harm: a one year follow up of risk behaviors among out of treatment cocaine users]. / Intentos de suicidio y heridas auto-inferidas: 12 meses de seguimiento de conductas de riesgo de consumidores de cocaína no consultantes de servicios de rehabilitación.

BACKGROUND: Cocaine users tend to have a higher frequency of risk behaviors. AIM: To compare risk behaviors of out -of -treatment Cocaine Base Paste (CBP) and Cocaine Hydrochloride (CH) users, by means of Privileged Access Interviewing in a one- year prospective study. MATERIAL AND METHODS: Twenty -eight interviewers were trained to recruit and administer a questionnaire on substance use patterns and related risk behaviors. Intentioned sampling was carried out in four municipalities of Santiago, Chile. Subjects who used CBP (group 1) or CH (group 2) at least once in the last month, with primary current use of CBP (group 1) or CH (group 2), and without treatment for substance abuse in the last six months were interviewed. Generalized Estimating Equations (GEE) were employed to compare risk behaviors during follow -up. RESULTS: Four hundred and two of 467 subjects (86.1%) were followed up for one year. CBP users (n = 204) reported greater frequency of self -inflicted injuries (Odds Ratio (OR): 1.97 [95% confidence intervals (CI): 1.07-3.66]) and suicide attempts (OR: 2.68 [95% CI: 1.19-6.01]) than CH users. CONCLUSIONS: CBP users had a greater frequency of self -inflicted injuries and suicide attempts, both life threatening risk behaviors, than CH users. This profile shows the high vulnerability of CBP users and should encourage further research and design of outreach interventions, particularly focused on this group.

Intentos de suicidio y heridas auto-inferidas: 12 meses de seguimiento de conductas de riesgo de consumidores de cocaína no consultantes de servicios de rehabilitación / Suicide attempts and self inflicted harm: a one year follow up of risk behaviors among out of treatment cocaine users

Background: Cocaine users tend to have a higher frequency of risk behaviors. Aim: To compare risk behaviors of out ­of ­treatment Cocaine Base Paste (CBP) and Cocaine Hydrochloride (CH) users, by means of Privileged Access Interviewing in a one­ year prospective study. Material and Methods: Twenty ­eight interviewers were trained to recruit and administer a questionnaire on substance use patterns and related risk behaviors. Intentioned sampling was carried out in four municipalities of Santiago, Chile. Subjects who used CBP (group 1) or CH (group 2) at least once in the last month, with primary current use of CBP (group 1) or CH (group 2), and without treatment for substance abuse in the last six months were interviewed. Generalized Estimating Equations (GEE) were employed to compare risk behaviors during follow ­up. Results: Four hundred and two of 467 subjects (86.1%) were followed up for one year. CBP users (n = 204) reported greater frequency of self ­inflicted injuries (Odds Ratio (OR): 1.97 [95% confidence intervals (CI): 1.07­3.66]) and suicide attempts (OR: 2.68 [95% CI: 1.19­6.01]) than CH users. Conclusions: CBP users had a greater frequency of self ­inflicted injuries and suicide attempts, both life threatening risk behaviors, than CH users. This profile shows the high vulnerability of CBP users and should encourage further research and design of outreach interventions, particularly focused on this group.

Los programas educativos para parejas y matrimonios: una nueva propuesta clínica para Chile / Educational programs for couples and marriages: a new clinical proposal to Chile

La educación dirigida a parejas y matrimonios tiene un amplio desarrollo en el mundo y en varios países se encuentra incorporada como parte de las políticas públicas preventivas de la discordia, ruptura y establecimiento de relaciones de parejas saludables y comprometidas. Iniciativas que originalmente fueron promovidas por grupos religiosos, hoy constituyen una alternativa preventiva y de promoción de relaciones saludables, basada en los avances de las investigaciones psicológicas y evaluadas en forma rigurosa. El artículo tiene por objetivo: (a) dar a conocer la lógica que fundamenta las intervenciones preventivas (b) dar a conocer las iniciativas en educación para parejas y matrimonios en otros países (c) sistematizar los hallazgos acerca de su efectividad (d) argumentar las razones por las cuales sería provechoso incorporarlas en el país.

Education aimed at couples and marriage has a broad development in the world and in several countries has been incorporated into adult educational programs as part of preventive public policies of disharmony, rupture and relationship healthy couples. Initiatives that were originally promoted by religious groups today are a preventive alternative to promote healthy relationships, based on advances in psychological research and rigorously evaluated. The paper presents (a) to present the logic behind preventive interventions (b) make known the initiatives in education for couples and families in other countries (c) systematize the findings about their effectiveness (d) discuss the reasons which would be useful for incorporation into the country.

A family outreach intervention for engaging young out-of-treatment drug users: pre- versus post-treatment comparison.

Only a small fraction of drug users worldwide enter treatment each year. We evaluated the efficacy of a systemic family outreach intervention (SFOI) for young, untreated drug users, using a quasi-experimental design in which the experimental group (EG) received SFOI and the control group (CG) received traditional outreach work (OW). Both pre- and post-treatment, we administered the Addiction Severity Index-6 (ASI-6), the Family Environment Scale (FES), and tests of parental practices and risky behavior. Post-treatment, there was a fivefold improvement on the ASI-6 and a significant worsening on the conflict sub-scale of the FES in the EG as compared with the CG. SFOI was more efficacious than OW in reducing drug use in the drug user's home environment. The increased conflict in the EG might be explained by parents' increased awareness of abnormal behaviors and implementation of strategies to protect their children.

[Smoking habit in school age children, in Chile]. / Consumo de tabaco en población menor de 18 años: estudio de prevalencia en escolares de Chile.

BACKGROUND: In Chile, there is no information about the prevalence of smoking among basic and high school students. AIM: To study the prevalence of smoking among school age population. MATERAL AND METHODS: A cross sectional survey was conducted during 2001, assessing tobacco use and smoking habit in a representative sample of 15,119 randomly selected students. RESULTS: Sixty four percent of students had smoked at least once in their lifetime. Eighteen percent of students smoked daily and 15%, occasionally. The figures for women were higher (19 and 18% respectively). The mean age for the first contact with smoking was 12.3 years and, for starting the smoking habit, 13.2 years. Smokers increased the amount of cigarettes during weekends. Higher prevalence rates of smoking were observed in students from the Southern region of the country and of lower socioeconomic levels. From the 3rd grade on, there is an increased risk of having contact with tobacco and smoking for the first time and from 6th grade on, this risk becomes permanent. The adjusted Odds Ratio to be a smoker is significantly higher when the mother is a current or irregular smoker (OR 1.9 95 CI; 1.7-2.0). CONCLUSIONS: High smoking prevalence rates were detected in this survey, mainly in women. The risk for smoking starts early during school life. Therefore, health promotion programs must include elementary and high school students.

Consumo de tabaco en población menor de 18 años: estudio de prevalencia en escolares de Chile / Smoking habit in school age children, in Chile

Background: In Chile, there is no information about the prevalence of smoking among basic and high school students. Aim: To study the prevalence of smoking among school age population. Material and Methods: A cross sectional survey was conducted during 2001, assessing tobacco use and smoking habit in a representative sample of 15.119 randomly selected students. Results: Sixty four percent of students had smoked at least once in their lifetime. Eighteen percent of students smoked daily and 15 percent, occasionally. The figures for women were higher (19 and 18 percent respectively). The mean age for the first contact with smoking was 12.3 years and, for starting the smoking habit, 13.2 years. Smokers increased the amount of cigarettes during weekends. Higher prevalence rates of smoking were observed in students from the Southern region of the country and of lower socioeconomic levels. From the 3rd grade on, there is an increased risk of having contact with tobacco and smoking for the first time and from 6th grade on, this risk becomes permanent. The adjusted Odds Ratio to be a smoker is significantly higher when the mother is a current or irregular smoker (OR 1.9 95 CI; 1.7-2.0). Conclusions: High smoking prevalence rates were detected in this survey, mainly in women. The risk for smoking starts early during school life. Therefore, health promotion programs must include elementary and high school students.

Modelo de evaluación del programa de salud familias en riesgos biopsicosocial en la atención primaria: centro de salud Villa OïHiggins en la comuna de La Florida / Evaluation model of families in biopsychosocial risk in the primary care health program: Villa OïHiggins health center, La Florida comunity

El Centro de Salud Villa OïHiggins de la Comuna de La Florida desarrolla desde 1994 un programa de atención familiar denominado Programa de Familias en Riesgo Biopsicosocial, dirigido a familias pobres, de baja asistencialidad y en riesgo de salud. Un equipo interdisciplinario de miembros de la Escuela de Psicología de la Pontificia Universidad Católica y del Centro de Salud está desarrollando un proyecto de investigación, cuyo objetivo general es mejorar significativamente la calidad del Programa de Familias en Riesgo Biopsicosocial. El presente trabajo presenta una reseña del Programa de Familias e informa de los principales resultados obtenidos en la primera evaluación de la calidad del programa, el que contempla una evaluación de la calidad social, calidad técnica y calidad económica, tanto a nivel de estructuras como de procesos, según el modelo de Saraceno & Levav (1992). Los principales resultados señalan la aceptación del enfoque por parte de los equipos de salud local y de los usuarios, la adecuada accesibilidad al programa y un costo económico razonable dada la complejidad de las familias atendidas. Las principales dificultades surgen por las difíciles problemáticas de salud, especialmente en salud mental, la falta de capacitación para su abordaje, la estructura tradicional de programas y la falta de indicadores apropiados para evaluar su efectividad. Se discuten las posibilidades de aplicación de un modelo de salud familiar en la Atención Primaria, el desarrollo de métodos eficaces de intervención y evaluación en los sistemas que se organizan en torno a los problemas de salud y enfermedad de la población

Clima organizacional en un centro de salud de atención primaria: evaluación e intervención para mejorar la satisfacción laboral del equipo de salud / Organizational environment in a health center of primary care: evaluation and intervention to improve work satisfaction of the health team

El nuevo enfoque de trabajo del Consultorio Villa O'Higgins, basado en la sectorización de la atención al público y la priorización de la atención a familias en riesgo biopsicosocial, implicó cambiar de una organización tradicional a una matricial. Dadas estas modificaciones se consideró necesario evaluar la satisfacción laboral de los trabajadores. Para este propósito se diseñó una intervención en clima organizacional consistente en un diagno>stico preintervención, una implementación de estrategias para mejorar la satisfacción laboral y una evaluación postintervención. En las mediciones pre y postintervención se utilizó la adaptación chilena del test de Litwin & Stringer para evaluar la percepción de los funcionarios en ocho variables de clima organizacional: estructura, oportunidad de desarrollo, calidez, equipo, dirección, motivación, recompensa y supervisión. Los resultados de la medición preintervención mostraron una satisfacción laboral regular. La mayor fortaleza del grupo es la motivación por su trabajo, mientras las mayores debilidades son las recompensas y la estructura. Al comparar los distintos programas de atención y las unidades del consultorio, el mejor clima labor ' al se registró en el programa de familias en riesgo biopsicosocial.Las estrategias de intervención se localizaron en las variables estructura, recompensa y calidez. La evaluación postintervención, nueve meses después, reflejó una mejoría global en la percepción de clima organizacional, principalmente por el aumento significativo de la satisfacción en las variables intervenidas. La percepción de los integrantes del programa de familia no cambió, dándose el mejoramiento en los otros programas y unidades

Capacitación del equipo de salud en un programa de atención de familias en riesgo biopsicosocial / Training of health team in a care program of families in biopsychosocial risk

Con el objetivo de potenciar la relación entre el equipo humano del Centro de Salud Villa O'Higgins y las familias atendidas en el Programa de familias en riesgo Biopsicosocial de dicho Centro, se efectuó una capacitación basada en el modelo sistémico de familia y de equipo profesional, la teoría de la comunicación y la biología del conocimiento. La evaluación del proceso mostró asimilación de los conceptos entregados. Se percibió la necesidad de contar con herramientas de manejo más específicas. A pesar de críticas de los participantes respecto a la metodología, el resultado global puede considerarse positivo; pero deben tomarse en cuenta los obstáculos culturales del sistema y los roles actuales en la atención de salud