Sergio Muñoz N

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).

Medición en salud: Algunas consideraciones metodológicas

Measurement process is a part of everyday work of health professionals. Technological advances have created precise and sensitive instruments whose results are highly accurate and cast little doubt. However, health care has diversified, becoming a multidimensional and complex task. This means that new aspects, that are difficult to measure, must be addressed, such as health perception by patients or cost usefulness ratios of health actions. Therefore, clinicians and researchers must have a good perception of the quality of measures that they use in their daily work, to make the correct diagnostic, therapeutic or prognostic decisions. This article explores the operational concepts that help in the development and assessment of measuring instruments in terms of validity and truthfulness.

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.

Elementos morfológicos pronósticos en el cáncer de la vesícula biliar

Background: The exact survival rates and prognostic factors of gallbladder cancer are still incompletely known. Aim: To report the actuarial survival of patients with gallbladder cancer. Material and methods: Six hundred thirty seven women, aged 59 years old as a mean and 108 men, aged 64 years old as a mean, with gallbladder cancer are reported. Patients were followed for up to 150 months. Results: Two hundred twenty four patients had an early and 521 had an advanced carcinoma. Overall survival was 38% at ten years. Sex or ethnic origin did not influence survival. Early tumors had a 92% survival at 10 years whereas the survival of advanced tumors was 16% at 5 years. Subserous tumors had a 5 years survival of 32% whereas serous tumors had a 5 years survival of 11%. Well-differentiated advanced tumors had a significantly better survival than moderately or poorly differentiated tumors. Vascular or lymphatic infiltration was also associated to a lower survival. All patients with advanced tumors and vascular infiltration died before 5 years. Conclusions: Tumor infiltration and differentiation degree were the most important prognostic independent factors in gallbladder cancer (Rev Med Chile 2002; 130: 387-395)

Prevalencia de anticuerpos anti-hantavirus en 10 comunas de la Novena Región de Chile donde se han diagnosticado casos de infección clínica por hantavirus

Background: Thirty six cases of clinical Hantavirus Cardiopulmonary Syndrome occurred in the IX Region of Chile. Most of these patients were young males, farm or timber workers, who lived near the Andes Mountain chain. Aim: To conduct an epidemiological and serosurvey study to determine the seroprevalence of IgG antibodies against Hantavirus in the general adult population living in rural and urban areas of 10 endemic communities of the IX region of Chile. Material and methods: A total of 400 subjects were included, 40 of each community, 20 rural residents and 20 urban residents, 20 males and 20 females. Results: Seroprevalence was 7.5% in Melipeuco, 5.0% in Lonquimay, 2.5% in Curacautin, 2.5% in Pucon and 0.0% in the remaining communities. Seroprevalence was higher in rural population (2.5%) than in the urban areas (1%). All seropositive subjects worked in farms or forests and observed rodents near their homes or working places. Females were affected the same as males and no differences were observed between Chilean natives and Hispanics. Conclusions: Prevalence of Hantavirus antibodies correlated with the geographic zone (Andes Mountain chain), overgrowth of wild rodents and exposure to rodent-infested environments (Rev Med Chile 2002; 130: 251-3)

Desde la displasia hasta el cáncer de la vesícula biliar

Background: There is scarcity of knowledge about the development of gallbladder cancer. Aim: To study the features of development and progression of gallbladder cancer. Material and methods: Review of histopathological studies of gallbladder obtained in 25,971 cholecytectomies performed in patients aged 45± 16 years, 79% females, between 1993 and 2004. Among these, 210 had a dysplasia not associated to cancer and 1,039 had a gallbladder cancer Clinical and morphological parameters of preneoplastic and neoplastic lesions were analyzed. Ninety five percent of patients were followed. Results: All cases of dysplasia were incidental findings. Metaplasia, dysplasia and carcinoma in situ were present in the adjacent mucosa in 66%, 81% y 69% of gallbladder carcinomas, respectively. Twenty five percent of gallbladders studied were carcinomas (mucous carcinoma in 18% and muscular carcinoma in 7%). Ninety two percent of cases had chronic inflammation in the gallbladder wall. Seventy two percent of mucous carcinomas were not detected macroscopically Five years survival of mucous carcinoma was 92%. There was an association between the intensity of the lesion and the age of the patients. The age difference between chronic cholecystitis and gallbladder cancer was 11 years for women and nine for men. Conclusions: From a morphological standpoint, the period in which a dysplasia becomes a carcinoma is approximately 10years.

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

Expresión inmunohistoquímica del complejo E-caderina-catenina en cáncer gástrico: Relación con variables clínico-morfológicas y sobrevida de pacientes

l cancer gastrico es la segunda neoplasia masfrecuente a nivel mundial, despues del cancerpulmonar. Las mayores incidencias se registran enChina, Japon, Europa del Este y Sudamerica. Estaneoplasia ocupa el segundo lugar a nivel mundialen mortalidad, con mejor sobrevida solo en Japon,Australia y Nueva Zelanda, debido principalmenteal diagnostico precoz

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)