Adapting a quality of life scale for children and young people with Down syndrome in Chile.

In Chile, there are no validated instruments for the evaluation of quality of life (QoL) of people with Down syndrome (DS). To analyze construct validity and reliability of the KidsLife-Down scale in Chile to measure QoL in people with DS aged from 4 to 21 years. Families of boys, girls, and young people with DS between 4 and 21 years were invited to participate. The scale was answered by relatives or caregivers. To assess the internal consistency, reliability tests were performed using Cronbach's alpha coefficient. A confirmatory factor analysis was performed. The scale was answered by 531 relatives or caregivers. Cronbach's coefficient was greater than 0.7 in all the items. The confirmatory factor analysis of the scale allowed its validation for clinical use in the Chilean population. "Kids Life Down-Chile" scale has adequate psychometric properties to be used in clinical practice and to help us improve QoL with better support strategies.

Associations between the stringency of COVID-19 containment policies and health service disruptions in 10 countries.

BACKGROUND: Disruptions in essential health services during the COVID-19 pandemic have been reported in several countries. Yet, patterns in health service disruption according to country responses remain unclear. In this paper, we investigate associations between the stringency of COVID-19 containment policies and disruptions in 31 health services in 10 low- middle- and high-income countries in 2020. METHODS: Using routine health information systems and administrative data from 10 countries (Chile, Ethiopia, Ghana, Haiti, Lao People's Democratic Republic, Mexico, Nepal, South Africa, South Korea, and Thailand) we estimated health service disruptions for the period of April to December 2020 by dividing monthly service provision at national levels by the average service provision in the 15 months pre-COVID (January 2019-March 2020). We used the Oxford COVID-19 Government Response Tracker (OxCGRT) index and multi-level linear regression analyses to assess associations between the stringency of restrictions and health service disruptions over nine months. We extended the analysis by examining associations between 11 individual containment or closure policies and health service disruptions. Models were adjusted for COVID caseload, health service category and country GDP and included robust standard errors. FINDINGS: Chronic disease care was among the most affected services. Regression analyses revealed that a 10% increase in the mean stringency index was associated with a 3.3 percentage-point (95% CI -3.9, -2.7) reduction in relative service volumes. Among individual policies, curfews, and the presence of a state of emergency, had the largest coefficients and were associated with 14.1 (95% CI -19.6, 8.7) and 10.7 (95% CI -12.7, -8.7) percentage-point lower relative service volumes, respectively. In contrast, number of COVID-19 cases in 2020 was not associated with health service disruptions in any model. CONCLUSIONS: Although containment policies were crucial in reducing COVID-19 mortality in many contexts, it is important to consider the indirect effects of these restrictions. Strategies to improve the resilience of health systems should be designed to ensure that populations can continue accessing essential health care despite the presence of containment policies during future infectious disease outbreaks.

Risk factors associated with higher scores in internalizing and externalizing behaviors in Chilean preschoolers.

Early detection of behavioral disorders in children is necessary for intervention. Available data show a high prevalence of child and adolescent psychiatric disorders in Chile (22.5%), but behavioral problems in younger children have not been evaluated. This work assesses behavioral disorders in preschoolers and their association with sociodemographic variables of the family and the child. The data was collected during the impact assessment of the Biopsychosocial Development Support Program "Chile Crece Contigo", using a multistage and representative random sample of 1377 preschoolers, aged between 30 and 48 months, who attended public health services. Homes were visited to apply a questionnaire and the Child Behavior Checklist (CBCL, 1.5-5 years). Results: Multivariable regression model for total raw scores shows that child's age, the number of chronic diseases in the child, and history of exposure to mother's alcohol consumption in pregnancy, remain significant when adjusted for all variables included (R2 of 17.8% and η2 of .19 (95% CI: .14-.22)). In externalizing and internalizing explanatory models, child's chronic diseases and a higher score of authoritarian beliefs about parenting show the two largest effect sizes. These results add to the evidence of urgent problems in preschool mental health.

La temprana detección de trastornos de comportamiento en los niños es necesaria para la intervención. La información disponible muestra una alta prevalencia de trastornos siquiátricos de niños y adolescentes en Chile (22.5%), pero no se han evaluado los problemas de comportamiento en niños más pequeños. Este trabajo evalúa trastornos de comportamiento en niños de edad prescolar y su asociación con variables sociodemográficas de la familia y del niño. La información se recogió durante la evaluación del impacto del Programa de Apoyo al Desarrollo Biosicosocial "Chile Crece Contigo," usando un grupo muestra de multiniveles representativo de 1,377 niños prescolares, de entre 30 y 48 meses de edad, quienes recibían servicios de salud pública. Se visitaron las casas para dar un cuestionario y la Lista de Comprobación del Comportamiento del Niño (CGCL, 1.5-5 años). Resultados: El modelo de regresión de variables múltiples para el total de la puntuación en bruto muestra que la edad del niño, el número de enfermedades crónicas en el niño, así como el historial de exposición al consumo de alcohol por parte de la madre durante el embarazo permanecen siendo significativos cuando se les ajusta para todas las variables incluidas (R2 de 17.8% y η2 de 0.19 (95% CI 0.14 a 0.22)). En los modelos explicativos de externalización e internalización, las enfermedades crónicas del niño y un más alto puntaje de creencias autoritarias acerca de la crianza demuestran ser las dos con la magnitud de efectos más extensa. Estos resultados contribuyen aun más a la evidencia sobre los problemas urgentes en la salud mental prescolar.

La détection précoce de troubles du comportement chez les enfants est nécessaire afin d'intervenir. Les données disponibles font état d'une forte prévalence de troubles psychiatrique de l'enfant et de l'adolescent au Chili (22,5%) mais les problèmes de comportement chez les plus jeunes enfants ne sont pas évalués. Ce travail évalue les troubles du comportement chez des enfants d'âge préscolaire et leur lien aux variables sociodémographiques de la famille et de l'enfant. Les données ont été recueillies durant l'évaluation de l'impact du programme de Soutien au Développement Biopsychosocial « Chile Crece Contigo ¼, en utilisant un échantillon aléatoire à plusieurs degrés et représentatif de 1 377 enfants d'âge préscolaire, âgés de 30 à 48 mois, qui participaient à des services de santé publique. Les domiciles ont été visités pour appliquer un questionnaire et la Checklist de Comportement de l'Enfant (CBCL, 1,5-5 ans). Résultats: Le modèle de régression multivariable pour les scores bruts totaux montre que l'âge de l'enfant, le nombre de maladies chroniques chez l'enfant et le passé d'exposition à la consommation d'alcool de la mère durant la grossesse restent importants après l'ajustement pour toutes le variables inclues (R2 de 17,8% and η2 de 0,19 (95% CI 0.14 à 0.22)). Dans les modèles explicatifs externalisant et internalisant les maladies chroniques de l'enfant et un score élevé de croyances autoritaire sur le parentage font preuves des plus grands effets de taille. Ces résultats s'ajoutent aux preuves sur les problèmes urgents de santé mentale préscolaire.

[State of complementary and alternative medicine education in psychiatry residency programs]. / Medicina integrativa en la enseñanza de la Psiquiatría: actitudes y conocimientos respecto a la medicina complementaria y alternativa en docentes de programas de la especialidad.

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.

[Impact of COVID-19 pandemic on the mental health of healthcare workers]. / El impacto de la pandemia de COVID-19 en la salud mental de los trabajadores de la salud en Chile: datos iniciales de The Health Care Workers Study.

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.

[Ethical guidelines for medical decision-making during COVID-19 pandemic in Chile]. / Orientaciones éticas para la toma de decisiones médicas en el contexto de la pandemia de COVID-19 en Chile.

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.

Vegetarian diets in first year university students. / Dietas vegetarianas en alumnos universitarios.

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.

[Dysregulation profile defined by Child Behavior Checklist in a sample of preschool children]. / Perfil de desregulación definido mediante el instrumento Child Behavior Checklist en preescolares.

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.

M-CHAT-R/F Validation as a screening tool for early detection in children with autism spectrum disorder. / Validación del M-CHAT-R/F como instrumento de tamizaje para detección precoz en niños con trastorno del espectro autista.

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.

[Association of physical activity and dietary habits with overweight in fertile Chilean women]. / Mujeres chilenas en edad fértil: su estado nutricional y la asociación con actividad física y hábitos alimentarios.

BACKGROUND: Women in Chile are mainly responsible in the formation of eating habits in the population, particularly at their homes. AIM: To explore the association of physical activity and alimentary habits with overweight among adult Chilean women in fertile age. MATERIAL AND METHODS: Cross sectional study using the data from de National Health Survey 2009-2010. Socio-demographic variables, dietary issues, multidimensional physical activity, sedentary free time and their link with nutritional status were studied in a sample of 1,195 women aged between 20 and 44 years. RESULTS: Sixty three percent of women were overweight. The factors positively associated overweight were having an age between 31 and 44 years (prevalence ratio (PR) = 1.4), having a lower education level (PR = 1.23), living in rural areas (PR = 2.21) and being exposed to work environment (PR = 1.29). The factors negatively associated with overweight were the consumption of whole grains at least once daily (PR = 0.59), being physically active according to a self-assessment scale (PR = 0.22) and being physically inactive during leisure time (PR = 0.61). CONCLUSIONS: The promotion whole grain cereal consumption and physical activity in women is advisable to prevent overweight, mostly in vulnerable groups such as those older than 31 years, with a low educational level and living rural areas.

[Qualitative research methodology in health care]. / La investigación cualitativa: un aporte para mejorar los servicios de salud.

Health care research requires different methodological approaches such as qualitative and quantitative analyzes to understand the phenomena under study. Qualitative research is usually the least considered. Central elements of the qualitative method are that the object of study is constituted by perceptions, emotions and beliefs, non-random sampling by purpose, circular process of knowledge construction, and methodological rigor throughout the research process, from quality design to the consistency of results. The objective of this work is to contribute to the methodological knowledge about qualitative research in health services, based on the implementation of the study, “The transition process from pediatric to adult services: perspectives from adolescents with chronic diseases, caregivers and health professionals”. The information gathered through the qualitative methodology facilitated the understanding of critical points, barriers and facilitators of the transition process of adolescents with chronic diseases, considering the perspective of users and the health team. This study allowed the design of a transition services model from pediatric to adult health services based on the needs of adolescents with chronic diseases, their caregivers and the health team.

[Neurodevelopmental assessment of patients with congenital hypothyroidism]. / Alteraciones del neurodesarrollo en pacientes con hipotiroidismo congénito: Recomendaciones para el seguimiento.

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.

[Quality scale for preschool spirometry interpretation]. / Elaboración de una escala de calidad para la interpretación de espirometrías en preescolares.

Since 2007, there are international guidelines for implementation and interpretation of spirometry in preschool children. A percentage of these patients cannot obtain maneuvers that meet all eligibility criteria. The objective of this study was to develop a quality scale for interpreting these partially acceptable spirometry. MATERIAL AND METHOD: Delphi methodology was used, which allows to reach consensus among experts analyzing a defined problem. We invited to participate pediatric pneumologists dedicated to lung function and who participated actively in scientific specialty societies in Chile. Successive rounds were conducted with questionnaires about criteria used to assess spirometry in preschool children. These criteria define the acceptability of spirometric maneuvers according to international guidelines. Proposed quality grades were “very good”, “good”, “fair” and “bad”. RESULTS: Thirteen of the 15 invited experts accepted our invitation. In the first round 9 disagreed with the degree of “regular” quality. In the second round this was removed and 11 experts answered, 9 of them agreed with the use of this new version. The most contentious criterion was the end of expiration. CONCLUSION: Most experts agreed with the final scale, using “very good”, “good” and “bad” judgments. This would help to improve the performance of spirometry in children between 2 and 5 years.

[Transition from pediatric to adult health care services for adolescents with chronic diseases: Recommendations from the Adolescent Branch from Sociedad Chilena de Pediatría]. / Transición de adolescentes portadores de enfermedades crónicas desde servicios pediátricos a servicios de adultos: Recomendaciones de la Rama de Adolescencia de la Sociedad Chilena de Pediatría.

The Adolescent Branch from Sociedad Chilena de Pediatría supports the implementation of planned programs for transition from child to adult health centers, oriented to adolescents with chronic diseases, in order to ensure an appropriate follow-up and a high-quality health care. Recommendations for care are set out in the FONIS and VRI PUC project carried out by the Division of Pediatrics of the Universidad Católica de Chile: “Transition process from pediatric to adult services: perspectives of adolescents with chronic diseases, caregivers and health professionals”, whose goal was to describe the experience, barriers, critical points, and facilitators in the transition process. Critical points detected in this study were: existence of a strong bond between adolescents, caregivers and the pediatric team, resistance to transition, difficulty developing autonomy and self-management among adolescents; invisibility of the process of adolescence; and lack of communication between pediatric and adult team during the transfer. According to these needs, barriers and critical points, and based on published international experiences, recommendations are made for implementation of gradual and planned transition processes, with emphasis on the design and implementation of transition policies, establishment of multidisciplinary teams and transition planning. We discuss aspects related to coordination of teams, transfer timing, self-care and autonomy, transition records, adolescent and family participation, need for emotional support, ethical aspects involved, importance of confidentiality, need for professional training, and the need for evaluation and further research on the subject.

[Early child development inequalities and associated factors between public and private providers at metropolitan region in Chile]. / Desigualdades en desarrollo infantil temprano entre prestadores públicos y privados de salud y factores asociados en la Región Metropolitana de Chile.

Early child development is a population determinant of physical, mental and social health. To know the base line situation prior to the implementation of "Chile grows with you" (Chile Crece Contigo) is key to its evaluation. OBJECTIVE: To compare early child development and associated factors at baseline in pre-school children from public and private health sectors. PATIENTS AND METHOD: The sample consisted of 1045 children aged 30-58 months, 52% male, and 671 from the public and 380 from the private sector of the metropolitan region in Chile were evaluated using Battelle Developmental Inventory-1 and a household interview of primary carer. RESULTS: Abnormal child development was found in 14.4% of children in the private sector compared to 30.4% in the public sector. There were no differences in adaptive area (26.3% vs 29.2%), but there were statistically significant differents in cognitive (8.8% vs 12.1%), social-personal (13.2% vs 32.5%), motor (19.2% vs 35.3%), and communication (19% vs 36.8%) development. The logistic regression showed that, independent of socioeconomic level, the risk factors are: Apgar<7 (OR: 5.4; 95% CI: 1.24-23.84); having childhood chronic diseases (OR: 1.3; 95% CI: 1.11-1.42). Protective factor is: home with resources to learn and play (OR: 0.8; 95% CI: 0.76-0.89). CONCLUSION: These results are another input about early child development situation and its importance for paediatric social policy.

[Opinions of medical students about complementary therapies]. / Opiniones sobre terapias complementarias por parte de los estudiantes de medicina de la Pontificia Universidad Católica de Chile. Año 2014.

BACKGROUND: There is increasing national and worldwide interest on complementary therapies (CT). AIM: To describe and analyze the opinions and interest about CT among medical students. MATERIAL AND METHODS: An anonymous and voluntary survey with questions used in previous studies, was applied to students from first to fifth year. RESULTS: The survey was answered by 526 medical students, corresponding to 86% of the target population. The students knew about an average of 4.7 therapies, out of 12 displayed. The better known therapy was acupuncture, followed by homeopathy and reiki, which raised the greater interest. The knowledge and interest was higher among women, who also had a more favorable opinion about CT. The interest decreases and the proportion of unfavorable opinions increases among students of upper level courses. Forty nine percent of respondents have used CT for themselves and 22% had no experience whatsoever with them. CONCLUSIONS: In general, there is an appreciable knowledge, experience, interest and positive opinions toward CT. This favorable attitude is higher in women and decreases as career progresses. Medical students consider that they should have some approach to CT during their career.

The Impacts of COVID-19 Restrictions on Quality Adjusted Life Years (QALY): Heterogeneous effects and post-pandemic recovery.

OBJECTIVES: Estimate the effects of non-pharmacological interventions used to prevent the spread of COVID-19 on the quality of life, measured by Quality Adjusted Life Years (QALYs). METHODS: A survey on 1,506 heads of households from Chile in May of 2022. Respondents were asked basic socioeconomic questions and a version of the EQ-5D-5L questionnaire that was used to calculate the evolution of HRQoLs. Comparisons of means in HRQoLs measures before the pandemic, at the peak of restrictions, and at the moment of the survey were performed. RESULTS: The average HRQoL of the population before the pandemic was similar to other countries in the region (0.96). At the peak of restrictions (June 2020-August 2021), the average HRQoL decreased to 0.87 (-9%). At the time of survey (May 2022), the average HQRoL was 0.91 (4%). Assuming the recovery trend continued, pre-pandemic HRQoLs would be reached by January 2024. Altogether, the pandemic would have reduced QALYs by 0.2 in average. The effect is larger and the recovery slower among women. Our estimates imply that the restrictions to manage the pandemic came at a cost of 2.4 months of life years for the average (surviving) person, 1.8 months for men and 3.4 for women. CONCLUSIONS: Our results suggest that COVID-19 had worse effects on life quality than previously thought. These effects are more significant among women than among men. Efforts to improve life quality and speed up its recovery could have large positive consequences for the population.

[Survey on moral judgment criteria among medical students]. / Criterios de juicio moral de estudiantes de Medicina, según el Modelo Intuitivo Social.

BACKGROUND: The evaluation of moral judgment criteria in medical students is important to develop effective educational programs in bioethics. AIM: To compare priority judgment criteria and moral judgment tendency in medical students of first and fifth grade. MATERIAL AND METHODS: The Moral Foundations Questionnaire (MFQ30), to identify moral criteria was applied to 259 students, 63.7% from first year and 50.2% women. RESULTS: The dominant moral tendency both in first and fifth year students was liberal. Justice and compassion were the most important criteria in men and in women, respectively. Respect towards authority and sanctity were the least important criteria in women and men, respectively. CONCLUSIONS: The implications for moral psychology and medical education of these results are discussed.

[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.