Perceived importance and interest in research by Chilean primary care providers.

BACKGROUND: Primary care providers (PCPs) are relevant stakeholders for primary care research (PCR). OBJECTIVE: We report the perceived importance and interest in PCR of a national sample of Chilean PCPs. METHODS: We conducted a cross-sectional study targeting Chilean PCPs. An electronic survey assessing perceived relevance of PCR, research training and experience, training interests, and demographics was disseminated through emails and WhatsApp messages. Descriptive statistics were used to summarize data. Logistic regression models were used to estimate adjusted probabilities and 95% confidence intervals for high interest in PCR, high interest in using research methods, and high interest in receiving research training, and predictors of these outcomes. RESULTS: A total of 387 providers completed the online survey. Only 26.4% of PCPs had research experience as a principal or co-investigator. However, most clinicians perceived PCR as very important (92.5%) and were interested in using research methods (90.7%) and receiving training (94.3%). There were no statistically significant differences in these perceptions between provider's discipline, role, sex, age, and geographical location after adjusting for covariates. CONCLUSIONS: Despite few Chilean PCPs have research training, a large majority perceive it as important, are interested in using it in their practice and would like to receive training.

Antecedente de depresión, síntomas de estrés postraumático, apoyo social percibido: prediciendo la depresión posparto / History of depression, post-traumatic stress symptoms, perceived social support: predicting postpartum depression

Objetivo: Describir y analizar si el apoyo social percibido modera la relación entre antecedente de depresión (AD) o síntomas de trastorno de estrés postraumático (TEPT) y desarrollo de síntomas de depresión posparto (SDPP), evaluado prospectivamente. Método: Diseño longitudinal de tres tiempos: antes del parto (n = 458), primer mes posparto (n = 406) y tercer mes posparto (n = 426). Se utilizaron la Escala de Depresión Posparto de Edimburgo (EPDS), la Escala de Síntomas de Estrés Postraumático (PCL-C) y la Escala de Apoyo Social Percibido (MOS). Se realizó un análisis de ocho modelos jerárquicos de regresión lineal múltiple, por cada tiempo de evaluación en el estudio. Resultados: Se encontró una asociación significativa entre síntomas de TEPT y puntaje de SDPP en los tres tiempos. El apoyo social percibido es un factor protector significativo para los SDPP en los tiempos 1 y 2, mientras que el AD es un factor de riesgo significativo en los tiempos 2 y 3. Los resultados no apoyan las hipótesis de interacción. Conclusiones: El apoyo social es un factor protector significativo, que puede disminuir los SDPP; sin embargo, disminuye con el tiempo. El apoyo social no logra revertir la asociación de los síntomas de TEPT con el puntaje en SDPP.

Objective: Describe and analyze if the perceived social support moderates the relationship between depression history or post-traumatic stress disorder symptoms and the development of symptoms of postpartum depression, prospectively evaluated. Method: Longitudinal design of three times: before partum (n = 458), one month (n = 458) and 3 months postpartum (n = 458). The version of the Edinburgh Postnatal Depression Scale (EPDS), the version of the PTSD Checklist-Civilian Version (PCL-C), and the version of the Medical Outcomes Study Social Support Survey (MOS) were used. Analysis of eight hierarchical multiple linear regression models. Results: A significant association was found between symptoms of post-traumatic stress and postpartum depression, in the three times measured. The perceived social support variable was found to be a significant protective factor for perinatal depression in times 1 and 2, and history of depression was significant in times 2 and 3. The results do not support the interaction hypothesis. Conclusions: Social support is a significant protective factor, which can reduce the symptoms of postpartum depression, nevertheless the significance decreases over time. However, social support fails to reverse the association of post-traumatic stress disorder symptoms with symptoms of postpartum depression score.

Mixed-Methods Evaluation of the Initial Implementation of Advanced Home Visits in Chile.

Home visiting programs are evidence-based interventions that have a myriad outcomes for mothers and newborns. Chile offers these services as part of the Chile Crece Contigo, a nationwide program. However, implementing home visiting programs in community settings is difficult. In this study, we report clinic, provider, and participant engagement with the implementation of advanced home visits (ViDAs) in Chilean primary care clinics. ViDAs include a high number of visits, external supervision, and the use of technology. In this study, qualitative and quantitative data were collected to assess the initial implementation of the home visiting strategy. Qualitative data consisted of individual interviews and focus groups with directors of city health departments, clinic managers, and providers conducting home visits. Quantitative data included clinic, provider, and participant recruitment. City health departments were approached to authorize the participation of primary care clinics in the ViDAs program. Then, clinic directors were invited to approve the implementation of the home visiting program at their health centers. In total, 16 clinics, 42 practitioners, and 185 participants were recruited. A large amount of resources was needed to recruit clinics, providers, and participants. The intervention had low acceptability, low adoption, and a high implementation cost. Initial program implementation experienced several challenges. Identified facilitators and barriers both highlighted the need for community engagement at all levels for the successful implementation of an innovation in Chilean primary care clinics. In addition, this article provides recommendations for practitioners and researchers regarding the conduct of research in community-based settings.

Reducing stigma toward mental illness and substance use issues in primary health care in Chile: Protocol of a cluster controlled trial study.

Background: Chile is implementing a Community Mental Health Model with a strong role of primary health care (PHC). PHC has great potential to early detection and provision of accessible and coordinated services to people who present mental illness and/or substance use issues (MISUI). However, stigma toward people with MISUI among PHC professionals is a significant barrier to accessing good quality of care. A wealth of literature supports the importance of reducing stigma for this population. The main goal of this research project is to determine the effectiveness of a comprehensive anti-stigma intervention in reducing stigmatizing attitudes and behaviors among PHC providers toward individuals with MISUI in the Chilean context, using Centros de Salud Familiar (CESFAMs) as the point of intervention. Methods: The intervention is based on an initiative that was previously developed in Canada and then also pilot-tested in Lima, Peru, with the Center for Addiction and Mental Health (Ontario, Canada). The model will be culturally adapted with CESFAM PHC provider and user inputs to be relevant and valid to Chile. The 18-month intervention includes five (5) components that are simultaneously implemented in CESFAMs: (1) Develop a Team of Local Champions in each intervention CESFAM, comprising PHC providers and users; (2) Analysis of Internal CESFAM Policies, Procedures, and Protocols to determine areas of improvement in service delivery for individuals with MISUI; (3) Raising Awareness of stigma toward MISUI using various forms of media within the CESFAM; (4) Innovative Contact-Based Education workshops on anti-stigma and recovery principles, co-lead by academic/clinical trainers and a person with lived experience of MISUI; and (5) Recovery-Based Arts, a multi-week arts workshop for PHC providers and users to produce artwork related to MISUI and recovery, culminating in an exhibition to showcase artwork for the CESFAM providers, users, and community. The expected intervention outcomes are the following: Participation in the experimental group will result in a significant decrease in stigmatizing attitudes among PHC providers toward individuals with MISUI compared with the control group as measured by the Chilean version of the Opening Minds Scale for Health Care Providers Scale (OMS-HC); Participation in the experimental group will result in a significant decrease of PHC users experiences of stigma conveyed by PHC providers compared with the control group as measured by the Internalized Stigma of Mental Illness (ISMI) scale, validated for the Chilean population. The changes in attitudes and behaviors within the experimental group will be sustained over time as measured at 6 months-follow-up. To evaluate the effectiveness of this 18-month intervention, a 4-year, two-arm, cluster-randomized controlled trial is proposed, with CESFAMs being the unit of randomization (or "cluster"). Implementation Science approach will be taken to measure relevant implementation outcomes for each component of the intervention, and through qualitative data collection with CESFAM providers and authorities. Data analysis will be carried out using SAS 9.4 (specifically, using POC MIXED and PROC GENMOD) and R 3.5. Mixed-effect modeling will used for both PHC provider and user data, which will include individuals and CESFAMs as random effects and group (intervention/control) as fixed effects. Discussion: This study represents a new stage of relevant and innovative research in mental health and stigma in Chile that will contribute to improving access and quality of care for people with MISUI. Evaluating the impact of the intervention model and its implementation will provide the necessary tools to scale the intervention up to other CESFAMs across Chile. Clinical trial registration: [www.ClinicalTrials.gov], identifier [NCT05578066].

[Pseudohypoparathyroidism: report of two cases of late presentation]. / Pseudohipoparatiroidismo de presentación tardía: reporte de dos casos.

Pseudohypoparathyroidism (PHP) is a group of rare genetic disorders that share organ targeted resistance to the action of parathyroid hormone (PTH) as a common feature. Biochemically, they may present with hypocalcemia, hyperphosphatemia and elevated PTH. Some forms present with a specific phenotype: short stature, round facies, short neck, obesity, brachydactyly and subcutaneous calcifications, called Albrigth's Hereditary Osteodystrophy (AHO). This spectrum of disorders are caused by several alterations in the gene coding for the alpha subunit of the G protein (GNAS): an ubiquitous signaling protein that mediates the action of numerous hormones such as PTH, TSH, gonadotropins, and ACTH, among others. According to their inheritance with maternal or paternal imprinting, they may manifest in a diversity of clinical forms. Although most commonly diagnosed during childhood, PHP may manifest clinically during adolescence or early adulthood. We report two late presenting cases of pseudohypoparathyroidism. A 21-year-old female with biochemical abnormalities characteristic of pseudohypoparathyroidism who was misdiagnosed as epilepsy and a 13-year-old boy with the classic AHO phenotype but without alterations in phospho-calcium metabolism, compatible with pseudopseudohypoparathyrodism.

Pseudohipoparatiroidismo de presentación tardía: reporte de dos casos / Pseudohypoparathyroidism: report of two cases of late presentation

Pseudohypoparathyroidism (PHP) is a group of rare genetic disorders that share organ targeted resistance to the action of parathyroid hormone (PTH) as a common feature. Biochemically, they may present with hypocalcemia, hyperphosphatemia and elevated PTH. Some forms present with a specific phenotype: short stature, round facies, short neck, obesity, brachydactyly and subcutaneous calcifications, called Albrigth's Hereditary Osteodystrophy (AHO). This spectrum of disorders are caused by several alterations in the gene coding for the alpha subunit of the G protein (GNAS): an ubiquitous signaling protein that mediates the action of numerous hormones such as PTH, TSH, gonadotropins, and ACTH, among others. According to their inheritance with maternal or paternal imprinting, they may manifest in a diversity of clinical forms. Although most commonly diagnosed during childhood, PHP may manifest clinically during adolescence or early adulthood. We report two late presenting cases of pseudohypoparathyroidism. A 21-year-old female with biochemical abnormalities characteristic of pseudohypoparathyroidism who was misdiagnosed as epilepsy and a 13-year-old boy with the classic AHO phenotype but without alterations in phospho-calcium metabolism, compatible with pseudopseudohypoparathyrodism.

[Medium-term effect of an intervention program for adolescent mothers]. / Efectos de mediano plazo de un programa de intervención para madres adolescentes.

OBJECTIVE: To analyze the medium-term results of an experimental study which evaluates the effects of home visits by para-professionals to a sample of adolescent mothers, which was successful in the short-term. DESIGN: Quantitative, follow up of two cohorts. FIELD OF STUDY: Two health centers in low socioeconomic areas, Santiago, Chile. PARTICIPANTS: From a sample of 104 adolescent mothers and their children, 69 were contacted when their sons or daughters were 48 month old. Lost data was about 33.6%. INTERVENTIONS: Outcomes variables were: mental health of the mothers; their social, work, and family integration; their interaction with the child; and language and socio-emotional development of the child. The independent variable was the intervention: home visiting. PRINCIPAL MEASUREMENT: The short-term evaluation in the experimental and control groups was carried out using standardized questionnaires when the children were between 12 and 15 months old, and the medium-term evaluation at the age of 48 months. RESULTS: The short term positive effects on the mental health of the mother and on language development of the child were not sustained in the medium-term. The only positive effect was the stability in the relationship with their partners. CONCLUSIONS: On the basis of these results, the importance of maintaining regular visits, in order to prevent the fading of the initial effects, is discussed.

[Effectiveness of a home visit program for adolescent mothers and their children]. / Evaluación de la efectividad de programas de visitas domiciliarias para madres adolescentes y sus hijos/as.

BACKGROUND: Home visiting is effective for the promotion and prevention of mother-child health in other countries, especially in vulnerable populations such as pregnant teenagers. AIM: To evaluate the association between receiving a home visiting program during pregnancy and child development during the first year of life, maternal mental health, perception of social support and school attendance. MATERIAL AND METHODS: Cross sectional assessment of 132 teenage mother-sibling pairs. Of these, 87 received home visits and 45 were randomly assigned to a control group. The assessed variables were maternal mental health, perception of social support, life satisfaction, incorporation of mothers to school after delivery, child development and frequency of child abuse and neglect. RESULTS: Mothers that received home visits had a better mental health and went back to school in a higher proportion. No significant differences between groups were observed on perception of social support or child development. CONCLUSIONS: These results suggest the effectiveness of domiciliary visits performed by non-professionals, to improve mental health and social integration of teenage mothers.

Evaluación de la efectividad de programas de visitas domiciliarias para madres adolescentes y sus hijos/as / Effectiveness of a home visit program for adolescent mothers and their children

Background: Home visiting is effective for the promotion and prevention of mother-child health in other countries, especially in vulnerable populations such as pregnant teenagers. Aim: To evalúate the association between receiving a home visiting program duringpregnancy and child development during thefirstyear oflife, maternal mental health, perception of social support and school attendance. Material and Methods: Cross sectional assessment of 132 teenage mother-sibling pairs. Ofthese, 87 received home visits and 45 were randomly assigned to a control group. The assessed variables were maternal mental health, perception of social support, Ufe satisfaction, incorporation of mothers to school after delivery, child development and frequency of child abuse and neglect. Results: Mothers that received home visits had a better mental health and went back to school in a higherproportion. No significant differences between groups were observed on perception of social support or child development. Conclusions: These results suggest the effectiveness of domiciliary visits performed by non-professionals, to improve mental health and social integration of teenage mothers.

[The characteristics, effectiveness and challenges of home visiting in early intervention programmes]. / Características, efectividad y desafíos de la visita domiciliaria en programas de intervención temprana.

The authors reviewed papers published between 1999 and 2009 in journals indexed in PsycInfo, PubMED, EBSCO and ProQuest concerning the characteristics, effectiveness and challenges of home visit programmes orientated towards early childhood intervention, clarifying the research's scope and limitations and its applications. Home visiting has been shown to be effective for a variety of relevant areas, especially for developing parent skills and child-caregiver relationships. The most effective programmes have started at pregnancy, lasted more than a year, had specially trained staff and have focused on building a trustworthy relationship and on modelling the infant-caregiver interaction. The importance of considering target population characteristics, the visiting model used and the visitor agent was identified in designing these programmes. In spite of the evidence accumulated in Anglo-Saxon studies, the costs associated with these programmes can be very high, thereby implying barriers which can make their dissemination difficult in Latin-American countries. The authors discuss the need for developing and evaluating other variants (i.e. including community agents), considering their cost/effectiveness ratio for treating early childhood problems, needs and characteristics in Latin-America.

Tobacco smoking in urban neighborhoods: exploring social capital as a protective factor in Santiago, Chile.

INTRODUCTION: Research examining the relationship between social capital and health in Latin America has been limited. The aim of this study is to evaluate the association between social capital and tobacco use in four low-income neighborhoods in Santiago, Chile. METHODS: A multistage probability sample was used to select households in 4 of the 10 poorest neighborhoods in the district of Puente Alto, in Santiago, Chile. A cross-sectional survey of 781 participants (81.2% response rate for households) included sociodemographic variables, questions pertaining to neighborhood social capital, and questions pertaining to tobacco. Main analyses were carried out at the individual level by performing a multiple logistic regression of individual tobacco use on individual perceptions of community social capital. RESULTS: The prevalence of smoking was 43.9% of the surveyed population. A five-factor structure for social capital was identified, including "perceived trust in neighbors," "perceived trust in organizations," "reciprocity within the neighborhood," "neighborhood integration," and "social participation." An inverse relationship between trust in neighbors and tobacco smoking was statistically significantly with an adjusted odds ratio of 0.95 (95% CI: 0.91-0.99). Trust in neighbors was also significantly inversely associated with the number of cigarettes smoked. DISCUSSION: Tobacco control remains a significant challenge in global health, requiring innovative strategies that address changing social contexts as well as the changing epidemiological profile of developing regions.

Características, efectividad y desafíos de la visita domiciliaria en programas de intervención temprana / The characteristics, effectiveness and challenges of home visiting in early intervention programmes

Se revisaron artículos publicados entre 1999 y 2009, en revistas indexadas en PubMED, EBSCO y ProQuest, sobre las características, efectividad y desafíos de los programas de visita domiciliaria orientados a la intervención en infancia temprana, clarificando los alcances y limitaciones de la investigación y sus ámbitos de aplicación. La visita domiciliaria se ha mostrado efectiva para una variedad de áreas relevantes, especialmente sobre el desarrollo de competencias parentales y la relación cuidadorinfante. En términos generales, los programas más efectivos comenzaban en el embarazo, duraban más de un año, contaban con personal especialmente entrenado y se focalizaban en construir una relación de confianza y en modelar la interacción cuidador-infante. Se identificó la importancia de considerar en su diseño las características de la población objetivo, del modelo de visita usado y del agente visitador. A pesar de la evidencia acumulada en estudios anglosajones, los costos asociados a estos programas pueden ser muy altos, implicando barreras que pueden hacer dificultosa su diseminación en los países latinoamericanos. Los autores plantean la necesidad de desarrollar y evaluar otras variantes (por ejemplo, incorporando monitoras comunitarias), ponderando su relación costo/efectividad.

The authors reviewed papers published between 1999 and 2009 in journals indexed in PsycInfo, PubMED, EBSCO and ProQuest concerning the characteristics, effectiveness and challenges of home visit programmes orientated towards early childhood intervention, clarifying the research's scope and limitations and its applications. Home visiting has been shown to be effective for a variety of relevant areas, especially for developing parent skills and child-caregiver relationships. The most effective programmes have started at pregnancy, lasted more than a year, had specially trained staff and have focused on building a trustworthy relationship and on modelling the infant-caregiver interaction. The importance of considering target population characteristics, the visiting model used and the visitor agent was identified in designing these programmes. In spite of the evidence accumulated in Anglo-Saxon studies, the costs associated with these programmes can be very high, thereby implying barriers which can make their dissemination difficult in Latin-American countries. The authors discuss the need for developing and evaluating other variants (i.e. including community agents), considering their cost/effectiveness ratio for treating early childhood problems, needs and characteristics in Latin-America.

A cost-effectiveness evaluation of a home visit program for adolescent mothers.

A home visit intervention program for adolescents throughout their pregnancy and during the early stages of motherhood was evaluated. The participants (N = 90) were part of a larger group of adolescents treated in two health centers in a poor neighborhood in Santiago, Chile. The program was carried out by volunteer community health monitors and evaluated through an experimental, randomized, controlled clinical trial. Cost-effectiveness was examined in comparison with standard health care. Results show higher scores for the intervention group on the mothers' mental health and nutritional state, as well as on the children's levels of linguistic development.

[Adaptation of the Multidimensional Trauma Recovery and Resilience (MTRR) questionnaire in a sample of Chilean mothers with a history of child abuse]. / Adaptación preliminar del instrumento MultidimensionalTrauma Recovery and Resilience (MTRR) en una muestrade madres maltratadoras fisicas con historia demaltrato fisico y madres no maltratadorascon historia de maltrato fisico.

OBJECTIVE: Adaptation of the Multidimensional Trauma Recovery and Resilience (MTRR) in a Chilean sample. METHOD: Participants were 80 mothers drawn from two large metropolitan areas (Santiago and Temuco). Sample participants (in a case control design) were redivided in two groups: 40 mothers identified as physical abusers with history of physical child abuse and 40 mothers identified as nonabusers with history of physical child abuse. Groups were matched on 5 sociodemographic variables. Reliability analysis, item analysis, and group comparisons on the 8 scales of the instrument were performed. RESULTS: Interrater agreement level was .79 (Kendall's W coefficient) and the internal consistency as measured by Cronbach's alpha coefficient was .75. Twenty-five items (26.3%) significantly discriminated between the groups. Group comparison tests (Wilcoxon Rank-sum Test) also indicated that six of the eight domains discriminated between the groups. CONCLUSION: In our sample, the instrument has reliable results which discriminate between the studied groups. These preliminary findings support future work toward the development of a Chilean version of this instrument.