A Review of Community Health Worker Integration in Health Departments.

Community health workers (CHWs) are frontline public health workers who bridge the gap between historically marginalized communities, healthcare, and social services. Increasingly, states are developing the CHW workforce by implementing training and certification policies. Health departments (HDs) are primarily responsible for community health through policy implementation and provision of public health services. The two objectives of this study are to explore: (1) state progress in establishing CHW training and certification policies, and (2) integration of CHWs in HD workforces. In this scoping review, we searched PubMed, CINAHL, and Google Scholar for articles published between 2012 and 2022. We looked for articles that discussed state-level certification and training for CHWs and those covering CHWs working with and for city, county, state, and federal HDs. We excluded studies set outside of the US or published in a language other than English. Twenty-nine studies were included for review, documenting CHWs working at all levels of HDs. Within the included studies, HDs often partner with organizations that employ CHWs. With HD-sponsored programs, CHWs increased preventative care, decreased healthcare costs, and decreased disease risk in their communities. Almost all states have begun developing CHW training and certification policies and are at various points in the implementation. HD-sponsored CHW programs improved the health of marginalized communities, whether CHWs were employed directly by HDs or by a partner organization. The success of HD-sponsored CHW programs and state efforts around CHW training and certification should encourage increased investment in CHW workforce development within public health.

Community Mental Health Workers: Their Workplaces, Roles, and Impact.

Mental health care in the U.S. is at a critical crisis, compounded with a severe shortage of providers. The cost burden is immense, with severe disparity seen in traditionally marginalized communities and rural populations. Community health workers have been used to increase access to physical health care in the U.S. for over seventy years-and have been used abroad for centuries. Their use in mental health care is more recent and can increase access, but raises policy, reimbursement, triage, and scopes-of-practice considerations. They are especially beneficial for many at-risk populations including communities of color, those with serious mental illness, rural communities, the elderly, and youth. This literature review searched PubMed, EMBASE, and Google Scholar and provides a broad review of the different types of community mental health workers (community health workers/promotores de salud, peer support, peer navigators, and lay counselors), how they increase access to care, skill sets, practice locations, and uses for specific at-risk populations. Increasing and expanding the use of community mental health workers expands much needed mental health care to those at risk by task-shifting the burden on the traditional professional workforce, offering a solution to both the workforce shortage and the lack of equity in mental health care.

Evaluation of the clinical and economic value of sofosbuvir/velpatasvir (SOF/VEL) in patients with chronic hepatitis C in Spain during the last 5 years.

OBJECTIVE: Direct-acting antivirals for the treatment of hepatitis C virus (HCV) represented a paradigm shift. In 2017, sofosbuvir/velpatasvir (SOF/VEL-Epclusa®) was approved, which showed a high cure rate in all patient, contributing to HCV elimination. The analysis aimed to quantify the clinical and economic value of SOF/VEL in HCV chronic patients since its approval in Spain. METHODS: An economic evaluation was elaborated adapting a Markov model that simulated the lifetime disease progression in of all HCV chronic patients treated with SOF/VEL (30,488 patients) since its launch (5-years), compared to previous therapies. Patients entered the model and were distributed between the fibrosis states (F0-to-F4) in treated and untreated. All patients (100%) were treated with SOF/VEL regardless of their fibrosis, and 49% with previous therapies in ≥F2. The average sustained viral response (SVR) rates 98.9% SOF/VEL versus 61.0% previous therapies. All parameters for the analysis were obtained from real-life data and literature. Only direct healthcare costs associated with disease management were included. The SOF/VEL value was measured as the number of hepatic complications avoided and their associated cost, and hepatic mortality compared to previous therapies. National Health System perspective and a 3% discount rate was applied. RESULTS: SOF/VEL decreased the number of liver complications, avoiding 92% decompensated cirrhosis, 80% hepatocellular carcinomas, and 87% liver transplants, as well as 85% liver-related mortality. Their cost associated was reduced, amounting to savings of 197M€. CONCLUSION: SOF/VEL adds relevant value to the HCV treatment, reducing the clinical and economic disease burden and contributing to HCV elimination in Spain.

Position statement of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis on sexuality and inflammatory bowel disease. / Documento de posicionamiento. Recomendaciones del Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa sobre sexualidad y enfermedad inflamatoria intestinal.

It is widely acknowledged that inflammatory bowel disease (IBD) is associated with a high prevalence of sexual dysfunction (SD). However, there is a notable paucity of specific literature in this field. This lack of information impacts various aspects, including the understanding and comprehensive care of SD in the context of IBD. Furthermore, patients themselves express a lack of necessary attention in this area within the treatment of their disease, thus creating an unmet need in terms of their well-being. The aim of this position statement by the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) is to provide a review on the most relevant aspects and potential areas of improvement in the detection, assessment, and management of SD in patients with IBD and to integrate the approach to sexual health into our clinical practice. Recommendations are established based on available scientific evidence and expert opinion. The development of these recommendations by GETECCU has been carried out through a collaborative multidisciplinary approach involving gastroenterologists, gynecologists, urologists, surgeons, nurses, psychologists, sexologists, and, of course, patients with IBD.

Use of digital health tools in inflammatory bowel disease. / Uso de herramientas digitales en salud en enfermedad inflamatoria intestinal.

OBJECTIVE: To analyse the characteristics and use of digital health tools (DHT) in inflammatory bowel disease (IBD). METHODS: We performed a qualitative study based on a narrative literature review, a questionnaire and on the opinion of 3 expert gastroenterologists. Several searches were carried out until September 2022 through Medline to identify articles on the use of DHT in IBD by healthcare professionals. A structured questionnaire was designed to be answered by health professionals involved in the care of patients with IBD. The experts generated a set of recommendations. RESULTS: There are multiple DHT for IBD with different characteristics and contents. We received 29 questionnaires. Almost 50% of the participants were 41-50 years old, the majority were women (83%) and 90% were gastroenterologists. A total of 96% reported the use of several DHT, but 20% used them occasionally or infrequently. Web pages were found the most used (62%). DHT are mostly used to get information (80%), followed by clinical practice issues (70%) and educational purposes (62%). G-Educainflamatoria website is the best known and most used HDS (96% and 64%, respectively). The main barriers to the use of DHT in IBD were the lack of time (55%), doubts about the benefit of DHT (50%) and the excess of information (40%). CONCLUSIONS: Healthcare professionals involved in the care of patients with to IBD frequently use DHT, although actions are needed to optimize their use and to guarantee their efficient and safe use.

Influence of social support and stressful life events on adherence to colorectal cancer screening using faecal occult blood test in Spanish medium risk population.

INTRODUCTION: Colorectal cancer (CRC) is the second cause of cancer-related deaths worldwide. Five-year survival rate in Spain is 57%. The most important prognostic factor is the stage of the tumor at the diagnosis. CRC can be early diagnosed, but the adherence to screening programs is low (<50%). This study aims to ascertain the influence of social support and stressful life events on the adherence to the population screening of CRC with fecal occult blood test in Spanish average risk population. METHODS: Multicenter case-control study. We conducted a simple random sampling among individuals invited to participate in the colorectal cancer screening program. We analyzed epidemiological and social variables associated with lifestyle and behavioral factors. We performed a descriptive and a bivariant analyses and a logistic regression analysis. RESULTS: Four hundred and eight patients (237 cases and 171 controls) were included. Multivariant analyses showed independent association between higher adherence to the screening program and older age (OR: 1.06; 95% CI: 1.01-1.10), stable partner (OR: 1.77, 95% CI: 1.08-2.89) and wide social network (OR: 1.68; 95% CI: 1.07-2.66). Otherwise, lower adherence was associated to perceiving barriers to participate in the program (OR: 0.92; 95% CI: 0.88-0.96). We find a statistically significant association between lower adherence and high impact stressful life events in the bivariant analyses, and the tendency was maintained (OR: 0.63, 95% CI: 0.37-1.08) in the multivariant. CONCLUSION: Social variables decisively influence the adherence to colorectal cancer screening. The implementation of social interventions that improve social support, reduce impact of stressful life events and the design of screening programs that decrease the perceived barriers, will contribute to increase the participation on these programs. Secondary, the colorectal cancer diagnosis will be made in early-stages with the consequent mortality reduction.

Psychometrics of psychosocial behavior items under age 6 years: Evidence from Nebraska, USA.

Because healthy psychosocial development in the first years of life is critical to lifelong well-being, governmental, and nongovernmental organizations are increasingly interested in monitoring psychosocial behaviors among populations of children. In response, the World Health Organization is developing the Global Scales of Early Development Psychosocial Form (GSED PF) to facilitate population-level psychosocial monitoring. Once validated, the GSED PF will be an open-access, caregiver-reported measure of children's psychosocial behaviors that is appropriate for infants and young children. This study examines the psychometric validity evidence from 45 items under consideration for inclusion in the GSED PF. Using data from N = 836 Nebraskan (USA) children aged 180 days to 71 months, results indicate that scores from 44 of the 45 (98%) items exhibit positive evidence of validity and reliability. A bifactor model with one general factor and five specific factors best fit the data, exhibited strong reliability, and acceptable model fit. Criterion associations with known predictors of children's psychosocial behaviors were in the expected direction. These findings suggest that measurement of children's psychosocial behaviors may be feasible, at least in the United States. Data from more culturally and linguistically diverse settings is needed to assess these items for global monitoring.

Debido a que el desarrollo sicosocial en los primeros años de vida es crítico para el bienestar de toda la vida, las organizaciones gubernamentales y no gubernamentales están más y más interesadas en observar vigilantemente las conductas sicosociales en la población infantil. Como respuesta, la Organización Mundial de la Salud está desarrollando el Formulario Sicosocial de las Escalas Globales del Temprano Desarrollo (GSED PF) para facilitar la observación sicosocial alerta al nivel del grupo de población. Una vez que se haya convalidado, el GSED PF será una medida de acceso abierto, que reportará el cuidador, sobre las conductas sicosociales de los niños que son apropiadas para infantes y niños pequeñitos. Este estudio examina la evidencia de la validez sicométrica de 45 puntos bajo consideración para ser incluidos en el GSED PF. Usando datos de N = 836 niños de Nebraska (Estados Unidos), de edad entre 180 días y 71 meses, los resultados indican que los puntajes de 44 de los 45 (98%) puntos muestran evidencia positiva de validez y confiabilidad. Un modelo bifactorial con un factor general y cinco factores específicos, que mejor encaja con los datos, mostró una fuerte confiabilidad y un modelo aceptable que encaja. Las asociaciones de criterio con factores de predicción conocidos acerca de las conductas sicosociales de los niños se encontraban en la dirección esperada. Estos resultados sugieren que la medida de las conductas sicosociales de los niños pudiera ser posible, por lo menos en los Estados Unidos. Se necesitan datos de escenarios más diversos cultural y lingüísticamente para evaluar estos puntos para la estar alerta en la observación global.

Reflective supervision and reflective practice in infant mental health: A scoping review of a diverse body of literature.

Reflective practice is a core component of Infant Mental Health (IMH) training and work in the form of reflective supervision/consultation (RS/C). RS/C supports and facilitates relationship-based practice, and is considered to help prevent burnout and promote work satisfaction. In response to an identified gap in empirical research on RS/C, this scoping review aimed to give an overview of the broad range of study designs and outcomes by systematically charting empirical studies on RS/C in IMH-based work with children and families. Searches of Academic Search Complete, CINAHL, MEDLINE, APA PsychArticles, APA PsycInfo, and Web of Science were supplemented with a Google Scholar search and citation searching. Following title/abstract screening (n = 233) and full-text review (n = 168), 35 reports met criteria for inclusion. Key findings were organized into four categories: Essential components and processes of RS/C; Experiences and outcomes of RS/C; Emerging issues in RS/C literature; and Measuring, researching, and reporting on RS/C. Results describe the components and experience of engaging in quality RS/C, and show that practitioners generally experience RS/C as supportive and beneficial. The existing literature has some methodological limitations and further empirical research is needed on outcomes of RS/C. Practice implications and potential future research directions are discussed.

La práctica con reflexión es un componente central del entrenamiento y trabajo en el campo de Salud Mental Infantil (IMH), en forma de una supervisión/consulta con reflexión (RS/C). RS/C apoya y facilita la práctica que tiene como base la relación y se considera que ayuda a prevenir el agotamiento y a promover la satisfacción en el trabajo. Como respuesta a un identificado vacío en la investigación empírica sobre RS/C, esta revisión de los antecedentes se propuso presentar una visión general de la amplia gama de diseños y resultados de estudios por medio de un trazado sistemático de estudios empíricos sobre RS/C en el trabajo basado en IMH con niños y familias. La búsqueda en Academic Search Complete (Completa Búsqueda Académica), en CINAHL, MEDLINE, APA, PsychArticles, APA PsycInfo y Web of Science (Red de la Ciencia) se suplementó con una búsqueda en Google Scholar y una búsqueda de citas anotadas. Después de seguir la detección de título/resumen (n = 233) y una revisión del texto completo (n = 168), 35 reportes reunieron los criterios para ser incluidos. Los resultados claves se organizaron en 4 categorías: Componentes y procesos esenciales de RS/C; Experiencias y resultados de RS/C; Asuntos incipientes en la literatura sobre RS/C; y Medir, investigar y reportar sobre RS/C. Los resultados describen los componentes y experiencias de participar en RS/C de calidad, y muestran que los profesionales de la práctica generalmente experimentan RS/C como un proceso de apoyo y beneficioso. La literatura existente tiene algunas limitaciones metodológicas y se necesita una mayor investigación empírica sobre los resultados de RS/C. Se discuten las implicaciones en la práctica y las potenciales directrices para la futura investigación.

How do maternal and child health nurses incorporate infant mental health promotion into their clinical practice? Experiences of an Australian municipality.

The field of infant mental health (IMH) has offered valuable insights into the critical importance of social-emotional development, including the enduring influence of early experiences throughout life. Maternal and Child Health (MCH) nurses are ideally placed to facilitate knowledge sharing with parents. This Australian-based qualitative exploratory descriptive study explored how MCH nurses incorporate IMH in their clinical practice, and how they share this information with caregivers. Ten community-based MCH nurses participated in voluntary, semi-structured interviews which were transcribed verbatim and analyzed thematically. Findings identified five themes that characterized how MCH nurses incorporated IMH concepts into their practice. These themes were: prioritizing physical health promotion activities, highlighting infant communications, variations in knowledge and application of IMH concepts, workplace time schedules, and the relational nature of the work. Recommendations include encouraging IMH as a health promotion activity, facilitating IMH assessment, further education, reflective supervision, and extension of predetermined appointment times to enable knowledge and skill sharing. Further research is also recommended to provide additional insights into how nurses with IMH training promote and share IMH concepts with caregivers. Adoption of these recommendations would further enhance the care given to families and the role of the MCH nurses.

El campo de la salud mental infantil (IMH) ha ofrecido perspectivas valiosas sobre la suma importancia del desarrollo socioemocional en los primeros años para el desarrollo social y emocional posterior. Las enfermeras de la salud materno-infantil (MCH) se encuentran en posición ideal para facilitar el proceso de compartir conocimiento con los progenitores. Este estudio cualitativo, exploratorio y descriptivo, llevado a cabo en Australia, exploró cómo las enfermeras MCH incorporan IMH en sus prácticas clínicas y cómo ellas comparten esta información con los cuidadores. Un grupo de enfermeras MCH de base comunitaria participó en entrevistas voluntarias semiestructuradas. Las entrevistas se transcribieron palabra por palabra y se analizaron temáticamente. Los resultados identificaron cinco temas que caracterizaban cómo incorporaron los conceptos de IMH en su práctica. Estos temas fueron: actividades para promover el darle prioridad a la salud física, enfatizar las comunicaciones del infante, variaciones en el conocimiento y la aplicación de conceptos de IMH, tablas de horarios del lugar de trabajo y la naturaleza relacional del trabajo. Entre las recomendaciones se incluyen el fomentar IMH como una actividad de promoción de la salud, facilitar la evaluación de IMH, más educación, supervisión con reflexión, así como extensión del horario de citas predeterminado para permitir el proceso de compartir conocimiento y habilidades. También se recomienda más investigación para ofrecer perspectivas adicionales de cómo las enfermeras con entrenamiento de IMH promueven y comparten los conceptos de IMH con los cuidadores. La adopción de estas recomendaciones mejoraría más el cuidado que se ofrece a familias y el papel de las enfermeras MCH.

Le domaine de la santé mentale du nourrisson (IMH en anglais) a permis de mieux comprendre l'importance critique du développement socio-émotionnel dans les premières années pour le développement social et émotionnel ultérieur. Les infirmiers et infirmières de la Santé Maternelle et de l'Enfant (MCH en anglais) sont idéalement situées pour faciliter le partage des connaissances avec les parents. Cette étude Qualitative Exploratoire Descriptive, en Australie, a exploré comment les infirmier/infirmières MCH incorporent l'IMH dans leur pratique clinique et comment ils/elles partagent cette information avec les personnes prenant soin des enfants. Une cohorte de 10 infirmiers/infirmières MCH basées dans leur communauté ont participé à des entretiens volontaires semi-structurés. Les entretiens ont été transcrits verbatim et analysé de manière thématique. Les résultats ont identifié cinq thèmes qui ont caractérisé les concepts IMH dans leur pratique. Ces thèmes étaient: donner la priorité à la promotion d'activités de santé physique, la mise en évidence des communications du nourrisson, les variations dans les connaissances et l'application des concepts IMH, les emplois du temps du lieu de travail et la nature relationnelle du travail. Les recommandations incluent la nécessité d'encourager l'IMH en tant qu'activité de promotion de la santé, la facilitation de l'évaluation IMH, une formation supplémentaire, une supervision de réflexion et l'extension de rendez-vous pour développer les connaissances et partager les compétences. De plus amples recherches sont recommandées afin d'éclairer la manière dont les infirmiers/infirmières formées en IMH promeuvent et partagent les concepts IMH avec les personnes prenant soin des enfants. L'adoption de ces recommandations pour améliorer davantage le soin offert aux familles et les rôles des infirmiers/infirmières MCH.

Infant and early childhood teleconsultation and training: Program description and feasibility outcomes from a statewide implementation.

To address high rates of mental health and developmental concerns facing young children ages 0-6 in the United States and internationally, providers across professional sectors need Infant and early childhood mental health (IECMH) training and support. The training and teleconsultation program (TTP) is a state-funded program developed in one Mountain West state in the United States to provide free IECMH training and teleconsultation to any provider working with young children. The TTP included access to webinars and individual or group consultation with licensed mental health providers. Webinars focused on increasing awareness and knowledge related to attachment and child development, supporting parents and caregivers, trauma-informed practice, supporting emotional health of staff and providers, and culturally responsive practices with infants, young children, and caregivers. Teleconsultation included case consultation, reflective individual and group supervision, and collaboration supports/referrals. During the 18-month evaluation period, 1568 unique providers engaged in either training or teleconsultation services, an average of 9% growth in new providers each month, with representation from all professional sectors and all state counties. This program demonstrates the feasibility and need for statewide training and teleconsultation programs to help meet the needs of providers who interact with and support young children and caregivers.

Para lidiar con las altas tasas de salud mental y preocupaciones sobre el desarrollo a las que se enfrentan los pequeños niños de edad 0-6 en los Estados Unidos e internacionalmente, quienes proveen el servicio dentro de la gama de todos los sectores profesionales necesitan entrenamiento y apoyo en el campo de la salud mental infantil y la temprana niñez (IECMH). El programa de entrenamiento y teleconsulta (TTP) es un programa con fondos estatales desarrollado en un estado del oeste montañoso en los Estados Unidos para ofrecer entrenamiento y teleconsulta gratis en IECMH a cualquier profesional que trabaja con niños pequeños. El TTP incluye acceso a seminarios web y consulta individual o en grupo con profesionales licenciados de la salud mental. Los seminarios web se enfocaron en incrementar la conciencia y el conocimiento relacionado con la afectividad y el desarrollo del niño, apoyar a progenitores y cuidadores, la práctica con atención informada sobre trauma, apoyar la salud emocional del personal y los proveedores, así como las prácticas culturalmente sensibles con los infantes, niños pequeños y quienes les cuidan. La teleconsulta incluyó consulta de casos, supervisión con reflexión tanto individual como de grupo, así como los apoyos/referencias colaborativas. Durante el período de evaluación de 18 meses, 1,568 proveedores con características particulares recibieron los servicios del entrenamiento o de la teleconsulta, un promedio de 9% de aumento de nuevos proveedores cada mes, con representación de todos los sectores profesionales y todos los condados del estado. Este programa demuestra la posibilidad y necesidad de programas de entrenamiento y teleconsulta a través de todo el estado para ayudar a satisfacer las necesidades de los proveedores que interactúan con y apoyan a los niños pequeños y quienes les cuidan.

Pour faire face aux taux élevés d'inquiétudes en matière de santé mentale et de comportement dont sont témoins les jeunes enfants âgés de 0-6 ans aux Etats-Unis et internationalement, les prestataires au travers des secteurs professionnels ont besoin de formation et de soutien en santé mentale du nourrisson et de la petite enfance (IECMH). Le programme de téléconsultation et de formation (TTP en anglais) est un programme financé au niveau de l'état développé dans un état des montagnes rocheuses aux Etats-Unis afin d'offrir une formation et une téléconsultation IECMH gratuite à tout prestataire travaillant avec de jeunes enfants. Le TTP a incorporé un accès à des webinaires et à une consultation individuelle ou de groupe avec des prestataires de santé mentale agréés. Les webinaires ont porté sur l'accroissement de la sensibilisation et des connaissances liées à l'attachement et au développement de l'enfant, au soutien des parents et des personnes prenant soin des enfants, à une pratique consciente des traumas, et au soutien de la santé émotionnelle des employés et des prestataires, et à des pratiques culturellement adaptées avec les nourrissons, les jeunes enfants et les personnes prenant soin d'eux. La téléconsultation a inclus une consultation de cas, une supervision de réflexion individuelle et de groupe, et des soutiens/références de collaboration. Durant la période d'évaluation de 18 mois, 1568 prestataires uniques se sont engagés soit dans une formation ou des services de téléconsultation, avec une moyenne de 9% de croissance chez les nouveaux prestataires chaque mois, avec une représentation de tous les secteurs professionnels et les comtés de l'état. Ce programme démontre la fiabilité et le besoin de programmes de formation et de téléconsultations au niveau de l'état afin d'aider à remplir les besoins des prestataires qui travaillent et soutiennent les jeunes enfants et les personnes prenant soin d'eux.

Low-income fathers are emotionally resilient: A qualitative exploration of paternal emotions across early parenting.

Emotions play an important role in fostering positive parenting and healthy child development. This qualitative study explored the affective experiences of racially diverse US fathers with low income across the prenatal, postnatal, and early childhood periods. Semi-structured interviews were conducted with 24 fathers. Interview questions asked about fathers' early parenting experiences that elicit parenting emotions of different valence. Results from thematic analysis demonstrated activation of multiple emotions depending on different proximal and distal experiences. Specific to proximal experiences, fathers reported feeling both excited and anxious about pregnancy and joyful and disappointed at childbirth. Related to distal experiences, fathers reported feeling encouraged by their social support networks that further aid their parenting, but feeling marginalized given systematic barriers (e.g., societal bias, high incarceration rates of Black fathers). Most importantly, fathers' parenting emotions, especially negative ones, led to them resolving to stay involved in their children's lives, gaining a sense of responsibility, and changing behaviors to do right by their children. Fathers resorted to various coping strategies to regulate their negative emotions. Overall, fathers with low income are emotionally resilient. Infant and early childhood health professionals should support fathers' mental health to promote father-child engagement and thus, ultimately, young children's mental health and wellbeing.

Las emociones juegan un papel importante en fomentar una crianza positiva y un saludable desarrollo del niño. Este estudio cualitativo exploró las experiencias afectivas de papás de Estados Unidos de bajos recursos económicos que son racialmente diversos a lo largo de los períodos prenatal, postnatal y la temprana niñez. Se llevaron a cabo entrevistas semiestructuradas con 24 papás. Las preguntas de la entrevista trataban acerca de las tempranas experiencias de crianza de los papás que provocaban emociones de crianza de valencia diferente. Los resultados de análisis temáticos demostraron la activación de múltiples emociones dependiendo de diferentes emociones proximales y distales. Específico a las experiencias proximales, los papás reportaron sentirse tanto emocionados como ansiosos acerca del embarazo y alegres y decepcionados al momento del nacimiento. Con relación a las experiencias distales, los papás reportaron sentirse animados por parte de sus redes de apoyo social que ayudaron en su acercamiento a la crianza y sentirse marginalizados dadas las barreras sistemáticas. De manera más importante, las emociones de crianza de los papás especialmente las negativas, les llevaron a decidir mantenerse involucrados en las vidas de sus niños, adquiriendo un sentido de responsabilidad y cambiando conductas para hacer lo correcto con sus niños. Los papás recurrieron a varias estrategias para regular sus emociones negativas. En general, los papás de bajas entradas económicas son emocionalmente fuertes. Los profesionales de la salud infantil y en la temprana niñez deben apoyar la salud mental de los papás para promover la compenetración papá­niño y a la larga, la salud mental y el bienestar de los niños pequeños.

Two babies, two bonds: Frequency and correlates of differential maternal-infant bonding in mothers of twins.

We assessed prevalence and correlates of differential maternal-infant bonding (i.e., experiencing a stronger bond with one baby vs. the other) in mothers of twins, focusing on aspects of maternal mental health, well-being, and pregnancy/birth that have been previously linked with maternal-infant bonding. Participants (N = 108 American women, 88.89% White, 82.41% non-Hispanic, aged 18-45, who gave birth to twins in the past 6-24 weeks) were recruited from postpartum support websites. Participants completed a Qualtrics survey assessing pregnancy/birth history, symptoms of depression and anxiety, sleep, stress, romantic relationship satisfaction, and postpartum bonding. Twenty-six participants (24.07%) reported a bonding discrepancy. These participants endorsed higher symptoms of depression and anxiety, lower relationship satisfaction, lower average postpartum bonding, higher general and parenting stress, and longer pregnancy (all ps > .05). Greater degree of bonding discrepancy correlated with more depression, higher parenting stress, longer pregnancy, and lower relationship satisfaction (all ps > .05). Mothers of twins may benefit from postpartum mental health support, stress management strategies, and interventions to improve bonding. Future work should assess the role of breastfeeding difficulties, delivery method, birth-related trauma, infant regulatory capacity, and temperament. Longitudinal studies will help test cause and effect and potential long-term repercussions of maternal-infant bonding discrepancies.

Evaluamos la prevalencia y factores correlacionados del apego afectivo diferencial materno­infantil (v.g. experimentar un apego más fuerte con un bebé vs. el otro) en madres de gemelos, enfocándonos en aspectos de salud mental materna, bienestar, así como el embarazo/parto que previamente han sido relacionadas con la afectividad materno­infantil. A las participantes (N = 108 mujeres estadounidenses, 88.89% blancas, 82.41% no hispanas, de 18­45 años, que dieron a luz gemelos en las pasadas 6­24 semanas) se les reclutó de los sitios de apoyo posterior al parto en la red. Las participantes completaron una encuesta Qualtrics para evaluar el historial de embarazo/parto, los síntomas de depresión y ansiedad, el sueño, el estrés, la satisfacción con la relación romántica, así como la afectividad posterior al parto. Veintiséis participantes (24.07%) reportaron discrepancia en el apego afectivo. Estas participantes confirmaron síntomas más altos de depresión y ansiedad, más baja satisfacción en la relación, más bajo promedio de apego afectivo posterior al parto, más alto estrés general y de crianza, así como un más largo embarazo (todos los ps > .05). Un mayor grado de discrepancia en el apego afectivo se relacionó con más depresión, un más alto estrés de crianza, un más largo embarazo, así como una más baja satisfacción en la relación (todos los ps > .05). Las madres de gemelos pudieran beneficiarse de un apoyo de salud mental posterior al parto, estrategias de cómo arreglárselas con el estrés e intervenciones para mejorar el apego afectivo. El trabajo futuro debe evaluar el papel de las dificultades de amamantar, el método usado para dar a luz, el trauma relacionado con el nacimiento, la capacidad regulatoria del infante y el temperamento. Estudios longitudinales ayudarán a poner a prueba la causa y el efecto las potenciales repercusiones a largo plazo de las discrepancias en el apego afectivo materno­infantil.

Nous avons évalué la prévalence et les corrélats du lien maternel­bébé différentiel (c'est­à­dire qui font l'expérience d'un lien plus fort avec un bébé par rapport à l'autre) chez les mères de jumeaux ou jumelles, en mettant l'accent sur les aspects de la santé mentale maternelle, le bien­être et la grossesse/naissance ayant précédemment été liés au lien maternel­bébé. Les participantes (N = 108 femmes américaines, 88,89% blanches, 82,41% non­latinas, âgées de 18­45 ans, ayant donné naissance à des jumeaux ou jumelles dans les 6­24 semaines précédentes) ont été recrutées à partir de sites internet de soutien postpartum. Les participantes ont rempli un questionnaire Qualtrics évaluant la grossesse/l'histoire de la naissance, les symptômes de dépression et d'anxiété, le sommeil, le stress, la satisfaction de la relation amoureuse et le lien postpartum. Vingt­six participantes (24,07%) ont fait état d'un écart du lien. Ces participantes ont fait état de plus de symptômes de dépression et d'anxiété, d'une satisfaction avec la relation plus basse, d'un lien postpartum plus bas en moyenne, d'un stress général et parental plus élevé, et d'une grossesse plus longue (tout ps >,05). Un degré plus élevé d'écart du lien a correspondu à plus de dépression, un stress de parentage plus élevé, une grossesse plus longue et une satisfaction de la relation plus basse tous ps > ,05). Les mères de jumeaux ou jumelles peut tirer profit d'un soutien en santé mentale postpartum, de stratégies de gestion du stress, et d'interventions pour améliorer le lien. Dans le futur des recherches devraient évaluer le rôle de difficultés de l'allaitement, la méthode d'accouchement, le trauma lié à la naissance, la capacité régulatoire du bébé et son tempérament. Des études longitudinales permettront de tester la cause et l'effet et les répercussions à long terme potentielle pour les écarts dans le lien maternel­bébé.

Associations between maternal smartphone use and mother-infant responsiveness: A cluster analysis of potential risk and protective factors.

Contradictory results in the extant literature suggests that additional risk factors should be considered when exploring the impacts of maternal smartphone use on mother-infant relationships. This study used cluster analysis to explore whether certain risk factors were implicated in mother-infant dyads with high smartphone use and low mother-infant responsiveness. A cross-sectional survey of 450 participants in the UK measured infant social-emotional development, maternal depressive, anxiety and stress symptoms, wellbeing, social support, smartphone use, and mother-infant responsiveness. Participants were predominantly White (95.3%) and living with a partner (95.2%), with infants who were born full-term (88.9%). Cluster analysis identified three clusters characterized as; cluster (1) "infant at risk" showing high infant development concerns, high maternal smartphone use, and low mother-infant responsiveness; cluster (2) "mother at risk" showing high maternal depressive, anxiety, and stress scores, low social support, high maternal smartphone use, and low mother-infant responsiveness, and cluster (3) "low risk" showing low maternal smartphone use and high mother-infant responsiveness. Significant differences were found between all risk factors, except for maternal smartphone use and mother-infant responsiveness between clusters 1 and 2 suggesting that both clusters require early intervention, although interventions should be tailored towards the different risk factors they are presenting with.

Resultados contradictorios en la literatura existente sugieren que se deben considerar factores de riesgo adicionales cuando se explora el impacto del uso que la madre hace del teléfono inteligente en las relaciones madre­infante. Este estudio usó un análisis de grupo para explorar si ciertos factores de riesgo estaban implicados en las díadas madre­infante con uso elevado del teléfono inteligente y la baja sensibilidad madre­infante. Una encuesta transversal de 450 participantes en el Reino Unido midió el desarrollo socioemocional del infante, los síntomas maternos depresivos, de ansiedad y estrés, el bienestar, el apoyo social, el uso del teléfono inteligente, así como la sensibilidad madre­infante. Las participantes eran predominantemente blancas (95.3%) y convivían con una pareja (95.2%), con infantes nacidos en un período de gestación completo (88.9%). Los análisis de grupo identificaron tres grupos caracterizados como: grupo 1) "infante bajo riesgo," mostrando altas preocupaciones sobre el desarrollo del infante, uso elevado del teléfono inteligente por parte de la madre, así como baja sensibilidad madre­infante; grupo 2) "madre bajo riesgo," mostrando altos puntajes de depresión, ansiedad y estrés maternos, bajo apoyo social, uso elevado del teléfono inteligente por parte de la madre, así como baja sensibilidad madre­infante; y grupo 3) "bajo riesgo," mostrando bajo uso del teléfono inteligente por parte de la madre, y alta sensibilidad madre­infante. Se encontraron diferencias significativas en todos los factores de riesgo, excepto en el caso del uso del teléfono inteligente por parte de la madre y la sensibilidad madre­infante entre los grupos 1 y 2, lo cual indica que ambos grupos requieren de una temprana intervención, aunque las intervenciones se deben moldear en términos de los diferentes factores de riesgo que se le presenta a cada grupo.

Les résultats contradictoires dans les recherches existantes suggèrent que des facteurs de risque supplémentaires devraient être pris en considération en explorant les impacts de l'utilisation maternelle du smartphone sur les relations mère­bébé. Cette étude a utilisé une analyse typologique afin d'explorer si certains facteurs de risque étaient impliqués chez les dyades mère­nourrisson avec une utilisation élevée du smartphone et une réaction mère­nourrisson faible. Une étude transversale de 450 participantes au Royaume Uni a mesuré le développement socio­émotionnel du bébé, les symptômes dépressives, d'anxiété et de stress maternel, le bien­être maternel, le soutien social, l'utilisation du smartphone et la réaction mère­nourrisson. Les participantes étaient essentiellement Blanches (95,3%), vivant avec un partenaire (95,2%), avec des bébés étant nés à terme (88,9%). Une analyse typologique a identifié trois clusters (types) avec ces caractéristiques: type 1) "nourrisson à risque" avec des problèmes de développement infantile élevés, une utilisation maternelle du smartphone élevée, et une réaction mère­bébé faible; type 2) "mère à risque" faisant état de scores maternels élevés de dépression, d'anxiété et de stress, d'un soutien social faible, avec une utilisation maternelle du smartphone élevée, et une réaction mère­bébé faible, et type 3) "risque faible" montrant peu d'utilisation maternelle du smartphone et une réaction élevée mère­bébé. Des différences importantes ont été trouvées entre tous les facteurs de risque, saut pour l'utilisation maternelle du smartphone et la réaction maternelle entre les types 1 et 2, ce qui suggère que les deux types exigent une intervention précoce, bien que les interventions devraient être adaptées aux différents facteurs de risque avec lesquelles elles se présentent.

Child-focused infant and early childhood mental health consultation: Shifting adult attributions to reduce the risk for preschool expulsion.

Infant and early childhood mental health consultation (IECMHC) in early care and education (ECE) settings is a promising approach to support young children. Although research on the effects of IECMHC is encouraging, it is limited by the complexities of the systems in which IECMHC is implemented and the variability in IECMHC models. The current study aims to clearly articulate a statewide, child-focused, short-term IECMHC model, assess consultee satisfaction, examine the effects of consultation on children's functioning in the school and home settings, and evaluate changes in teacher perceptions associated with expulsion risk following consultation. In total, 268 children ages 1-5 (69% White, 75% male) and their family and school caregivers participated in consultation in a New England state, and 95 children and caregivers were included in an evaluation subsample. Of this subsample, teachers and ECE administrators, but not families, indicated significant improvement in children's functioning from referral to end of consultation. There was also a significant decrease in children's risk of expulsion, as measured by teachers' perceptions associated with expulsion decisions. This study contributes to the IECMHC literature by providing results specific to a child-focused model of consultation and highlighting the possible role of adult attributions for children in ECE.

La consulta de salud mental infantil y la temprana niñez (IECMHC) en los entornos de cuidados y educación tempranos (ECE) es un acercamiento prometedor para apoyar a los niños pequeños. A pesar de que la investigación sobre los efectos de IECMHC es alentadora, está limitada por las complejidades de los sistemas dentro de los cuales se implementa IECMHC y la variabilidad en los modelos de IECMHC. El presente estudio se propone articular claramente un modelo de IECMHC para todo el estado, con enfoque en el niño y a corto plazo, evaluar la satisfacción que quienes participan de la consulta, examinar los efectos de la consulta sobre el funcionamiento de los niños en la escuela y en el entorno del hogar, así como evaluar los cambios en las percepciones de los maestros asociadas con los riesgos de expulsión después de la consulta. En total, 268 niños de edad 1­5 (69% blancos, 75% varones) y sus familias y quienes les cuidaba en la escuela participaron en la consulta en un estado de Nueva Inglaterra, y se incluyó a 95 niños y sus cuidadores en una evaluación de un subgrupo muestra. De este subgrupo muestra, los maestros y los administradores de ECE, pero no las familias, indicaron significativas mejorías en el funcionamiento de los niños desde la referencia hasta el final de la consulta. Se dio también una significativa disminución en el riesgo de expulsión de los niños, tal como se midió por medio de las percepciones de los maestros asociadas con las decisiones de expulsión. Este estudio contribuye a la literatura informativa sobre IECMHC por medio de ofrecer resultados específicos al modelo de consulta enfocado en el niño y subrayar el posible papel de las atribuciones del adulto para los niños en ECE.

La consultation de santé mentale du nourrisson et de la petite enfance (Infant and early childhood mental health consultation abrégé en anglais IECMHC) dans des contextes éducatifs et de crèches (abrégé ici CEC selon le français) est une approche prometteuse pour le soutien aux jeunes enfants. Bien que les recherches sur les effets de l'IECMHC sont encourageantes, elles sont limitées par les complexités des systèmes dans lesquels l'IECMHC est mise en oeuvre et la variabilité des modèles de l'IECMHC. Cette étude s'est donné pour but de clairement articuler un modèle IECMHC au niveau de l'état, focalisé sur l'enfant et à court terme, d'évaluer la satisfaction de la personne consultée, d'examiner les effets de la consultation sur le fonctionnement des enfants à l'école et à la maison, et d'évaluer les changements dans les perceptions de l'enseignant liée au risque d'expulsion après la consultation. En tout 268 enfants âgés de 1­5 ans (69% blancs, 75% garçons) et leur famille et les personnes prenant soin d'eux à l'école ont participé à une consultation dans un état de nous Nouvelle Angleterre (aux Etats­Unis), et 95 enfants et personnes prenant soin d'eux ont été inclus dans un sous­échantillon d'évaluation. Dans ce sous­échantillon les enseignants et administrateurs CEC, mais pas les familles, ont fait état d'une amélioration important dans le fonctionnement des enfants du moment de la référence à la fin de la consultation. Il n'a pas de baisse importante du risque d'expulsion des enfants, mesurée par les perceptions des enseignants liées aux décisions d'expulsion. Cette étude contribue aux recherches sur l'IECMHC en offrant des résultats spécifiques à un modèle de consultation focalisé sur l'enfant et en mettant en lumière le rôle possible des attributions adultes pour les enfants dans les CEC.

[Community reorientation of primary care in a health area: ROCAP project]. / Reorientación comunitaria de la atención primaria en un área de salud: proyecto ROCAP.

AIM: Evaluate the effectiveness of an intervention to incorporate group and community activities on a sustained basis in all the Basic Health Zones (ZBS) of a health area. DESIGN: During January and February 2019, two members of the research team traveled to each ZBS to interview the medical and nursing coordinators who had previously received an ad hoc initial assessment questionnaire (QAI) by email. PLACE: The scope is the 11 ZBS of a health area. PARTICIPANTS: The study population is the ZBS and the respective teams represented by the medical and nursing coordinations. INTERVENTIONS: Promote a community health commission, carry out training actions, record activities in clinical history and incorporate management objectives. MAIN MEASUREMENTS: Quantitative and qualitative analysis was carried out pre and post after the first year of intervention. RESULTS: In the pre-evaluation: 6 primary care teams (EAP) reported having group activities, 4 were participating in local action projects, 4 had a professional referent for community activities, 3 participated in projects with populations in vulnerable situations and 4 stated have specific meetings on community health. After the intervention: 11 EAPs had group activities, 8 had a reference professional, 6 were participating in local action projects, 4 collaborated in projects with vulnerable populations and 5 held meetings on community health. CONCLUSIONS: The intervention proved effective after its first year of implementation, since all the EAPs carried out group activities and collaborated with the local councils in the area; the majority had leading professionals in community care and, to a lesser extent, participation in local action projects and in vulnerable populations increased.

[Digital literacy as a key element in the digital transformation of health organizations]. / La alfabetización digital como elemento clave en la transformación digital de las organizaciones en salud.

In the last years, the digital transformation, has become a reality influencing organizational processes and advancing services for users. This transformation must align with WHO guidelines, addressing the needs of individuals globally and acknowledging Social Determinants of Health and emerging Digital Determinants of Health and the digital divide thas has been created. To accomplish this, the appropriate legislation and infrastructures are required. Correspondingly technology enables enhanced self-care and increased participation in decision-making across various levels, consequently, addressing the digital divide must not be an exception, and needs to include citizens, communities, entities, and professionals to work on how to diminish it and solve it. As a result of this national and supranational campaigns should formulate unified plans and strategies, that include training requirements and establishing programs for both professionals and users, highlighting the significance of incorporating digital knowledge on both groups.

[The influence of the institutions on local health councils]. / La influencia de las instituciones en los consejos locales de salud.

OBJECTIVE: To analyze the influences of the institutions in the operation of the Local Health councils. DESIGN: qualitative, descriptive and exploratory study. STUDY SETTING: 02 Primary Health Care services of a municipality in the inland of the state of São Paulo, Brazil. PARTICIPANTS: twenty-four members of the Local Health Councils and 4 key informants. METHODS: Supported by the theoretical methodological framework of Institutional Analysis. Data were produced through 28 semi-structured interviews, observation and participation in the activities of the councils and recording in the research diary. Data were organized and analyzed by the process of transcription, transposition and reconstitution. RESULTS: The institutions act in the territories represented by social actors who occupy positions and functions within the Primary Health Care services, evidencing the perpetuation of hierarchization with valorization of the speeches of professionals and managers to the detriment of patients and predominance of bureaucratized meetings. The social actors reproduce the ideals of the collective to which they belong in these spaces. CONCLUSIONS: The health management teams do not recognize the different forces that act in the health territory, however, these forces interfere in the activities performed and in health care. The groups act both in formal spaces through official representatives who meet and discuss issues in collegiate meetings and in informal spaces, and constitute forces in dispute in the health territory.

Practices and knowledge of health personnel about transgenderity in Primary Health Care.

OBJECTIVE: To describe the practices and knowledge of Nursing Technicians and Community Health Agents of Primary Health Care for the transgender population. DESIGN: Descriptive research with a qualitative approach. SITE: The study was developed in a digital environment. PARTICIPANTS: 18 Community Health Agents and 12 Nursing Technicians who worked in Primary Health Care Units from several Brazilian states. METHOD: Sampling technique by chain indication or networks (snowball), data production by Google Forms form. The theoretical saturation technique was used to close the interviews. Categorical thematic content analysis with IRAMUTEQ software support. RESULTS: Professionals' lack of knowledge about policies and terms was evidenced; there were conceptual confusions, inadequate associations, and a restricted approach to the prevention of sexually transmitted infections. CONCLUSIONS: The lack of training reflects a cisnormative and binary approach, compromising the assistance to the transgender population. Disrespect for the social name persists, highlighting the need for permanent education for health professionals, aiming at an inclusive and respectful care practice.

[Barriers and facilitators in accessing and using primary health care centers for people experiencing homelessness]. / Barreras y facilitadores en el acceso y la utilización de los centros de atención primaria para las personas en situación de sinhogarismo.

OBJECTIVE: To identify barriers and facilitators for the access and use of primary care centers for people experiencing homelessness. DESIGN: Qualitative study, phenomenological theoretical-methodological approach. Between May 19 and July 27, 2023. LOCATION: Besòs Primary Health Care Center and Gregal social dining (Besòs and Maresme neighborhood, Barcelona). PARTICIPANTS: People experiencing homelessness attending the Gregal social dining and professionals from the Besòs Primary Health Care Center. METHOD: Theoretical purposive sampling. Individual and group interviews and open non-participant observation. Thematic content analysis, triangulation by independent analysis of three members of the research team and triangulation of methods. Discourse saturation was achieved through variability of discourse and techniques. RESULTS: Eleven individual interviews, three group interviews and two observations. Different barriers and facilitators were identified. These were classified into five categories: (1)concept and identification of people experiencing homelessness; (2)personal factors of people experiencing homelessness; (3)behaviors and attitudes of professionals; (4)structural factors related to health system regulation, anf (5)internal organizational factors of primary health care centers. CONCLUSIONS: People experiencing homelessness face multiple barriers to access primary health care, although there are also facilitators such as trusting relationships and multidisciplinary and intersectoral work that can be enhanced from primary health care centers to contribute to health equity.