Luis Bustos M

Violencia conyugal en la ciudad de Temuco: Un estudio de prevalencia y factores asociados

Background: Violence against women is a recognized public health problem in developed countries. There is increasing awareness on family violence in Chile, but there is scant information about its prevalence. Aim: To determine the prevalence of family violence against women in a population sample in Temuco, Chile. Material and methods: A standardized questionnaire about family violence was applied to a sample of 422 women at their homes. The questionnaire had six sections that included a list of violent behaviors from husbands or partners, a standardized instrument to assess mental health and alcohol consumption by the couple, history of child abuse, community support, type of employment and years of school education. Results: Forty nine percent of women reported psychological aggression, 13% reported physical violence and 5.5%, sexual violence. The presence of anxiety or depressive symptoms, being witness of violence between parents during childhood, a lower educational level, being a housewife, alcohol abuse and lack of community support were risk factors for violence among women. Among men, the history of child abuse, a lower education level, and alcohol abuse were identified as risk factors for violent behaviors. Conclusions: Conjugal violence is a significant mental health problem in Temuco, Chile (Rev Med Chile 2001; 129: 1405-12)

Creencias, actitudes y conocimientos en educación sexual

Background: Previous reports show that Chilean teenagers have an inadequate knowledge about sexuality and reproduction. Aim: To compare the knowlege about sexuality among adolescents coming from private and public schools, with and without sexual education programs. Material and methods: A structured anonymous inquiry, containing multiple choice and open questions, was applied to a sample of 229 adolescents attending seventh and eigth grade of junior school, in private and public schools of Temuco, Chile. Results: Eleven percent of adolescents had already their first sexual intercourse at a mean age of 12.2 ± 2.4 years old. Of these, 96% came from public schools. An overall analysis of tests, disclosed a 53% of correct answers to the inquiry. Adolescents coming from private schools had a better performance than those coming from public schools. Sexual attitudes were not influenced by sexual education programs. Conclusions: Adolescents coming from private schools have a better sexual knowledge level and more conservative attitudes towards sexuality. Overall knowledge is inadequate albeit overvalued. These teenagers are high risk group for unwanted pregnancies and sexually transmitted diseases and require efficient sexual education programs. (Rev Med Chile 2000; 128: 574-83).

Maltrato infantil en la ciudad de Temuco: Estudio de prevalencia y factores asociados

BACKGROUND Child maltreatment is recognised as a significant health problem in developed countries. There is increasing awareness on family violence in Chile, becoming a health priority in the last five years, but there is scant information about its prevalence. AIM Determine prevalence of child abuse, and associated factors in a population sample from Temuco, Chile. MATERIAL AND METHODS A standardised questionnaire was applied to a sample of 422 women at their homes. Instrument had questions about disciplinary practices by caretakers, a standardised questionnaire to assess mental health, as measures of risk and protective factors for violence RESULTS The prevalence of psychological aggression delivered by mothers or fathers was 17.5% and 6.8% respectively. The figures for corporal punishment delivered by mother or fathers were 42.3% and 17% respectively. Three percent of mothers and 1.2% of fathers recognised severe physical abuse. Associated factors were mother impaired mental health, antecedents of child abuse in both parents, parents alcohol abuse and child emotional/behavioral problem. CONCLUSION Child abuse is a extended significant problem in Temuco that requires multidisciplinary intervention programs.

Violencia y factores sociales en mujeres de la ciudad de Temuco

Background: Among women, risk factors for mental disorders are violence, economical inequities and disadvantages and discrimination. Aim: To determine the prevalence of anxiety and depressive symptoms in women and to determine factors associated with them. Material and methods: A cross sectional study of a probabilistic sample of 422 women aged 34 years as a mean, living in a medium to low income neighborhood in Temuco, Chile. Mental health was assessed with the self reporting questionnaire (SRQ20), partner violence was evaluated using a 12 item scale and family conflict and violence was evaluated using the Conflicts Tactics scale. A logistic repression analysis was used to identify factors associated with mental health alterations. Results: Forty one percent of women had anxiety or depressive symptoms. The main associated factors with these symptoms were severe physical violence against children (odds ratio (OR) =14.3), sexual violence against women (OR =9.7), self perception of health (OR =4.5), alcohol abuse (OR =4.4), psychological violence during childhood (OR =3.2) and lack of family support network (OR =2.7). Unemployment and lack of a support network of relatives had an OR 3.3 for mental health alterations. The OR for psychological violence plus sexual violence was 18.5. The figure for psychological violence plus sexual violence plus a history of parental violence during childhood was 26.5. Conclusions: Forty one percent of this group of women had mental health alterations. There is a strong association between these alterations, family violence and socioeconomic factors. Language: es

Nivel de conocimiento de los pacientes con artritis reumatoide acerca de su enfermedad y tratamiento

Background:The transfer of information in the physician-patient relationship is important, especially in chronic diseases such as Rheumatoid Arthritis (RA), since it influences the perception and behavior that the patient has about his or her illness. Aim: To evaluate the level of knowledge and concern of their illness and treatment and their relationship with functional disability, perception of the pain and global assessment of disease activity, in patients with RA. Patients and Methods: Cross sectional study of 104 patients (mean age 56 years, 100 women) with RA. Demographic and clinical variables were registered. The knowledge about their illness and requirement of further information and concern about aspects of the illness and treatment, were assessed. Physical functioning was measured using the Health Assessment Questionnaire (HAQ). A visual analogue (VAS) and Likert scales were used for a global assessment of disease activity. Results: Sixty percent of patients had only primary school studies. The median evolution of the illness was 14 years. Ninety eight percent knew their diagnosis and 91% required further information. There was a high degree of concern about the disease and treatment. The average HAQ score was 0.9. There was a statistically significant relationship between HAQ score and pain VAS (r =0.41, p <0.01). There was a moderate agreement between the global assessment of disease activity made by patients and physicians (Kappa =0.499; p =0.000). Conclusions: Even though patients with RA are informed about their disease, they require further information. Their highest concern is about the functional consequences of RA and they perceive a higher activity of the disease than their treating physicians

Factores asociados a síntomas depresivos y síntomas somáticos en mujeres climatéricas de la ciudad de Temuco

Background: Depression is an important mental health problem. The Chilean Ministry of Health has considered depression in women as one of the health priorities for the country. Aim: To assess the prevalence of depressive and somatic symptoms and their risk factors in climacteric women. Material and methods: A special questionnaire was applied to 171 women (45 to 55 years of age), coming from a community organization (PRODEMU) and a private health institution (ISAPRE Banmedica). Risk factors for depression were determined using multiple logistic regression. Results: The prevalence of depressive symptoms was 43%. Women with primary education had an odds ratio for depression of 2.49, compared with women with high school or university education. Other risk factor for depression was the lack of a remunerated job (Odds ratio 1.9). The risk factors for somatic symptoms were the presence of depressive symptoms (OR 3.2), lack of secondary or university education (OR 2.4), low income (OR 1.9) and having a current partner (OR 3.6). Conclusions: There is a high prevalence of depressive symptoms in the studied population of climacteric women. Lack of education and of a remunerated job are important risk factors for the presence of such symptoms. Women with a low level of education and with depressive symptoms have also a high risk of presenting somatic symptoms (Rev Med Chile 2002; 130: 885-91)

HISTERECTOMÍA OBSTÉTRICA EN EL HOSPITAL DE PUERTO MONTT, 2000-2005

SUMMARY We present a clinical review of 25 patients with peripartum obstetric hysterectomy over a six year (2000 -2005) in Puerto Montt Hospital (Chile). The overall incidence of peripartum obstetric hysterectomy was 1.15 per 1.000 deliveries. 24 (96%) of them were cesarean section. The Odd Ratio of peripartum obstetric hysterectomy is 56 time higher in cesarean than in vaginal birth. The main indication for elective operative delivery was two or more previous cesarean section and 3rd trimester bleeding for emergency cesarean section. The most common clinical indication for peripartum obstetric hysterectomy was placenta accreta in 12 cases (48%) and uterine atony in 8 cases (32%). Histologyc study was performed in 76% of cases, 80% of which had placenta accreta. Total obstetric hysterectomy was performed in 13 cases (52%) and subtotal hysterectomy in 12 cases (48%). The mean operative time was 124.3 ± 37.8 minutes. The post surgical hematocrit was lesser in subtotal than total hysterectomy (p< 0.05). The main operative complication was bladder injury in 4 patients (16%), more frequent in total hysterectomy than subtotal hysterectomy (3:1),

Artritis reumatoidea en población mapuche.: Una experiencia de 16 años en la IX región de Chile

Background: Mapuche, Chilean natives, represent approximately 9.8% of Chilean population and in the IX region of the country, they account for 18.4% of population over 15 years old. They preserve some socio-cultural characteristics that make them different to the rest of the population. Aim: To describe the epidemiological characteristics rheumatoid arthritis among Mapuche natives. Subjects and methods: Retrospective review of patients of Mapuche origin with rheumatoid arthritis, seen at Temuco Hospital between 1980 and 1996. Results: Among 308 cases gathered, only 106 (93 women, aged 55 ± 10 years old) complied with 1987 American College of Rheumatology (ACR) criteria for rheumatoid arthritis. The disease began between 29 and 52 years old in 73% of patients and the mean delay in diagnosis was 4.4 years. At diagnosis, 99% had symmetric poliarthritis, 28.3% had either fatigue, fever or weight loss, and 46.9% were in class III or in class IV of ACR-1991. Fifty three percent of patients developed Sicca syndrome, 36% developed nodules, 23% developed Raynaud phenomenon, 11% developed pulmonary involvement, 7% developed vasculitis, 5% developed neurological manifestations and 19% developed ophthalmologic involvement. Rheumatoid factor was positive in 78% and 73% had erosions. HLA DR4 was (+) in 60% of 30 patients. Thirty percent required 3 or more disease modifying drugs and prednisone over 10 mg/day. There was no correlation between functional capacity and several other features of the disease. Conclusions: Mapuche rheumatoid arthritis patients are detected late and have a poor functional capacity at the time of diagnosis. They also have a higher proportion of extraarticular manifestations, more erosions and require more aggressive treatments. (Rev Med Chile 2001; 129: 253-8).

Docencia e investigación en Medicina Legal: Situación actual y desafíos para las Facultades de Medicina de Chile

Fourteen deans answered the questionnaire. In all theresponding faculties, forensic medicine is an obligatory course, generally during the fifth yearand mostly combining theory with practice. In seven faculties, forensic medicine concepts areincluded in other courses. Forensics is taught in only two of 10 dental schools, two of 17 nursingschools, one of nine midwives schools and one of nine medical technology schools. It is nottaught in phonoaudiology, kinesiology and nutrition schools. There are 74 physicians that teachthe specialty but only 10 are certified by the National Board of Medical Specialty Certification(CONACEM). Treatment of most topics on forensics is insufficient. Thanatology is the strongesttopic and forensic dentistry is the weakest. There are 52 publications in the area, mostly on“medical law”.

Niveles de Ansiedad en la Comunidad Estudiantil Odontológica: Universidad de La Frontera, Temuco - Chile

Estudios demuestran que el aumento de los niveles de ansiedad se relacionan con el avance curricular al enfrentarse a situaciones de mayor complejidad, con la edad y el sexo. El objetivo de este estudio fue determinar la frecuencia de los niveles de ansiedad: rasgo y estado en los alumnos de Odontologia. Se realizo un estudio de corte transversal basado en una cohorte estratificada por avance curricular, edad y sexo, evaluada con el cuestionario IDARE (Inventario de Ansiedad Rasgo Estado). La muestra fue constituida por 269 alumnos de primer a quinto ano quienes consintieron participar y estar presentes en la actividad. El 56,9% correspondio a mujeres y 43,1% a hombres, la edad promedio fue 21,9 anos (DE ± 2,94). Los puntajes promedios de escala Ansiedad-Estado fueron 45,3 (2o semestre); 46,4 (4o semestre) ; 48,7 (6o semestre); 48,8 (8o semestre) y 55,5 (10o semestre) (p=0,0002). En la escala Ansiedad-Rasgo, los promedios fueron 36,4; 41,5; 43,9; 41,5 y 47,0 respectivamente (p=0,0000). Segun sexo, en las escalas Ansiedad-Estado y Ansiedad-Rasgo no se observaron diferencias significativas (p>0,05). Segun edad, la escala Ansiedad-Estado presenta asociacion significativa y correlacion baja (p=0,0122, r=0,1523). La correlacion no fue significativa para edad en la escala de Ansiedad-Rasgo (p=0,0597, r=0,1147). La ansiedad aparece como fenomeno frecuente en nuestros estudiantes con tendencia al aumento segun su avance curricular. La relacion de estos niveles con sexo y edad no fue significativa.