Abstract: Introduction: medical speciality residents are exposed to high burnout, which harms professionalism. This mental health situation has led to creating programs promoting well-being and self-care, which have not been installed transversally in medical education. The present study seeks to identify self-care/well-being activities in psychiatry residences in Chile and the teaching interest in implementing them. Methods: 80 professors from 3 Departments of Psychiatry were invited via email to answer a questionnaire on aspects of well-being. A quantitative analysis was performed. Results: 69.4% of those surveyed said their residence does not have formal content or a self-care/well-being program for its residents. The self-care/well-being activities most included in the residents surveyed were supervision, conflict resolution and communication skills, and support or guided group work. The main barriers are limited time and lack of knowledge. Discussion: The well-being of residents has gained relevance in recent years, so much so that the Accreditation Council for Graduate Medical Education (ACGME) actively promotes it. In Chile, the situation seems to be different; there is a systematic lack of standardized activities aimed at self-care and the resident's well-being. Including mental health advocating programs is an essential challenge considering the context of pandemic and the relevance of preventing burnout in health personnel.

Resumen: Introducción: los residentes de especialidad médica están expuestos a un alto nivel de burnout lo cual impacta negativamente en el profesionalismo. Esto ha promovido que los programas de residencias instalen curricularmente actividades de bienestar y autocuidado. Este estudio busca identificar la presencia de actividades de autocuidado/bienestar en residencias de psiquiatría de Chile y conocer la opinión docente respecto del tema. Materiales y métodos: se realizó un estudio descriptivo transversal invitando vía correo electrónico a 80 docentes de 3 departamentos de psiquiatría a contestar un cuestionario sobre el tema de bienestar/autocuidado de sus residentes en sus programas de formación. Se realizó un análisis cuantitativo de los datos. Resultados: un 69,4% de los encuestados señaló que su residencia no cuenta con contenidos curriculares formales o un programa de autocuidado/bienestar para sus residentes. Las actividades existentes para las residentes relacionadas al autocuidado/bienestar y mencionadas por los docentes son: supervisión, resolución de conflictos, habilidades de comunicación y apoyo o trabajo grupal guiado. Las principales barreras son la limitación de tiempo, la falta de conocimiento y el financiamiento. Discusión: el bienestar de los residentes ha ganado relevancia en los últimos años. El Consejo de Acreditación de Educación Médica para Graduados (ACGME) lo promueve activamente. En Chile, según los programas encuestados, hay poca presencia sistemática de actividades estandarizadas o programas dirigidos al autocuidado y bienestar de este grupo. Parece necesario incluir este aspecto considerando el impacto del burnout en el personal de salud especialmente en un contexto de pandemia o crisis sanitaria.

Abstract: 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 development of the child. Objective: to characterize Paternal-fetal attachment, based on maternal perspective, 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.

Resumen: Introducción: El estudio del vínculo prenatal paterno es un área de investigación reciente, que cobra relevancia por su correlación con el vínculo paterno postnatal y que incide en el desarrollo cognitivo y socioemocional de niños y niñas. Objetivo: Caracterizar el vínculo prenatal paterno, a partir de la percepción materna, en puérperas atendidas en un Hospital público de la Región Metropolitana. Sujetos y Mé todo: Estudio observacional transversal. Se entrevistó a mujeres puérperas hospitalizadas, a quienes se les aplicó un cuestionario con variables sociodemográficas de ambos padres y la Escala de Percep ción Materna del Vínculo Prenatal Paterno, previamente adaptada y validada. Se realizó un análisis descriptivo y de asociación para conocer el comportamiento del indicador vínculo con respecto a las variables sociodemográficas. Resultados: El puntaje promedio del Vínculo prenatal paterno desde la perspectiva materna fue de 41,5 (rango 10-50). El resultado del vínculo prenatal paterno desde la perspectiva materna es significativamente mayor en los casos en que los padres viven juntos, la relación de pareja es mayor a dos años y en embarazos planificados y controlados antes de las doce semanas. No hubo diferencias en el vínculo prenatal paterno desde la perspectiva materna en relación al número de hijos, nacionalidad o nivel de estudios. Discusión: El vínculo prenatal paterno está determinado fundamentalmente por características de la relación de los padres y no por las particu laridades individuales de los progenitores, por lo cual la mirada del vínculo debe ser desde la tríada.

Abstract: 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.

Resumen: Introducción: El Trastorno del Espectro Autista (TEA) es una condición del neurodesarrollo con alteraciones en la comunicación e interacción social y comportamientos e intereses repetitivos y restringidos. La Disfo ria de Género (DG) es la incongruencia entre el sexo que se siente y el asignado al nacer, con deseo de ser del sexo opuesto. El desarrollo de la identidad sexual es un elemento esencial en la construcción de la identidad global individual. Objetivo: Analizar un caso clínico de coocurrencia de TEA y DG en un adolescente desde una comprensión psicodinámica de su identidad personal. Caso Clínico: Paciente de sexo biológico masculino de 15 años diagnosticado con TEA y capacidad intelectual limítrofe. Desde la etapa preescolar manifestó conductas femeninas e intereses por juegos de niñas con imita ción de figuras femeninas, verbalizando querer ser del sexo opuesto. Una evaluación multidisciplinaria en la adolescencia concluyó que presentaba una identidad general difusa, con identidad de género ambivalente, por lo que se determinó que no era candidato a terapia hormonal. Se sugirió iniciar proceso terapéutico que favoreciera una mayor exploración y flexibilidad cognitiva para contribuir al desarrollo de una identificación de género más definida. Conclusiones: En condiciones de adversidad identitaria, como las presente en el TEA, el sujeto afectado con frecuencia retrasa o bien, no consolida la identidad sexual, coexistiendo una difusión de identidad y de género como en el caso reportado. La coocurrencia de TEA y DG requiere de evaluación multidisciplinaria, incluyendo evaluación comple ta de la identidad global para definir la orientación terapéutica definitiva respecto del género.

Background: The incorporation of integrative medicine as a holistic approach increased in medical education. However, complementary and alternative medicine (CAM) formal teaching in psychiatry residency programs is limited. Aim: To assess the incorporation of CAM education in different Chilean psychiatry programs and to determine the knowledge and attitudes toward this issue. Material and Methods: An online survey was sent to 80 academic staff from five psychiatry programs. Forty-nine participants answered the survey (61%). Some of the questionnaire topics were the inclusion of CAM content in the program, types of CAM included, and motivation and strategies for the CAM content incorporation in their training curriculum. Results: Most respondents answered that there is no formal CAM content in their program’s curriculum. The main topics to incorporate CAM in a psychiatry residency are sleep hygiene, stress management, and motivational interviewing. The lack of knowledge, time constraints, and the limited resources are major barriers to include CAM in their curriculums. Conclusions: Our results suggest that many academic staff of Chilean psychiatry training programs are aware of the importance of having CAM content in their curriculum. However, some barriers hinder their incorporation and implementation.

Background: Healthcare workers’ mental health was affected by SARS-CoV-2 pandemic. Aim: To evaluate healthcare workers’ mental health and its associated factors during the pandemic in Chile. Material and Methods: An online self-reported questionnaire was designed including the Goldberg Health Questionnaire, the Patient Health Questionnaire, (PHQ-9), and the Columbia-Suicide Severity Rating Scale among other questions. It was sent to 28,038 healthcare workers. Results: The questionnaire was answered by 1,934 participants, with a median age of 38 years (74% women). Seventy five percent were professionals, and 48% worked at a hospital. Fifty nine percent of respondents had a risk of having a mental health disorder, and 73% had depressive symptoms. Significant associations were found with sex, workplace, and some of the relevant experiences during the pandemic. Fifty one percent reported the need for mental health support, and 38% of them received it. Conclusions: There is a high percentage of health workers with symptoms of psychological distress, depression, and suicidal ideas. The gender approach is essential to understand the important differences found. Many health workers who required mental health care did not seek or received it.

Abstract: Introduction: There has been an increase in the popularity of vegetarian diets, especially among adolescents and young adults. These diets seem to be healthy and balanced, but the recommendations are contro versial regarding potential nutritional deficits. Objective: To identify the frequency and types of ve getarian diet used, their motivation, and sources of information. Patients and Method: Cross-sec tional analytical study in freshmen students from the Pontifical Catholic University of Chile (PUC). Through an online survey, we collected demographic information and diet characterization of those who considered themselves as vegetarians. Variables were analyzed using IDM SPSS Statistics® soft ware and in Excel® spreadsheet in a quantitative way. Results: 152 students answered the survey (15.2% of the sample) and, out of these, 49.4% were vegetarian. 32.4% started this eating pattern bet ween the ages 12 and 18 and among their most frequent motivations were environmentalists (91.9%) and animalists (72.9%). 52.9% of vegetarians take vitamin B 12 supplementation but only 15.9% reported having this deficiency. 75.7% obtain information related to vegetarian diets through digital media. Conclusion: In the surveys answered, we found a high percentage of vegetarian students, the refore, health professionals need to be trained in this area to assure adequate nutritional education, supplementation if necessary, and follow-up.

Resumen: Introducción: Se ha observado un aumento en la popularidad de las dietas vegetarianas, en especial en la población adolescente y adulto joven. Estas dietas se presentan como saludables y balanceadas pero las reco mendaciones son controversiales en cuanto a los potenciales déficit nutricionales. Objetivo: Iden tificar la frecuencia y tipos de dieta vegetariana utilizada, su motivación y fuentes de información. Pacientes y Método: Estudio transversal y analítico en universitarios de primer año de la Pontificia Universidad Católica de Chile (PUC). Se realizó una encuesta vía online obteniendo información demográfica y caracterización de dietas de aquellos que se consideraban vegetarianos. Las variables fueron analizadas mediante el software IDM SPSS Statistics® y en planilla Excel® de forma cuantita tiva. Resultados: 152 alumnos respondieron la encuesta (15,2% del total), siendo el 49,4% de estos vegetariano. El 32,4% inició este patrón alimentario entre los 12-18 años; sus motivaciones más frecuentes fueron las medio ambientalistas (91,9%) y animalistas (72,9%). El 52,9% de los vegetarianos reciben suplementación de vitamina b 12 pero solo un 15,9% reportó presentar este déficit. El 75,7% obtiene información relacionada acerca de las dietas vegetarianas a través de medios digitales. Con clusión: Se encontró un alto porcentaje de estudiantes vegetarianos en las encuestas contestadas, lo que hace necesario que los profesionales de salud estén capacitados en esta área para asegurar una adecuada educación nutricional, suplementación si es necesario, y seguimiento.

The catastrophic emergency experienced by many countries with the COVID-19 pandemic emphasized the importance of bioethics for decision-making, both at the public health (equitable and effective policies) and at the clinical level. At the clinical level, the issues are the fulfillment of medical care demand with adequate health care teams, infrastructure, and supplies, and to cover critical care demands that surpass the available resources. Therefore, ethically correct approaches are required for the allocation of life sustaining resources. There are recommendations for the allocating life support during disasters based on multiple considerations, including ethical ones. However, the ethical criteria of existing guidelines are variable. Ethical principles usually considered are saving the greatest number of lives, saving the greatest number of years of life and the principle of the life cycle or the goal to give each individual equal opportunity to live through the various phases of life. However, the centrality of the human being and the search for the common good should be considered. Knowledge of public perspectives and moral benchmarks on these issues is essential. A successful assignment effort will require everyone's trust and cooperation. Decision making should be planned and discussed in advance, since in-depth deliberation will be extremely complex during the disaster. Our goal is to help the health care teams to wisely allocate resources in shortage periods.

Abstract: This article is an ethical and legal reflection about the current trend of parents to refuse vaccination of their children under a legal regime that establishes mandatory use of certain vaccines. We analyze the main arguments used by parents to refuse obligatory vaccination, i.e., the fear of the negative effects that vaccination may have on the child; the violation of the “right to autonomy”; religious or pseudo-philosophical beliefs; and the resistance to the State intervention in personal or family mat ters. Therefore, this statement implies a necessary ethical analysis of childhood vaccination. Finally, it will be discussed the responsibility of parents and the State -the health authority- in the care of mi nors. Vaccination is a benefit for both the inoculated and the community, the best preventive policy. At the same time, it is considered a complex case that demands a profound debate, whose purpose should be the transition from an apparent conflict between parents and the State, to convergence for the care of minors. In other words, it is emphasized the fact that parents, beyond the fulfillment of a heterogeneous normative duty, must act motivated by voluntary adherence to the best interest of the child and the community.

Resumen: Este artículo se presenta como una reflexión ética y jurídica acerca de la tendencia actual de los pa dres a rechazar la vacunación de sus hijos en un régimen jurídico que establece la obligatoriedad de determinadas vacunas. Se analizan los principales argumentos que los padres usan para rechazar las vacunaciones obligatorias, y, en concreto: el temor a los efectos negativos que la vacunación pueda provocar en el menor; la violación del “derecho a la autonomía”; las creencias religiosas o pseudo- filosóficas; la resistencia a la intervención del Estado en asuntos personales o familiares. De esto, nace un necesario análisis ético sobre la vacunación infantil. Finalmente, se discute la responsabilidad de los padres y del Estado (autoridad sanitaria) en el cuidado de los menores de edad. La vacunación es un beneficio tanto para el inoculado como para la comunidad, la mejor política preventiva. Al mismo tiempo, se configura como un caso complejo que demanda un debate profundo, cuyo fin debe ser el tránsito desde un aparente conflicto entre los padres y el Estado, a una convergencia por el cuidado de los menores de edad. En otros términos, se recalca el hecho de que los padres, más allá del cum plimiento de un deber normativo heterogéneo, deben actuar motivados por la adhesión voluntaria al bien del hijo y de la comunidad.

Abstract: Introduction: Screening for Autism Spectrum Disorders (ASD) using the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) increases early detection, allowing early interventions and improving prognosis. This tool is part of the management in case of suspected ASD in several clinical guidelines. The objective of this article was to conduct the concurrent and discrimi nant validation and the reliability analysis of M-CHAT-R/F in the Chilean population. Patients and Method: This is the second stage of the cross-cultural adaptation of cross-sectional design. M-CHAT- R/F was applied to a sample of 20 children with suspected ASD and 100 randomly selected healthy control children, aged between 16-30 months. Autism Diagnostic Observation Schedule (ADOS-2), considered as reference, was applied to the 20 patients of the clinical sample, to 20 children of the healthy control sample and to those cases of the healthy control sample with M-CHAT-R/F positive. Cronbach alpha was calculated, as well as M-CHAT-R/F and ADOS-2 correlation, sensitivity, and specificity analyses. Results: In the healthy sample, M-CHAT-R/F was positive in two patients, with one of them positive and the other one negative for ASD with ADOS-2 test. In the clinical sample, M- CHAT-R/F was positive in all cases, three of them were negative in the ADOS-2 test. The Alfa relia bility of M-CHART-R/T was 0,889, the discriminant sensitivity and specificity were 100% and 98%, and the concurrent ones were 100% and 87.5% respectively. Conclusions: The Chilean M-CHAT- R/F version was reliable, sensitive and specific, similar to the original test, which opens the possibility for its use in clinical samples and for research. Validating M-CHAT-R/F is an ongoing process which must be further developed.

Resumen: Introducción: El tamizaje de los Trastornos del Espectro Autista (TEA) mediante el Modified Chec klist for Autism in Toddlers - Revised with Follow Up (M-CHAT-R/F) aumenta la detección precoz, posibilitando intervenciones tempranas y mejorando el pronóstico. Este instrumento es parte del algoritmo de manejo ante la sospecha de TEA en diversas guías clínicas. El objetivo fue realizar la validación concurrente, discriminante y el análisis de confiabilidad del M-CHAT-R/F en una pobla ción chilena. Pacientes y Método: Esta es la segunda etapa de la adaptación transcultural, de diseño transversal. Se aplicó M-CHAT-R/F a una muestra de 20 niños con sospecha de TEA y 100 niños de control sano seleccionados al azar, de 16-30 meses de edad. Se aplicó Autism Diagnostic Observation Schedule (ADOS-2), considerado como referencia, a los 20 pacientes de la muestra clínica, a 20 niños de la muestra de control sano y a aquellos casos de la muestra de control sano con M-CHAT-R/F po sitivo. Se calculó alfa de Cronbach, análisis de correlación de M-CHAT-R/F y ADOS-2 y sensibilidad y especificidad. Resultados: En el grupo de control sano, M-CHAT-R/F resultó alterado en 2 pacien tes, siendo uno positivo y otro negativo para TEA con ADOS-2. En muestra clínica el M-CHAT-R/F fue positivo en todos, con test de ADOS-2 negativo en 3 casos. La confiabilidad Alfa del M-CHAT- R/F fue =0,889, la sensibilidad y especificidad discriminante de 100 y 98% y la concurrente 100% y 87,5% respectivamente. Conclusión: M-CHAT-R/F en su versión chilena resultó fiable, sensible y específico de manera similar al original, lo cual abre la posibilidad de su utilización en población clínica y para investigación. La validación es un proceso continuo que se debe profundizar.

Abstract: Introduction: The dysregulation profile (DP) is a relevant clinical entity in the children and ado lescent area since its association with future psychopathology. DP is defined by the Child Behavior Checklist (CBCL), combining internalizing symptoms (anxiety/depression) and externalizing ones (aggressiveness, attention problems). Objectives: To study the frequency of CBCL-DP in a sample of Chilean preschoolers. Patients and Method: A sociodemographic survey and CBCL 1.5-5 was applied to caregivers of children aged 30 to 48 months in a national representative sample of public health system users. Frequency was estimated using the Kim et al. method and an explanatory model was made using binary logistic regression of DP using the child, caregiver, and contextual variables. Results: The sample size was n = 1,429 preschool children and their caregivers. The frequency of DP was 11.6% (95% CI 9.9-13.5%). The variables that allow to classify DP in 88.6% of cases were: current depressive symptoms in the main caregiver (OR: 2.24; 95% CI 1.37-3.67); number of stressful events experienced by the main caregiver (p = 0.005); number of available elements for child development stimulation in the home (p = 0.001); number of chronic diseases of the child (p = 0.006). Conclu sions: DP has a high frequency in preschoolers, which implies a relevant mental health burden. This finding points to the need for interventions in this area and also longitudinal monitoring of this subgroup.

Resumen: Introducción: El perfil de desregulación (PD) es una entidad clínica de interés en el área infantojuvenil, puesto que se asocia a psicopatología futura. El PD se define a partir del instrumento Child Beha vior Checklist (CBCL), combinando síntomas internalizantes (ansiedad/depresión) y externalizantes (agresividad, problemas de atención). Objetivo: Estudiar la frecuencia del perfil de PD por CBCL en una muestra de preescolares chilenos. Pacientes y Método: Se aplicó una encuesta sociodemográfica y Cuestionario CBCL 1% - 5 a cuidadores de niños entre 30 y 48 meses de edad, en una muestra representativa nacional de usuarios de red pública. Se estimó la frecuencia utilizando el método de Kim y colaboradores y se realizó un modelo explicativo mediante regresión logística binaria del PD utilizando variables del cuidador, del niño y del contexto. Resultados: La muestra fue de 1429 pre escolares y sus cuidadores. La frecuencia de PD fue de 11,6% (IC 95% 9,9-13,5%). Las variables que permiten predecir el PD en un 88,6% fueron: Síntomas depresivos actuales en el cuidador principal (OR: 2,24; IC95%: 1,37-3,67); Número de eventos vitales estresantes vividos por el cuidador principal (p = 0,005); Número de elementos disponibles para estimulación en el hogar (p = 0,001); Número de enfermedades crónicas del niño (p = 0,006). Conclusiones: PD tiene una frecuencia alta en preesco lares, lo que implica una carga en salud mental relevante, apuntando a la necesidad de intervenciones en esta área, además de seguimiento longitudinal de esta subpoblación.

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.

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.

Congenital hypothyroidism (CH) is the most common cause of preventable cognitive disability worldwide. Generally, it is produced by an alteration in the embryogenesis of the thyroid gland or by an alteration in the synthesis of thyroid hormones, which determine that affected patients have low or absent thyroid hormone concentrations. The importance of this fact is that brain development during the first three years of life is highly dependent on thyroid hormones. Prior to the implementation of national neonatal screening programs around the world, 8 to 27% of children with CH had an IQ lower than 70. Nowadays, this percentage is close to 0 in countries that have implemented the program. In Chile, CH neonatal screening program achieved national coverage in 1996. Currently, the incidence of the disease in our country is 1: 3163. The degree of disability produced by CH not only depends on the time of detection of the disease and the prompt start of therapy, but also on an adequate monitoring. Despite screening programs, neurocognitive impairment in schoolchildren and teenagers with CH is still observed, reflected in lower scores in cognitive, language and gross motor assessments, receptive communication, expressive communication, fine motor and gross motor skills compared to healthy children. Also, lesser achievements in learning and language disorders are observed. The objective of this review is to update the information available on neurodevelopment of patients with CH.

Abstract: The aim of this investigation is to identify the main topics of the discussion about medical ethics in clinical practice in Chile. 143 articles in Chilean medical and bioethics journals were identified. They were put under a systematic study using comparison, codification and text analysis techniques of the Grounded Theory approach. 30 subjects were identified in the discussion, where the treatment of the ethics from a “professional deontology” predominates. Emergent speeches of an ethics that appeals to goods and values superiors to the professional duties in the search of the good of the patient can be found. The transformation of the context in which the clinical practice takes place is the background of the discussion.

Resumen: El objetivo de esta investigación es identificar los principales temas de la discusión sobre de ética médica en la práctica clínica en Chile que se suscitan en las revistas de Medicina y Bioética chilenas. Se identificaron 143 artículos que fueron sometidos a un análisis sistemático utilizando técnicas de comparación, codificación y análisis de textos propios del enfoque de la Teoría Fundamentada. Se distinguieron 30 temas en la discusión, en la que predomina el tratamiento de la ética desde la “deontología profesional”. También se observan discursos emergentes de una ética que apela a bienes y valores superiores a los deberes profesionales en la búsqueda del bien del paciente, en el marco de un proceso de transformación del contexto en que se ejerce la práctica clínica.

Resumo: O objetivo desta pesquisa é identificar os principais tópicos da discussão sobre ética médica na prática clínica no Chile, presentes nas revistas nacionais de medicina e bioética. Identificaram-se 143 artigos que foram submetidos a uma análise sistemática, utilizando-se técnicas de comparação, codificação e análise de textos próprios da abordagem da Teoria Fundamentada. Identificaram-se 30 temas na discussão, nos quais predominam o tratamento da ética a partir da "deontologia profissional". Também se observam discursos emergentes de uma ética que apela aos bens e valores superiores aos deveres profissionais na busca pelo bem do paciente, no âmbito de um processo de transformação do contexto em que é exercida a prática clínica.