Download - CO031052007 Analisis Asociacion Trastorno Personalidad Antisocial Trastornos Consumo Sustancias Estudio Corte

8/16/2019 CO031052007 Analisis Asociacion Trastorno Personalidad Antisocial Trastornos Consumo Sustancias Estudio Corte

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Análisis de asociación entre el Trastorno de Personalidad Antisocial y los trastornos

por consumo de sustancias. Un estudio de corte

Tesis para optar por el titulo de Magister en Epidemiologia

Por: Carlos Andrés Mejía Mosquera

Asesor: Carlos Alberto Palacio Acosta

Facultad Nacional de Salud PublicaUniversidad de Antioquia

Agosto de 2007

Medellín


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Por: Carlos Andrés Mejía Mosquera


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RESUMEN.

Introducción: se ha reportado una asociación entre el Trastorno de PersonalidadAntisocial (TPA) y los Trastornos por Consumo de Sustancias Psicoactivas (TCSP).En nuestra sociedad un gran número de delitos están relacionados de formadirecta e indirecta con el consumo de sustancias. Es posible que los sujetos conTPA y TCSP tengan mayor riesgo de transgredir las leyes.

Materiales y métodos: 182 sujetos fueron evaluados con el Diagnostic Interviewfor Genetic Studies in Psychiatry (DIGS) en la cárcel Bellavista de Medellín. Fueron

seleccionados de manera aleatoria y entrevistados por clínicos expertos. Se hizo

diagnóstico categórico de TPA y de los TCSP, además se evaluaron algunascaracterísticas sociodemográficas. Se realizó un análisis de regresión logísticabasado en varios modelos clínicos, se calcularon OR crudos y ajustados con susrespectivos Intervalos de Confianza del 95%.

Resultados: El promedio de la población es menor de 30 años, con secundariaincompleta y dos terceras partes vive en estratos socioeconómicos 1 y 2. Laprevalencia de TPA es de 63.2%, el TCSP más prevalente en los internos es la

dependencia a la marihuana con 57.7%, mientras que la prevalencia dedependencia a la marihuana y a la cocaína en los sujetos con TPA es 78.3% y63.5%, así mismo estos TCSP están más asociados con el TPA (OR 12.48

(IC95%6.04-25.78) y OR 11.2 (IC95% 6,56-24.88) respectivamente. Los ORajustados para la asociación entre TPA y los TCSP son 9.08 (IC95% 4.08-20.17) con

la dependencia a la marihuana y OR 5.98 (IC95% 2.48-14.41) en la dependenciaa la cocaína.

Discusión: Es difícil establecer sí el TPA conlleva a los TCSP o viceversa. Laasociación entre las sustancias psicoactivas y el TPA podría estar relacionadacon un efecto neurobiològico directo o por efectos de tolerancia que lleva auna búsqueda imperiosa recurriendo a la actividad delincuencial.


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+? 9?= @E96A: ?9 ,6@I;:=76A ";7?CQ6?k W:C U?;?76A +78>6?= 6; 1=DAb6@7CD _, E@C7? >? FZ>6A:= I?;?C@9?=d FZ>6A:= ?=78>6@;7?= >? E:=IC@>: ?; E=6a86@7CV7?CA?C @[: D E=6a86@7C@= A9V;6A:=d EC?Q6@F?;7? A@E@A67@>:= D ?;7C??fE?C7:= ?; 9@ @E96A@A6B; >?9 6;=7C8F?;7: a8? C?A6O6?C:; =8 ?;7C?;@F6?;7: A8@;>: =? ?=7@O@ Q@96>@;>: ?9 6;=7C8F?;7: ,"U+ D a8? E?C7?;?A?; @9 U";Q?=76I@A6B; ?; 1=6a86@7CV@ >? 9@ N@A897@> >? 3?>6A6;@ >? 9@ #;6Q?C=.@>@ ?;7C?Q6=7@ 78Q: ?; EC:F?>6: 8;@ >8C@A6B; G b:C@= E:C =8T?7:4 -9 ,"?;7C?Q6=7@ ?=7C8A78C@>@ ?9 A8@9 b@A? >6@I;:=76A: A@7?IBC6A: ?; 9:= ?T?="K !0d a8? @E:C7@ 7:>@ 9@ 6;W:CF@A6B; >?7@99@>@ >? 9:= AC67?C6:= >6@7C@=7:C;: F?;7@94 +? C?@96\: C?Q6=6B; >?9 a8? 76?;?; 9:= 6;7?C;:= ?; 9@ :W6A6A8@9 =6I8? =8 EC:A?=: : ?9 ?fE?>6?;7? a8? 99?Q@ ?9 ? !C@7@F6?;7: D ,?=@?; ?9 A?;7C: >? 0?A98=6B; 5?99@Q6=7@ a8? A:;76?;? 9:= 6;W:CF?= E=6A:9BI6A:=d 7D E?>@IBI6A:= >? 9:= 6;7?C;:=4 (>?F6@;?=d A:FE@[?C:= >? C?A98=6B; : W@F696@C?= >? 9:= 6;7?C;:= A E:=6O9? E@C@ @8F?;7@C 9@ A:;W6@O696>@> >? 9@ 6;W:CF@A6B;4

10%.-+(3"-)!% ,- $%+ ,(!%+

$@= Q@C6@O9?= a8? =? 87696\@C:; =:; ?; =8 F@D:CV@ A8@967@76Q@= ;:F6;>?=E8Z= >? C?@96\@C 8; >6@I;:=76A: A9V;6A: 7?;6?;>: A:F: F@CA: >? C?W?C?;A6!04 $@= Q@C6@O9?= =? F6>?; >? F@;?C@ >6A:7BF6A@ +"u)% =?IJ; b@D@ A8FEAC67?C6:= >6@I;B=76A:= E@C@ A@>@ E@7:9:IV@ ?; ?=E?AVW6A:4

1:C ?T?FE9: E@C@ >?7?CF6;@C =V 8; =8T?7: ?= ,?E?;>6?;7? @9 (9A:b:9 _=6u;:` F EC?I8;7@= >?O?; =?C >?O6>@F?;7? >696I?;A6@>@=4 ,? 9@ F6=F@ F@;?C@ E@C@=8T?7: 76?;? : ;: !1( =? >?O?; >? A8FE96C 8;@ =?C6? >? V7?F= ?; 9@= EC8?O@= >6@


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19

! K@C6@O9? >?E?;>6?;7?& ,6@I;B=76A: >? 7C@=7:C;: >? E?C=:;@96>@> @;F?>6>@ A:F: 8;@ Q@C6@O9? A8@967@76Q@ ;:F6;@9 >6A:7BF6A@ =6u;:

! K@C6@O9?= 6;>?E?;>6?;7?=& ,6@I;B=76A: >? !C@=7:C;:= E:C 8=:d @O8=:d

>? =8=7@;A6@= E=6A:@A76Q@=& @9A:b:9d ;6A:76;@d F@C6b8@;@d A:A@F?>6>@= A:F: Q@C6@O9?= A8@967@76Q@= ;:F6;@9?=d >6A:7BF6A@ =6u;

! .:Q@C6@O9?=& -,(, F?>6>@ A:F: 8;@ Q@C6@O9? A8@;767@76Q@ A:; ;6Q?9>? C@\B;d -+!0(!% +%."% -.%)/3".% F?>6>@ A:F: 8;@ Q@C6@O9? A8@967@7;:F6;@9 :C>6;@9d -+.%$(0",(, F?>6>@ A:F: 8;@ Q@C6@O9? A8@;767@766;7?CQ@9:4

+? C?A:>6W6AB 9@ Q@C6@O9? ?>@>d >6A:7:F6\@;>:9@d !?;6?;>: A:F: AC67?C6F?>6@d F?>6@;@ D F:>@d E:;6?;>: 8; E8;7: >? A:C7? >? GL4 -=7@ ?>@> ?= ?=A:I6>@J976F:= C?E:C7?= ?; 9@ 967?C@78C@ >? !1( >? 6;6A6: 7@C>V:d a8? E:>CV@; >6W!1( >? 6;6A6: 7?FEC@;: _GP`

+? C?A:>6W6AB 9@ Q@C6@O9? ?=A:9@C6>@>d b@A6Z;>:9@ >6A:7BF6A@ D ?9?=A:9@C6>@> >? MF: IC@>:d 7:>:= 9:= a8? 7?;I@; F?;:= >? ?=@ ?=A:9@C6>@> =? >A:; pO@T@ ?=A:9@C6>@>q D 9:= a8? 7?;I@; E:C ?;A6F@ =? >?;:F6;@C@ p@A?E7@$@ Q@C6@O9?= ?=7C@7: =:A6:?A:;BF6A: =? C?A:>6W6A@C:; E@C@ W@A@IC8E@C:; 9:= ?=7C@7:= R D G D =? >?;:F6;: p?=7C@7: O@T:qd F6?;7C@= a8? 9:= S D H =? >?;:F6;@C:; E?C7?;?A6?;7?= @ p?=7C@7: F?>6:q4 +:9: b8O: 8; C?I6=7C: >? D ?=7? =? A:;=6>?CB >?;7C: >?9 ?=7C@7: F?>6:4 _!@O9@ G`4

1@C@ ?9 @;: =? b6\: 8; ?fE9:C@A6B; >? WC?A8?;A6@= EA8@967@76Q@=d >?=?;9@A? D ?fE:=6A6:;?=d @=V A:F: E@C@ 9@= A:Q@C6@

F6=F: ;6Q?9 >? F?>6A6B;4 +? b6A6?C:; F?>6>@= >? 7?;>?;A6@ A?;7C@9 E@C@ A8@;767@76Q@=d F?>6@=d F?>6@;@= D >?=Q6@A6B; ?=7@C4 _!@O9@ G`

N8?C:; 7?;6>@= ?; A8?;7@ :7C@= Q@C6@O9?= =:A6:>?F:IC? 9:= 6;7?C;:= @9 F:F?;7: >? 9@ A:;>?;@d @9I8;:= @;7?A?>?;7?= FZ>


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6FE:C7@;A6@ A:F: b@O?C =8WC6>: 8; !C@8F@ -;AZW@9: .C@;?@;: _!-.` A:; 6;Ab@O?C 7?;6>: 7C@=7:C;:= >? @EC?;>6\@T? : b6E?C@A76Q6>@>4 %7C@ Q@C6A8?;7@ W8? 9@ A@;76>@> >? b6T:= a8? 76?;?; 9:= 6;7?C;:=4 _K?C IC6=7C6O8A6B; >? WC?A8?;A6@= >? 9:= >?967:= E:C 9:= A8@9?=A:;>?;@>:= ?; 9@ A?7?CF6;@C:; 9@= WC?A8?;A6@= >? 9@= EC?Q@9?;A6@= >? 9:= 7C@=7:C;=8=7@;A6@= E=6A:@A76Q@=d ?9 7C@=7:C;: >? E?C=:;@96>@> @;76=:A6@9 >? >6@I;B=76A:= ,+3 "K _!@O9@ H`

+? C?@96\@C:; IC? >6=E?C=6B; E@C@ :O=?CQ@C Q@9:C?= ?f7C?A8@;767@76Q:=4 $:= Q@9:C?= E?C>6>:= W8?C:; @;@96\@>:= A:F: 7@9?=d ;: b8O>? ?=7:= ?; :7C@= Q@C6@O9?= E@C@ ?=7? EC6F?C @;? Ab6 A8@>C@>: >? 6!$%&%' ()*) )+ ? Q@C6@O9?= A8@967@76Q@=d EC8?O@ ! >? =78>?;,-)+./.)./0)1 ,2+ -+ !$%&%'& $@ W8?C\@ >? 9@ @=:A6@A6B; =? A@9A89B A:; 8;

A@9A89@C@; 9:= ";7?CQ@9:= >? A:;W6@;\@ >?9 gLh _".gLh`4

-9 %0 AC8>: =? :O78Q: @9 AC8\@C ?9 >?=?;9@A? _!1(` A:; A@>@ 8;: >? 9:= >6@I;?fE:=6A6B; _8=:d @O8=:d >?E?;>?;A6@ >? =8=7@;A6@=`4 _!@O9@ L`4

-9 ".gLh >?7?CF6;@ 9@ EC?A6=6B; >? 9:= C?=897@>:=d @=V A:F: 9@ >6C?AA6B; >9@ =6I;6W6A@;A6@ ?=7@>V=76A@ >? 9@ @=:A6@A6B;4 ".gLh a8? A:;7?;I@; ?9 Q

A:;=6>?C@>:= A:F: ;: =6I;6W6A@76Q:=4 %0v G4L =?C?C@>@= A:F: @W8?C7?=d ?;7C? R4L D G4L F:>?C@>@= D ?;7C? R @ R4L >ZO69?=d 7:>@= E:=676Q@=4 1@C@ >?7?CF6;@C ?9 AC67?C6: >? W:C7@9?\@ >? 8;@ @=:A6@A6Ru%0 D @E96A@C


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+? 78Q6?C:; ?; A8?;7@ AC67?C6:= A9V;6A:= >? 6FE:C7@;A6@ @ 9@ b:C@ >? >?7?CQ@C6@O9?= >? A:;W8=6B;4 -fE?C7:= E=6a86@7C@= >?7?CF6;@C:; a8? E:=6O9?= Q?=7@C A:;W8;>6?;>: 9@ Q?C>@>?C@ @=:A6@A6B; ?;7C? 9:= !.+1 D ?9 !1(d =? 7:

Q@C6@O9?= >? A:;W8=6B; 7:>@= 9@= A:Q@C6@O9?= C?A:>6W6A@>@=d E:C @9A:b:9 D >?E?;>?;A6@ @ 9@ A:A@V;@ : >?E?;>?;A6@ @ 9@ ;6A:76;@ D >?F@C6b8@;@d >? 9@ F6=F@ F@;?C@ =? A:;=6>?C@C:; @a8?99@= a8? ?=7Z; C?9@?Q?;7: D A:; 9@ ?fE:=6A6B;d E?C: a8? ;: =?@ 8; E@=: 6;7?CF?>6: ?;7C? 9@= >:= Q@Cb@D@; =6>: C?E:C7@>@= ?; 9@ 967?C@78C@ _g]iRGS`4 +? b6\: A:CC:O:C@A6B; @A:;76;I?;A6@ GfG E@C@ Q?C =V ?9 E:=6O9? A:;W8=:C A8FE9? A:; >:= >? 7C?=7@>V=76A:=4 .8@;>: ;: W8?C@ @=V =? E9@;7?B a8? ;: =? A:FE:C7@ A:F: 8;@A:;W8=6B;4 .@O? 9@ E?;@ @;:7@C a8? ?; ?9 =6I86?;7? E@=:d ?9 @;? A:;W8=6B; W8?C:; 6;A986>@= E8?=7: a8? ?; ?=7? ? EC?9@A6B; @ 9@ A9V;6A@ WC?;7? @ 9@ ?=7@>V=76A@4 ,?=E8Z= =? Q?C6W6AA:F: 9@ Q@C6@O9? A:;W8;>? 9@ Q?C>@>?C@ @=:A6@A6B;d :O=?CQ@;>: ?9 %0A8@;>: =? A:;7C:9@ E:C 9@= E:=6O9?= Q@C6@O9?= A:;W8=:7@=d ?; a8? =?;7@=:A6@A6B; : E:C =6 9: A:;7C@C6: =? F@;76?;? A:;=7@;7?4 +V 9@ @=:A6@A6B; =8=7@;A6@9F?;7?d ?=7@ Q@C6@O9? ?C@ A:;=6>?C@>@ A:;W8=:C@ >? 9@ Q?C>Y`4

+? C?@96\B 8; @;: E@C@ O8=A@C A:;W8=6B; ? 6;7@=:A6@A6:;?= a8? A@FO6@C:; _@8F?;7@C:; : >6=F6;8D?C:;` 9@ >6C?AA6B; D 9@?W?A7: ?; F?9 R]h A:; ?9 %0 AC8>: =? C?@96\B 8; %0 @T8=7@>: E:C 9@ 7ZA;6AD X@;\?9 D 9@ EC8?O@ >? b:F:I?;?6>@> A:; Ev]4G E@C@ ?=7@O9?A?C =V ?; A:;W8;>6?;>: : ;: 9@ @=:A6@A6B;4 (a8?99:= %0 E:C ?=7C@7: A8D@ F@I;67A:FE9?7@F?;7? >6W?C?;7?= @ 9:= %0 AC8>:= =? A:;=6>?C@C:; A:F: 6;7?C@AC?E:C7@C:; A:F: 7@9?=d @=8F6?;>: a8? 9@ b?7?C:I?;?6>@> ?; 9:= ?Q?;7:= ?= 7@; @

C?a86?C? 8;@ F?>6>@ E:;>?C@>@ 8 %0 @T8=7@>: _RGH`4

+? C?@96\B 8; F:>?9: >? C?IC?=6B; 9:IV=76A@ A:; @;? F@;?C@?FE?\@;>: A:; 7:>@= 9@= Q@C6@O9?= ?; ?9 F:>?9: D ?FE?\@;>: @ >?=A@C7@?=7@>V=76A: >? m@9>d b@=7@ ?;A:;7C@C 9@= Q@C6@O9?= a8? F@;78Q


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?=7@>V=76A@ A:; ?9 >?=?;9@A?4 ,?=E8Z= =? b6\: ?9 @;: Q@AV: D ?;7C@;>: >? F@;?C@ F@;8@9 Q@C6@O9? E:C Q@C6@O9? b@=7@ ?;A:;71:C J976F: =? C?@96\B 8; @;? C?IC?=6B; 9:IV=76A@ E@=: @ E@=: b@A6

@a8?99@= @=:A6@A6:;?= a8? ?; ?9 @;: b@D@; 7?;6>: =6I;6W6A@b@=7@ 8;@ p >? ]4GL4 (>?F@= ?; A8?;7@ E@C@ ?9 F:>?9: @a8?99@=a8? 78Q6?C:; Ev]4GL E?C: a8? 76?;?; C?9?Q@;A6@ A9V;6A@ 6FE:C7@;7? O6?; =?@ >? 9@ 967?C@78C@ Du: E:C 9@ ?fE?C6?;A6@ A9V;6A@ >6C?A7@ : 6;>6C?A7@ _!@

+? ?=A:I6B ?9 F?T:C F:>?9: =?IJ; 9:= AC67?C6:= >? E@C=6F:;6:=6>@> D >? @A8?C>>? F D X:=F?C $?F?=b:Q4 +6; ?FO@CI:d ?9 AC67?C6: F@= 6F?9 A9V;6A: E@C@ 9@ ?9?AA6B; >?9 F:>?9:4

-9 F?T:C F:>?9: W8? @a8?9 a8? A:; F?;:= Q@C6@O9?= ?fE96AB 9@ F@D:C Q@C6@Q@C6@O9? >? >?=?;9@A?4 +6; ?FO@CI:d ?9 F?T:C F:>?9: W8? @a8?9 A@E@A:b?C?;7?F?;7? ?9 W?;BF?;:d >:;>? 9@= Q@C6@O9?= a8? a8?>@C:; A:F: ?fE96A@768; E?=: A9V;6A: C?9?Q@;7?4

ariables etiqueta naturaleza nivel de medición?>@> ?>@> ?; @[:= A8FE96>:= A8@;767@76Q@ C@\B;-+!0(!% ?=7C@7: =:A6: ?A:;:F6A: A8@;767@76Q@ 6;7?CQ@9:?=A:9@C6>@> ?=A:9@C6>@> ?; @[:= @EC:O@>:= A8@;767@76Q@ C@\B;?=7A6Q69 ?=7@>: A6Q69 A8@967@76Q@ ;:F6;@9;8F?Cb6T:= ;8F?C: >? b6T:= A8@;767@76Q@ C@\B;@;77>@b (;7?A?;>?;7? >? !,(X ?; 9@ 6;W@;A6@ A8@967@76Q@ ;:F6;@9@;7!-.6;W (;7?A?>?;7? >? !-. ?; 9@ 6;W@;A6@ A8@967@76Q@ ;:F6;@9:A8E@A6:; :A8E@A6B; 8 :W6A6: A8@967@76Q@ ;:F6;@976E:>?967: 76E: >? >?967: E:C ?9 A8@9 ?=7@ ?; 9@ A6I= (O8=: >? @9A:b:9 =?IJ ; ,+3 "K ,"U+ A8@967@76Q@ ;:F6;@9>@9>6I= ,?E?;>?;A6@ @9 @9A:b:9 =?IJ; ,+3 "K ,"U+ A8@967@76Q@ ;:F6;@9@A@;@>6I= (O8=: >? F@C6b8@;@ =?IJ; ,+3 "K ,"U+ A8@967@76Q@ ;:F6;@9>A@;@>6I= ,?E?;>?;A6@ @ 9@ F@C6b8@;@ =?IJ; ,+3 "K ,"U+ A8@967@76Q@ ; :F6;@9@A:A:>6I= (O8=: >? A:A@V;@ =?IJ; ,+3 "K ,"U+ A8@967@76Q@ ;:F6;@9

>A:A@>6I= ,?E?; >?;A6@ @ 9@ A:A@V@; =?IJ; ,+3 "K ,"U+ A8@967@76Q@ ;:F6; @9>O\>>6I= ,?E?;>?;A6@ @ 9@= O?;\:>6@A?E6;@= =?IJ; ,+3 "K ,"U+ A8@967@76Q@ ;:F6;@9>; 6A:>6I= ,?E?; >?;A6@ @ 9@ ; 6A:76; @ =?IJ; ,+3 "K ,"U+ A8@967@76Q@ ;:F6; @978=:>6I= !C@=7:C; : E:C 8=: >? =8=7@;A6@= =?IJ; ,+3 "K ,"U+ A8@967@76Q@ ; :F6;@97E@>6I= !C@=7:C;: >? 1?C=:;@96>@> (;76=:A6@9 =?IJ; ,+3 "K ,"U+ A8@967@76Q@ ;:F6;@9?=7C@7:C?A:> ?=7C@7: =:A6: ?A:;:F6A: O@T: D F?>6: A8@967@76Q@ ;:F6;@9?=A:9@C6C?A:>6W ?=A:9@C6>@> ?; @[:= @EC:O@>:= E8;7: >? A:C7? =ZE76F: IC@>: A8@967@76Q@ ;:F6;@9?>@>C?A:>GL ?>@> ?; @[:= A8FE96>:= E8;7: >? A:C7? GL @[:= A8@967@76Q@ ; :F6;@9

Tabla 1. variables y nivel de medición


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23

.%)+",-0(."%)-+ ^!".(+

-=7? 7C@O@T: A8FE9? A:; 9@= ;:CF@= >? 6;Q?=76I@A6B; ?; =?C?= b8F@;:= =?IJ; 9?; 9@ C?=:98A6B; ): ]]PHS] >? RggS >?9 36;6=7?C6: >? +@98> D ?; 9@ ,?A9@C@X?9=6;l6 >? G4]]]4 -= 8;@ 6;Q?=76I@A6B; >? C6?=I: FV;6F:4 $:= EC:A?>6F6?;7:=?W?A78@>:= E:C E?C=:;@= A@96W6A@>@= D A:FE?7?;7?= >?=>? ?9 E8;7: >? Q6=F:F?;7:d =? 7:F@C6>@= ;?A?=@C6@= E@C@ C?=E?7@C 9@ EC6Q@AF?>6@;7? 9@ A:>6W6A@A6B; >? 9@ 6;W:CF@A6B; @9 =?C =6=7?F@76\@>@i 9:= ?=7@C@>:= ?; A:;>6A6:;?= =?I8C@= D A:;W6>?;A6@9?= =B9: E:C EC6;A6E@94

( A@>@ 8;: >? 9:= =8T?7:= =? 9?= :WC?A?C< 6;W:CF@A6B; A9@C@ D Q?C@\ =:O:OT?76Q: >?9 ?=78>6: D ?9 =?;76>: >? =8 E@C76A6E@A6B;d 9: A8@9 >?O? a8?>F?>6@;7? 9@ W6CF@ >? 8; A:;=?;76F6?;7: 6;W:CF@>: _(;?f: R` E:C E@C7? >? Z9 D 8-; >6Ab: A:;=?;76F6?;7: a8?>@ ?=E?A6W6A@>: a8? 9@ E@C76A6E@A6B; ?; ?9 ?=78?; ;6;I8;@ W:CF@ A:; =8 =678@A6B; T8>6A6@94

LA INFORMACIÓN RECOGIDA EN ESTA INVESTIGACIÓN SERÁCONFIDENCIAL, HECHO QUE SE LE INFORMARÁ A LOS SUJETOS. LOSRESULTADOS PUBLICADOS PRESERVARÁN LA EXACTITUD DE LOSMISMOS Y HARÁN REFERENCIA A DATOS GLOBALES Y NO APERSONAS PARTICULARES.


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0-+#$!(,%+

$@ ?>@> EC:F?>6: >? 9:= 6;7?C;:= >? 9@ A? 5?99@Q6=7@ ?= >? SR @[:= E:O9@A6B; ?= F?;:C >? Gg @[:=4 $@ >?=Q6@A6B; ?=7@C ?= >? P4H @[:= D 9@=? C?E67? ?; 9:= =8T?7:= ?= 9@ >? GS @[:=4

$@ ?=A:9@C6>@> EC:F?>6: >? 9:= =8T?7:= ?= >? =ZE76F: @[: @EC:O@>:d 9@ F67@b@ ?=78>6@>: b@=7@ ?=7? IC@>: ?=A:9@Cd E?C: ?9 ;6Q?9 @A@>ZF6A: @9 A?=78>6@C D a8? F? =?f7: IC@>:4 -f6=7?; RH =8T?7:= A:; =8E?C6:Cd E?C: =:9: R >? ?99:= b@ 7?CF6;@>: 9@ 8;6Q?C=6>@>43? >:= 7?CA6:= >? 9@ F8?=7C@ 76?;? 8; ?=7C@7: =:A6:?A:;BF6A: O@T:d ?=7@;

R D G4 +:9@F?;7? R =8T?7: @>F676B ?=7@C ?; 8; ?=7C@7: =:A6:?A:;BF6A: @97-;7:;A?= 8;@ 7?CA?C@ E@C7? ?=7@ ?; ?=7C@7:= F?>6:=4 ): ?f6=7?; >6W?C?;A6@= =6I;6W6A@76Q@= ?; 9@ ?>@>d 9@ ?=A:9@C6>=:A6:?A:;BF6A: >?E?;>6?;>: >? =V EC?=?;7@; : ;: ?9 !1(4 _!@O9@ G`4


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RP No Sí inferior superior

edad

de 18 a 25 años n 18 38 1 - -% 26,87 33,04

de 26 a 35 años n 31 40 0,83 0,63 1,09% 46,27 34,78

de 36 a 45 años n 17 28 0,92 0,69 1,23% 25,37 24,35

de 46 a 55 años n 1 8 1,31 0,98 1,76% 1,49 6,96

mayores de 56 años n 0 1 1,47 1,23 1,76% 0 0,87

Escolaridad Analfabetismo n 2 3 1 - -

% 3,03 2,61Primaria incompleta n 15 15 0,83 0,37 1,85

% 22,73 13,04Primaria completa n 8 16 1,11 0,51 2,40

% 12,12 13,91secundaria incompleta n 28 58 1,12 0,54 2,33

% 42,42 50,43Secundaria completa n 11 11 0,83 0,36 1,91

% 16,67 9,57universitario n 2 12 1,43 0,68 3,02

% 3,03 10,43Estrato socioeconómico

Estrato 1 n 18 31 1 - -% 27,27 26,96

Estrato 2 n 27 44 0,98 0,74 1,30% 40,91 38,26

Estrato 3 n 17 31 1,02 0,76 1,38% 25,76 26,96

Estrato 4 n 4 8 1,05 0,67 1,66% 6,06 6,96

Estrato 5 n 0 1 1,58 1,28 1,96% 0 0,87

EdadPromedio 31mediana 29rango intercuartílico 40desviacion estandar 8.42

EscolaridadPromedio 7.07mediana 7rango intercuartílico 20desviacion estandar 3.6RP: Razones de Prevalencia

TPATabla 1. Características sociodemográficas de la población carcelaria

IC95%

-=7@>V=76A@= >?=AC6E76Q@=

EDAD EC:F?>6: S]4g SR4H".gLh Gg4RcSG4M Gg4McSS4RF?>6@;@ S] GP,?=Q6@A6B; ?=7@;>@C M4H g

ESCOLARIDAD EC:F?>6: Y4Y M4S".gLh L4PcM4L Y4YcPF?>6@;@ Y P,?=Q6@A6B; ?=7@;>@C S4L S4Y

RP: Razones de prevalencia

Tabla 2.


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26

3? 7C?= A8@C7@= E@C7?= >? 9@ E:O9@A6B; ?=78>6@>@ ?= =:97?C@4 9?I@9F?;7? A@=@>: D A@=6 ?9 RRh =? b@ =?E@C@>: >? =8 E@C?T@4

1.01%

75.38%

1.01%

10.55%

13.07%

MissingSolteroViudoSeparadoCasado

Estado civil

Gráfica 2. Distribución de frecuencias de la población de internos de la cárcel Bellavista según el estado civil.

Valores perdidos


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27

$@ :A8E@A6B; F?=?FE?[@; 9:= 6;7?C;:= =:; 9@= C?9@9@ F?A?=? EC:W?=6:;@94 $@ =?I8;>@ D 7?CA?C@ :A8E@A6B; F@ A:; 9@= Q?;7@= D ?9 7C@O@T@C ?; ?9 IC?F6: >?9 7C@;=E:C7? CC?E:C7@; ;6;I8;@ :A8E@A6B; ?9 M4]Mh >? 9:= 6;7?C;:= D G4]Gh >? 9:= a8? ?=7?7?;6>:= =? >?=?FE?[@O@; ?; @9IJ; :CI@;6=F: >? =?I8C6>@> >?9 ?=7@>:4

#; E:A: F? 8; A8@C7: >? 9@ E:O9@A6B; >? 6;7?C;:= 76?;? @;7?A?>?;7?= >? !C E:C ,ZW6A67 >? (7?;A6B; A:; X6E?C@A76Q6>@> _!,(X` : !C@=7:C;: >? (EC?;>6\@6;W@;A6@4

Missing

no sabe, no responde

Oficios Varios

Desempleado

Estudiante

Fuerzas armadas

Limpiadores de equipos y...

transporte o movimiento de...

Operarios de Máquinas y...

Mecánica, reparación,...

Otras ocupaciones agrícolas...

Operarios de fincas

Otras ocupaciones de servicio

Vigilancia y seguridad Auxiliares administrativos

Vendedores

Técnicos

Escritores, artistas, animadores y...

Profesionales

Ejecutivos, administradores y...

O

c u p a c

i ó n a c

t u a

l

20151050

Y Axis

1.52%

51%

51%

7.07%

3.03%

2.02%

9.09%

13.13%

2.53%

16.67%

6.06%

51%

8.08%

4.04%3.03%

15.15%

5.05%

51%

.01%

2.02%

Ocupación actual

Gráfica 3. Distribuciòn de frecuencias de la población según ocupación actualPorcentaje

perdidos


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28

.@=6 ?9 g]h >? 9:= =8T?7:= >? 9@ A


29/49

29

-9 EC:F?>6: >? b6T:= C?E:C7@>:= E:C 9:= 6;7?C;:= ?= >? R4SS E:C A@>@ =8T?7:d =6F@D:CV@ >? 9:= 6;7?C;:= ;: 76?;? ;6;IJ; b6T:d 8; E:A: F?;:= >?9 8; 7?CA6: >? 9@ E:O976?;? 8; b6T: D =:9@F?;7? 8; 7?CA6: >? 9:= =8T?7:= 76?;? >:= : F


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30

#; A8@C7: >? 9@ E:O9@A6B; ?=7@ A:;>?;@>@ E:C >?967:= @=:A6@>:= @ ;@CAB76A:=d :7C: A8@C7: >? 9@ E:O9@A6B; ?=7@ A:;>?;@>@ E:C >?967:= @=7?CA?C@= E?C=:;@=4 -9 7?CA?C >?967: F6:4

6420

Número de hijos

80

60

40

20

0

F r e q u e n c y

Mean = 1.33Std. Dev. = 1.504N = 199

Histogram

Gráfica 6. Distribución de frecuencias de hijos que tienen los internos de la cárcel Bellavista

Porcentaje


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31

Tabla 4. Distribución de frecuencias de los delitos

HY GLdS GLdSHH GHdG HgdLGS RGdY YGdRR] LdL YMdYg Hdg MGdLg Hdg MMdLP HdH PRdgM SdP PLdMM SdP PgdYL GdM gGdSH GdG gHdLS RdY gYdGG RdR gMdSR dL gMdPR dL gPdHR dL gPdgR dL ggdLR dL R]]d]

1:=?=6B; >? ;@CA:76A:=b8C7:b:F6A6>6:>?967:= =?f8@9?==?A8?=7C:?f7:C=6:;Q@C6:= E:C7? 69?I@9 >? @CF@=;@CA:7C?96;a86C 7?;7@76Q@ >? b:F6A6>6:6;@=6=7?;A6@ @96F?;7@C6@9?=6:;?= E?C=:;@9?=WC@8>?W8I@ >? EC?=:=7?CC:C6=F:6;=8F:= a86F6A:=C?A?E7@A6B;

K:=NC?A8?;A6@

1:CA?;7@T?Q:

1:CA?;7@T?@A8F89@>:

(EC:f6F@>@F?;7? ?9 R]h >? 9:= =8T?7:= ?=7@; A:;>?;@>:= E:C >?967:= A:;=6>?C@>>? 9?=@ b8F@;6>@>d 7@9?= A:F: ?9 =?A8?=7C:d 9@ ?f7:C=6B; D ?9 7?CC:C6=F:46;7?C;:= ?=7?;@>:= E:C >?967:= =?f8@9?=d F?;:= >?9 Gh =? ?;A8?;7C@; EC6Q=8 96O?C7@> E:C 6;@=6=7?;A6@ @96F?;7@C6@4

Tabla


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NO Sí(%) (%) Inferior Superior

Trastorno de Personalidad Antisocial 36,8 63,2 56 70 Abuso de alcohol 75,0 25,0 19 31Dependencia al alcohol 56,0 44,0 37 52

Abuso de Marihuana 87,9 12,1 7 17Dependencia de marihuana 42,3 57,7 50 65

Abuso de cocaina DSM-IV-Digs 86,3 13,7 9 19Dependencia de cocaina DSM-IV-Digs 54,9 45,1 38 52Dependencia de BZD 93,4 6,6 3 10Dependencia a la nicotina 55,5 44,5 37 52Trast por uso de sustancias 87,9 91,2 87 95

IC95%

Tabla 2. Distribución de Prevalencias de Trastorno de Personalidad Antisocial y Trastornos por Consumo de Sustancias Psicoactivas en

población carcelaria de Medellín. n=183 internos

Trastorno

$@ EC?Q@9?;A6@ >?9 !1( ?; E:O9@A6B; A@CA?9@C6@ ?= >?9 YS4Gh4 $@ E>?E?;>?;A6@ @ 9@ F@C6b8@;@ ?= 9@ F?;7C: >? 9@ E:O9@A6B; A@=6?;>: ?=7@ >? LM4Mh4 36?;7C@= a8? 9@ >?E?;>?;A6@ @ 9@= O?;\:>6@A?E6;F?;:C EC?Q@9?;A6@ >?;7C: >? ?=7:= 7C@=7:C;:= =6?;>: >? Y4Yh4 _!@O9@ H`4

TPA TPAsi no

n= 115 (%) n= 67 (%) valor de p Abuso de alcohol 27.2 21.2 1.39 (0.68-2.85) 0.475Dependencia al alcohol 51.3 31.3 2.23 (1.23-4.34) 0.013

Abuso de marihuana 11.3 13.4 0.82 (0.33-2.04) 0.814Dependencia a la marihuana 78.3 22.4 12.48 (6.04-25.78) 0.000

Abuso de cocaína 18.3 6 3.52 (1.15-10.74) 0.025Dependencia a la cocaína 63.5 13.4 11.2 (6.56-24.88) 0.000Dependencia a las benzodiacepinas 9.6 1.5 6.98 (0.88-55.33) 0.058Dependencia a la nicotina 53.9 28.4 2.96 (1.55-2.96) 0.010Trastornos por uso de sustancias 99.1 77.6 32.88 (4.23-255.61) 0.000

Trastornos por Consumo de SustanciasPsicoactivas OR (IC95%)

Tabla 3. Asociación entre el Trastorno de Personalidad Antisocial y los Trastornos por Consumode Sustancias Psicoactivas en población de internos de la cárcel Bellavista de Medellín.

valor de p según chi cuadrado de Mantel y Hanzel

-; ?9 @;: O6Q@C6@>: =? ?;A8?;7C@; @=:A6@A6:;?= 6FE:C7@;7?=>?O6>@= @9 @\@C ?;7C? !1( D 9@= =6I86?;7?= Q@C6@O9?=& >?E?;>?;A6@ @9 W8?C7?d F?>6@;@F?;7? EC?A6=@`d @O8=: >? F@C6b8@;@ _@=:A6@A6B; W8>?E?;>?;A6@ >? F@C6b8@;@ _@=:A6@A6B; F:>?C@>@d A:; 8; 6;7?CQ@9:

Tabla 4

Tabla 5


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33

C?9@76Q@F?;7? ?=7C?Ab:`d @O8=: >? A:A@V;@ _@=:A6@A6B; W8?C7?d E:A: E>? A:A@V;@ _@=:A6@A6B; W8?C7?d E:A: EC?A6=@` D ?;7C? ?9 !1( D 7:>:= 9:= 7C>? =8=7@;A6@=d 6;A986>@ 9@ >?E?;>?;A6@ @ 9@ ;6A:76;@d a8? ?= F8D W8?C

_!@O9@ L`

-f6=7? 8;@ W8?C7? @=:A6@A6B; ?;7C? 9:= =8T?7:= a8? 76?;?; !1( D >?E?;>?;A6@ A:; 9@ >?E?;>?;A6@ @ 9@ F@C6b8@;@ D 9@ A:A@V;@ _!@O9@ Y`4 36?;7C@=!1( a8? >?E?;>?; @ 9@ F@C6b8@;@ 76?;?; 8;@ @=:A6@A6B; =6I;6W6A@76Q@ ? 6F>?E?;>?;A6@ @ 9@ A:A@V;@4 $@ >?E?;>?;A6@ @ 9@ A:A@V;@ ?= ?9 !.+1 a8? F<@9 !1( A8@;>: ?f6=7? E:96A:;=8F: >? =8=7@;A6@= E=6A:@A76Q@=4 _!@O9@ Y`4 =:A6:>?F:IC6?;>: 9@ Q?C>@>?C@ @?9 !1( D 9:= !.+14


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34

,?=E8Z= >? b@A?C FJ976E9?= @;? C?IC?=6B; 9:IV=76A@d ?=7:= F:=7C@

a8? =? @=:A6@ A:; ?9 !1( _A:F: Q@C6@O9? >?E?;>6?;7?` D =? EC?=?;7@ A:F: 86;>?E?;>6?;7? ?= 9@ >?E?;>?;A6@ @ 9@ A:A@V;@ D 9@ >?E?;>?;A6@ @ 9@ :O=7@;7?d A8@;>: =? 7:F@ A:F: Q@C6@O9? >?E?;>6?;7? 9@ >?E?;>?;A6@ @9 @F@D:C ?=A:9@C6>@> =? A:FE:C7@ A:F: 8; W@A7:C EC:7?A7:Cd a8? >6=F6;8D??;7C? ?=7? !.+1 D ?9 !1( _Q@C6@O9? 6;>?E?;>6?;7?`4 $@ F@I;678> >? 9@ @=:A6@

TPA TPAsi no

Dependencia al alcohol n=59 (%) n=21 (%)Dependencia a la marihuana 81.4 19 18.54 (5.2-66.1) 0.000Dependencia a la cocaína 67.8 14.3 12.63 (3.31-48.19) 0.000Dependencia a las benzodiacepinas 13.6 4.8 - 0.43Dependencia a la nicotina 54.2 38.1 1.93 (0.69-5.33) 0.310

No dependencia al alcohol n=56 (%) n=46 (%)Dependencia a la marihuana 75 23.9 9.54 (3.85-23.67) 0.000Dependencia a la cocaína 58.9 13 9.56 (3.48-26.25) 0.000Dependencia a las benzodiacepinas 3 0 0.80 (0.62-1.06) 0.25Dependencia a la nicotina 53.6 23.9 3.67 (1.59-8.65) 0.003

Dependencia a la marihuana n=90 (%) n=15 (%)

Dependencia al alcohol 53.3 26.7 3.14 (0.93-10.61) 0.92Dependencia a la cocaína 70 20 9.33 (2.43-37.75) 0.000Dependencia a las benzodiacepinas 12.2 0 - 0.358Dependencia a la nicotina 58.9 40 2.15 (0.71-6.55) 0.26

No dependencia a la marihuana n=25 (%) n=52 (%)Dependencia al alcohol 44 32.7 1.62 (0.61-4.31) 0.448Dependencia a la cocaína 40 11.5 5.11 (1.59-16.43) 0.007Dependencia a las benzodiacepinas 0 1.9 - 1Dependencia a la nicotina 36 25 1.69 (0.60-4.72) 0.42

Dependencia a la cocaína n= 73 (%) n= 9 (%)Dependencia al alcohol 54.8 33.3 2.42 (0.56-10.44) 0.297Dependencia a la marihuana 86.3 33.3 12.6 (2.7-58.66) 0.001Dependencia a las benzodiacepinas 12.3 0 - 0.587Dependencia a la nicotina 64.4 33.3 3.615 (0.83-15.67) 0.144

No dependencia a la cocaína n=56 (%) n=46 (%)Dependencia al alcohol 45.2 31 1.87 (0.8-4.18) 0.208Dependencia a la marihuana 64.3 20.7 6.9 (2.81-16.89) 0.000Dependencia a las benzodiacepinas 4.8 1.7 2.85 (0.25-32.51) 0.571Dependencia a la nicotina 35.7 27.6 1.46 (0.62-3.48) 0.392

OR (IC95%) valor de pDependencia a:

Tabla 4. Asociación entre el Trastorno de Personalidad Antisocial y los Trastornos por Consumode Sustancias Psicoactivas en población de internos de la cárcel Bellavista de Medellín, según la

dependencia a diferentes sustancias psicoactivas.

Valor de p según chi cuadrado de Mantel y Hanzel

Tabla 6


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35

F:>?9: Rd S D H ?= IC@;>?d =6; ?FO@CI: 9@ EC?A6=6B; >? 9:= C?=897@>:= ?= E:A@?; ?9 F:>?9: G 9@ F@I;678> >? 9@ @=:A6@A6B; ?= F:>?C@>@ D 9:= C?=897@>:=_!@O9@ M`4

B Wald OR ajustado †Inferior Superior

Modelo 1*Dependencia a la marihuana 2.20 29.31 9.08 4.08 20.17Dependecia a la cocaina 1.78 15.901 5.98 2.48 14.41

Modelo 2**Escolaridad menor a séptimo grado 0,648 4.20 0.52 0.28 0.97Trastorno de Pesonalidad Antisocial 0.803 5.95 2.23 1.17 4.23

Modelo 3***Dependencia a la cocaína 1.10 7.64 3.00 1.38 6.52Trastorno de Pesonalidad Antisocial 2.14 28.38 8.48 3.86 18.63

Modelo 4****Trastorno de Pesonalidad Antisocial 1.84 17.14 6.31 2.63 15.10Dependencia a la marihuana 1.10 7.64 3.00 1.37 6.52

* TPA como variable dependiente.

** Dependencia al alcohol como variable dependiente

*** Dependencia a la marihuana como variable dependiente

**** Dependencia a la cocaína como variable dependiente

† Ajustado por edad, estrato socioeconómico, escolaridad, dependencia al alcohol, dependencia a la nicotina

Tabla 5. Análisis de regresión logística entre el TPA y los TCSP en población carcelariacon diferentes modelos teóricos

IC95%

Tabla 7


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36

,"+.#+"/)

-9 ?=78>6: F:=7CB a8? 9@ E:O9@A6B; >? 6;7?C;:= >? 9@ A >? 9@ E:O9@A6B; ?=7@ E:C >?O@T: >? 9@ S?C@ >ZA@?>8A@A6B; =?A8;>@C6@ 6;A:FE9?7@d D Q6Q? ?; ?=7C@7: =:A6: ?A:;BF6A:;A:C>@;A6@ A:; :7C:= ?=78>6:= a8? b@; C?E:C7@>: b@99@\I:= =6F69@C?=_A@C@A7?CV=76A@= =:A6:>?F:IC@= ?=7: 9@@a8?99:= =8T?7:= A:; F?;:C?= :E:C78;6>@>?= ?; 9@ Q6>@d 9:= a8? 76?;>?; @ ?;C@A76Q6>@>?= >?96;A8?;A6@9?= D a8? E@C7? >? ?=7@= =:; T8=76W6A@>@

E:=6O696>@>?= >? :O7?;?C 8; 7C@O@T: >6I;: D 9?I@9 E@C@ I@C@;76\@C =8 =8=8 W@F696@4 ): :O=7@;7?d 7@FO6Z; =? E8?>? E?;=@C a8? 9:= =8T?7:= >?96;A8?;C@F?;7? 9@ ?>8A@A6B;d =? ?;C:9@; ?; @A76Q6>@>?= C6?=I:=@= ? 69?I@76?FE: 9:= 99?Q@ @ 7?CF6;@C ?; EC6=6B; @W?A7@;>: =8= A:;>6A6:;?= ?A:;BF E@C7?d 7@FO6Z; ?= E9@8=6O9? E?;=@C a8? E:C 9@= A@C@A7?CV=76A@=?=A:9@C6>@> D =8 T8Q?;78> =?@; W?96;A8?;7?=4 !@FO6Z; 9:= C?=897@>:= =8I6?C?; a8? 9:= =8T?7:= A:; F?T:C?= A:?A:;BF6A@= D F@D:C ?=A:9@C6>@> E8>6?C@; ?Q@>6C ?9 =6=7?F@ >? T8=76A;: 99?I@C @ 9@ A? 9@ A?F:IC? ?=7:= =8T?7:=d ?f6=76?C@; >6W?C?;A6@= E:C ?T?FE9: C?A98=:= TBQ?;?= 7?FEC@;: ?=A:9@C Q6Q6?;>: ?; A:;>6A6:;?= >6WVA69?= 78Q6?C@; F@D:C EC:O@!1(4 +6; ?FO@CI:d ?; ?=7@ E:O9@A6B; A@CA?9@C6@ =? ?;A:;7CB a8? ?9

E?C=:;@96>@> ;: ?=78Q: 6;W98?;A6@>: E:C A:;>6A6:;?= =:A6:?A:;BF6A@F?;A6:;@>@=4

$@ EC?Q@9?;A6@ >? !1( ?= >?9 YS4Gh ?; 9:= 6;7?C;:= >? 9@ A?99V;d N@\?9 ?; >:= >6W?C?;7?= C?Q6=6:;?= =6=7?F? 9@ 967?C@7


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37

A:; 8;@ E:O9@A6B; >? GS4]]] 6;7?C;:=d b:FOC?= D F8T?C?=d >? A? 7:>: E?C: ?; ?=E?A6@9 >? 9@ #+( D ?9 0?6;: #;6>:d C?E:C7B EC?Q@9?;A6@= >? !1( ?; =6a8? 6O@; >?=>? ?9 SGh b@=7@ ?9 YHhd A:; 8; EC:F?>6: >? HPh _;wSMRM` D ?; A:;>

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