Twitter Analysis of Health Care Workers' Sentiment and Discourse Regarding Post-COVID-19 Condition in Children and Young People: Mixed Methods Study.

BACKGROUND: The COVID-19 pandemic has had a significant global impact, with millions of cases and deaths. Research highlights the persistence of symptoms over time (post-COVID-19 condition), a situation of particular concern in children and young people with symptoms. Social media such as Twitter (subsequently rebranded as X) could provide valuable information on the impact of the post-COVID-19 condition on this demographic. OBJECTIVE: With a social media analysis of the discourse surrounding the prevalence of post-COVID-19 condition in children and young people, we aimed to explore the perceptions of health care workers (HCWs) concerning post-COVID-19 condition in children and young people in the United Kingdom between January 2021 and January 2022. This will allow us to contribute to the emerging knowledge on post-COVID-19 condition and identify critical areas and future directions for researchers and policy makers. METHODS: From a pragmatic paradigm, we used a mixed methods approach. Through discourse, keyword, sentiment, and image analyses, using Pulsar and InfraNodus, we analyzed the discourse about the experience of post-COVID-19 condition in children and young people in the United Kingdom shared on Twitter between January 1, 2021, and January 31, 2022, from a sample of HCWs with Twitter accounts whose biography identifies them as HCWs. RESULTS: We obtained 300,000 tweets, out of which (after filtering for relevant tweets) we performed an in-depth qualitative sample analysis of 2588 tweets. The HCWs were responsive to announcements issued by the authorities regarding the management of the COVID-19 pandemic in the United Kingdom. The most frequent sentiment expressed was negative. The main themes were uncertainty about the future, policies and regulations, managing and addressing the COVID-19 pandemic and post-COVID-19 condition in children and young people, vaccination, using Twitter to share scientific literature and management strategies, and clinical and personal experiences. CONCLUSIONS: The perceptions described on Twitter by HCWs concerning the presence of the post-COVID-19 condition in children and young people appear to be a relevant and timely issue and responsive to the declarations and guidelines issued by health authorities over time. We recommend further support and training strategies for health workers and school staff regarding the manifestations and treatment of children and young people with post-COVID-19 condition.

Acceptability of HPV Vaccines: A Qualitative Systematic Review and Meta-Summary.

In 2006, the human papillomavirus (HPV) vaccine was approved for use as an effective intervention for reducing the risk of developing cervical cancer; however, its successful implementation is dependent on acceptability. This study aims to provide a comprehensive understanding of the reasons that favor or do not favor the acceptability of HPV vaccines. METHODS: We conducted a systematic review and meta-summary of qualitative research on 16 databases. A total of 32 articles that considered the perspectives of vaccine users, their parents, and the professionals who care for them were reviewed. Synthesis was conducted as described by Sandelowski and Barroso. RESULTS: We used inductive and deductive methods to obtain a total of 22 dimensions, out of which three issues stood out that should be considered to improve acceptability and are formed by three groups of study, namely, information about the vaccine, fears and side effects, and sexuality associated with the vaccine. CONCLUSIONS: Acceptability, as well as adherence to HPV vaccination, is a complex concept. This review highlights the perspectives of the three sets of actors involved in the process (i.e., users, parents, and professionals) and views these factors in relation to acceptability as a guide for new interventions.

Discriminación racial y Determinantes Sociales de la salud en niños y niñas migrantes: revisión narrativa

Objetivo: Analizar la relación entre Determinantes Sociales de la Salud (DSS) y discriminación en niños, niñas y adolescentes migrantes a partir de la información disponible en la literatura científica. Método: Revisión narrativa de estudios primarios publicados entre 2008 y 2021 en las bases de datos PubMed y Web of Science. Se utilizaron los descriptores "Psychological/Social Discrimination", "Racism", "Social Stigma", "Social Determinants of Health", "Public Health", "Health Equity", "Transients and Migrants", "Refugees", "Emigrants and Immigrants", "Undocumented Immigrants", "Child", "Adolescent", "Child, "Preschool". Los operadores booleanos utilizados fueron AND y OR. Se incluyeron artículos observacionales (analíticos o descriptivos) que evaluaran la relación entre discriminación racial y DSS, publicados en inglés o español. La población de estudio fueron niños, niñas y adolescentes. La selección de artículos se realizó siguiendo las recomendaciones PRISMA. La calidad de la evidencia fue evaluada mediante la herramienta MMAT. Resultados: De un total de 1249 artículos identificados, se incluyeron 55. La mayor cantidad de artículos identificó el efecto de la relación entre discriminación racial y migración en ámbitos de salud mental negativa. Fue escasa la evidencia respecto de determinantes estructurales, sin embargo, destaca la relación entre discriminación racial y el efecto moderador de la familia y la escuela. Conclusiones: Analizar la discriminación racial que perciben niños y niñas migrantes mediante un enfoque de DSS permite identificar áreas sensibles al desarrollo estrategias de reducción de inequidades en este grupo.

Objective: To analyze the relationship between Social Determinants of Health (SDH) and racial discrimination in migrant children and adolescents, based on the information available in the scientific literature. Method: Narrative review of primary studies published between 2008 and 2021 in PubMed and Web of Science databases. The descriptors "Psychological/Social Discrimination", "Racism", "Social Stigma", "Social Determinants of Health", "Public Health", "Health Equity", "Transients and Migrants", "Refugees", "Emigrants and Immigrants", "Undocumented Immigrants", "Child", "Adolescent", "Child", "Preschool" were using. The Boolean operators used were AND OR. We included observational articles (analytical or descriptive) that evaluated the relationship between racial discrimination and SDH, published in English or Spanish. The study population was children and adolescents. We select articles following the PRISMA recommendations. The evaluation of the quality of the evidence was made using MMAT. Results: Of a total of 1249 articles identified, 55 articles were included. The most significant number of articles identified the relationship between racial discrimination and migration on adverse mental health outcomes. Evidence regarding structural determinants was scarce; however, the relationship between racial discrimination and the moderating effect of family and school stands out. Conclusions: Analyzing racial discrimination as perceived by migrant children through a DSS approach allows us to identify sensitive areas to develop strategies to reduce inequities in this group.

Barreras y facilitadores percibidos en la atención de salud a personas migrantes en Chile / Perceived barriers and facilitators in health care for migrants in Chile

Objetivo principal: Explorar barreras y facilitadores percibidos por profesionales de salud en la atención a migrantes en Atención Primaria de Salud (APS) de Santiago de Chile en 2020. Metodología: Diseño cualitativo, estudio de caso. Se entrevistó a 10 profesionales de APS. Mediante análisis de contenido se determinaron patrones temáticos según Creswell. Se contó con aprobación del Comité de ética de Universidad Andrés Bello, Chile. Resultados principales: El idioma fue percibido como una de las principales barreras para la atención de salud de personas migrantes, así como también la falta de entrenamiento. Como facilitadores destaca la disponibilidad de herramientas tecnológicas para reducir brechas de comunicación y disposición por parte de los profesionales para establecer una relación terapéutica. Conclusión principal: La atención a migrantes en APS requiere estrategias de pertinencia cultural, considerando barreras como el idioma y la falta de entrenamiento, y aprovechando herramientas tecnológicas para una comunicación efectiva.(AU)

Main objective: To explore barriers and facilitators perceived by health professionals in the care of migrants in Primary Health Care (PHC) in Santiago de Chile in 2020. Methodology: Qualitative design, case study. Ten PHC professionals were interviewed. Content analysis was used to determine thematic patterns, according to Creswell. Approval was obtained from the Ethics Committee of Universidad Andrés Bello, Chile. Main results: Language was perceived as one of the main barriers to health care for migrants and a lack of training. The availability of technological tools to reduce communication gaps and the willingness of professionals to establish a therapeutic relationship were highlighted as facilitators. Main conclusion: Care for migrants in PHC requires culturally relevant strategies, considering barriers such as language and lack of training, and taking advantage of technological tools for effective communication.(AU)

Teoría del Manejo del Síntoma: análisis para investigación en multimorbilidad en ambientes comunitarios / Symptom Management Theory: Analysis for Multimorbidity Research in Community Settings

Objetivo: Analizar críticamente la teoría de rango medio Symptom Management Theory y evaluar su utilidad en la investigación sobre multimorbilidad en ambientes comunitarios. Metodología: Análisis teórico según estrategia de subestructuración de Dulock, consistente en 4 pasos: identificación de constructos y conceptos; descripción de las relaciones; operacionalización de los conceptos con indicadores empíricos y representación pictórica y jerarquizada del modelo. Resultados: El modelo cuenta con una clara estructura jerárquica, vinculando el sistema teórico y operativo. Esta estructura teórica es coherente, sencilla y tiene un respaldo suficiente para ser aplicada en el estudio de la gestión de síntomas en usuarios portadores de multimorbilidad en ambientes comunitarios. Conclusiones: La teoría de rango medio Manejo del Síntoma es útil para el estudio de la multimorbilidad en contextos comunitarios.(AU)

Objective: To critically analyze the middle-range theory Symptom Management Theory and evaluate their utility in research on multimorbidity in community settings. Methodology: Theoretical analysis using Dulock's substruction strategy, consisting of four steps: identification of constructs and concepts, description of relationships, operationalization of concepts with empirical indicators, and hierarchical pictorial representation of the model. Results: The model's hierarchical structure is clear, effectively linking the theoretical and operational systems. This theoretical structure is coherent, straightforward, and sufficiently supported for its application in the study of symptom management in individuals with multimorbidity in community settings. Conclusions: The middle-range theory of Symptom Management is valuable for investigating multimorbidity in community contexts.(AU)

[Perceptions regarding health rights for migrants in Chile: Twitter data analysis]. / Percepción de los derechos de salud para la población migrante en Chile: análisis desde Twitter.

OBJECTIVE: To describe the different perceptions about health rights for migrant population in Chile published on Twitter, concerning the first liver transplant carried out in Chile to a foreign national woman from Haiti, in September 2018. METHOD: Qualitative study, case analysis. The case corresponded to the first emergency liver transplant in a migrant woman in Chile. Opinions expressed on Twitter regarding this case were collected between September 29 and November 17 (n=339). Thematic analysis was performed using NVivo12 software, with codes defined conforming to the objective. RESULTS: According to the perceptions raised on Twitter, the right to access health services of the migrant population in Chile should be limited, and priority should be given to nationals. These opinions coexist with viewing health as a human right. There are also feelings of racism and discrimination towards this group. CONCLUSIONS: In Chile, there are different perceptions of what should grant rights of access to migrant health services. This situation can generate a worsening of stigmatization and vulnerability faced by migrants and a barrier to the policy's implementation, further exacerbating the presence of health inequities.

Development of an instrument to measure the cultural competence of health care workers.

OBJECTIVE: To validate an instrument measuring the cultural competence in health care workers from Chile. METHODS: Using Sue & Sue's theoretical model of cultural competence, we designed a scale, which was assessed by health care workers and experts. Subsequently, the scale was applied to a sample of 483 different health care workers, during 2018 in Santiago de Chile. The analysis included: exploratory and confirmatory factor analysis, estimation of reliability, and analysis of measurement bias. Finally, the level of cultural competence was calculated for every professional who participated in this study. RESULTS: The final scale include 14 items that are grouped into three dimensions concordant with the theoretical model: sensitivity to own prejudices, cultural knowledge, and skills to work in culturally diverse environments. This scale showed good fit in factor models, adequate reliability and lack of evidence of measurement bias. Regarding the performance of health care workers, sensitivity showed a lower level compared with the other dimensions evaluated. CONCLUSION: The scale for measuring the level of cultural competence in health care workers (EMCC-14) is a reliable instrument, with initial support for its validity, which can be used in the Chilean context. Additionally, the results of this study could guide some possible interventions in the health sector to strengthen the level of cultural competence.

Development of an instrument to measure the cultural competence of health care workers / Desarrollo de un instrumento para medir competencia cultural en trabajadores de Salud

ABSTRACT OBJECTIVE To validate an instrument measuring the cultural competence in health care workers from Chile. METHODS Using Sue & Sue's theoretical model of cultural competence, we designed a scale, which was assessed by health care workers and experts. Subsequently, the scale was applied to a sample of 483 different health care workers, during 2018 in Santiago de Chile. The analysis included: exploratory and confirmatory factor analysis, estimation of reliability, and analysis of measurement bias. Finally, the level of cultural competence was calculated for every professional who participated in this study. RESULTS The final scale include 14 items that are grouped into three dimensions concordant with the theoretical model: sensitivity to own prejudices, cultural knowledge, and skills to work in culturally diverse environments. This scale showed good fit in factor models, adequate reliability and lack of evidence of measurement bias. Regarding the performance of health care workers, sensitivity showed a lower level compared with the other dimensions evaluated. CONCLUSION The scale for measuring the level of cultural competence in health care workers (EMCC-14) is a reliable instrument, with initial support for its validity, which can be used in the Chilean context. Additionally, the results of this study could guide some possible interventions in the health sector to strengthen the level of cultural competence.

RESUMEN OBJETIVO Validar un instrumento de medición de competencia cultural en trabajadores de salud de Chile. MÉTODOS Utilizando el modelo teórico de Sue y Sue, se diseñó un instrumento de medición el cual fue evaluado por trabajadores de salud y expertos. Este instrumento se aplicó a una muestra diversa de 483 proveedores de salud, durante 2018 en Santiago de Chile. Se realizó análisis factorial exploratorio, confirmatorio, estimación de confiabilidad y análisis de sesgo de medición. Se estimó el nivel de competencia cultural alcanzado por los profesionales. RESULTADOS El instrumento final contó con 14 ítems los cuales se agruparon en tres dimensiones: sensibilidad a los propios prejuicios, conocimiento cultural y habilidades para trabajar en entornos culturalmente diversos. Esta herramienta mostró buen ajuste en los modelos factoriales, adecuada confiabilidad y ausencia de evidencias de sesgo de medición. Los trabajadores de salud evaluados exhibieron un bajo nivel de sensibilidad a los propios prejuicios en comparación con las otras dimensiones evaluadas. CONCLUSIONE La Escala de Medición de Competencia Cultural en trabajadores de salud (EMCC-14) es una herramienta confiable, con soporte inicial para su validez, que puede usarse en el contexto Chileno. Además, los resultados de este estudio podrían guiar algunas posibles intervenciones en el sector de la salud para fortalecer el nivel de competencia cultural.

[Initial care for migrants in Chile: status of a primary health care initiative after one year of implementationAtenção inicial a populações migrantes no Chile: iniciativa em atenção primária à saúde após um ano da sua implementação]. / Atención inicial de migrantes en Chile: iniciativa en atención primaria de salud a un año de su implementación.

OBJECTIVE: Describe sociodemographic characteristics, health needs, effective referrals, and immediate evaluation of international migrants who participated in the Initial Care for Migrants program during its first year of implementation (May to December 2016) at the Ignacio Domeyko Family Health Center in Santiago, Chile. METHODS: Descriptive study. An intervention was designed and implemented to welcome international migrants. It included an initial comprehensive evaluation, a situation assessment, identification of needs, referral to other health services, and transfer of information. Statistical analysis was performed, using measures of central tendency and absolute and relative frequencies to describe sociodemographic characteristics, migratory processes, health needs, and effective referrals after one year of monitoring, as well as the results of a user satisfaction survey. RESULTS: 436 people were registered, of whom 270 (61.9%) participated; 80% were women, mostly from Peru and Venezuela. The largest number of referrals were to pregnancy services (32.6%), followed by family planning (30%) and social services (27.04%). After one year of monitoring, there was 100% compliance for referrals to cardiovascular testing, 97.7% for pregnancy, and 87.7% for social services. The lowest compliance was for referrals to mental health services (11.1%). CONCLUSIONS: This intervention, the first of its kind in Chile, welcomed international migrants and provided them with key information, while providing referrals based on health needs and promoting the inclusion of the immigrant population in the Chilean health system.

OBJETIVO: Descrever as características sociodemográficas, necessidades em saúde, encaminhamentos efetivados e avaliação imediata da população migrante internacional que participou do Programa de Atenção Inicial ao Migrante no primeiro ano da sua implementação (entre maio e dezembro de 2016) no Centro de Saúde Familiar Ignacio Domeyko, na cidade de Santiago, no Chile. MÉTODOS: Estudo descritivo com base em uma intervenção que foi concebida e implementada para acolher populações migrantes internacionais. A intervenção consistiu de uma avaliação inicial completa, diagnóstico da situação, identificação das necessidades em saúde e encaminhamento a outros serviços de atendimento, além de um componente informativo. A análise se baseou em medidas de tendência central e frequências absolutas e relativas usadas para descrever características sociodemográficas, processo migratório, necessidades em saúde, efetivação dos encaminhamentos em um ano de acompanhamento e resultados da pesquisa de satisfação dos usuários. RESULTADOS: Dos 436 inscritos, 270 participaram do programa (61,9%). Destes, 80% eram mulheres e a maioria era proveniente do Peru e da Venezuela. Os principais encaminhamentos efetivados foram ao atendimento pré-natal (32,6%), planejamento familiar (30%) e serviços sociais (27,04%). Após um ano de acompanhamento, os encaminhamentos para avaliação cardiovascular foram efetivados em 100%, para atenção pré-natal em 97,7% e para serviços sociais em 87,7%. O encaminhamento à atenção de saúde mental foi o menos efetivado (11,1%). CONCLUSÕES: Esta foi uma intervenção pioneira no Chile que possibilitou acolher e instruir as populações migrantes internacionais, além de realizar encaminhamentos a serviços conforme as necessidades em saúde e promover a inserção da população imigrante no sistema de saúde chileno.

Atención inicial de migrantes en Chile: iniciativa en atención primaria de salud a un año de su implementación

[RESUMEN]. Objetivo. Describir las características sociodemográficas, necesidades de salud, derivaciones efectivas realizadas y evaluación inmediata de la población migrante internacional que participó en el Programa de Atención Inicial al Migrante durante el primer año de ejecución (entre mayo y diciembre del año 2016), implementado en el Centro de Salud Familiar Ignacio Domeyko, Santiago de Chile. Métodos. Estudio descriptivo. Se diseñó e implementó una intervención para dar bienvenida a migrantes internacionales, que contemplaba la evaluación integral inicial, el diagnóstico de situación y detección de necesidades y derivación a otras atenciones, y la entrega de información. Para el análisis se describen, por medio de medidas de tendencia central y frecuencias absolutas y relativas, las características sociodemográficas, el proceso migratorio, las necesidades de salud, el cumplimento de derivaciones a un año de seguimiento y los resultados de la encuesta de satisfacción usuaria. Resultados. Se inscribieron 436 personas, de las cuales asistieron 270 (61,9%). El 80% eran mujeres, provenientes en su mayoría de Perú y Venezuela. La principal derivación realizada fue a control de embarazo (32,6%), seguido de planificación familiar (30%) y servicios sociales (27,04%). A un año de seguimiento, las derivaciones para controles cardiovasculares alcanzaron 100% de cumplimiento, 97,7% para embarazo y 87,7% para servicios sociales. El menor cumplimiento en las derivaciones fue a salud mental (11,1%). Conclusiones. Esta intervención, pionera en Chile, permitió dar bienvenida y proporcionar información clave a la población migrante internacional, así como también realizar derivaciones basadas en necesidades de salud y promover la inserción de la población inmigrante al sistema de salud chileno.

[ABSTRACT]. Objective. Describe sociodemographic characteristics, health needs, effective referrals, and immediate evaluation of international migrants who participated in the Initial Care for Migrants program during its first year of implementation (May to December 2016) at the Ignacio Domeyko Family Health Center in Santiago, Chile. Methods. Descriptive study. An intervention was designed and implemented to welcome international migrants. It included an initial comprehensive evaluation, a situation assessment, identification of needs, referral to other health services, and transfer of information. Statistical analysis was performed, using measures of central tendency and absolute and relative frequencies to describe sociodemographic characteristics, migratory processes, health needs, and effective referrals after one year of monitoring, as well as the results of a user satisfaction survey. Results. 436 people were registered, of whom 270 (61.9%) participated; 80% were women, mostly from Peru and Venezuela. The largest number of referrals were to pregnancy services (32.6%), followed by family planning (30%) and social services (27.04%). After one year of monitoring, there was 100% compliance for referrals to cardiovascular testing, 97.7% for pregnancy, and 87.7% for social services. The lowest compliance was for referrals to mental health services (11.1%). Conclusions. This intervention, the first of its kind in Chile, welcomed international migrants and provided them with key information, while providing referrals based on health needs and promoting the inclusion of the immigrant population in the Chilean health system.

[RESUMO]. Objetivo. Descrever as características sociodemográficas, necessidades em saúde, encaminhamentos efetivados e avaliação imediata da população migrante internacional que participou do Programa de Atenção Inicial ao Migrante no primeiro ano da sua implementação (entre maio e dezembro de 2016) no Centro de Saúde Familiar Ignacio Domeyko, na cidade de Santiago, no Chile. Métodos. Estudo descritivo com base em uma intervenção que foi concebida e implementada para acolher populações migrantes internacionais. A intervenção consistiu de uma avaliação inicial completa, diagnóstico da situação, identificação das necessidades em saúde e encaminhamento a outros serviços de atendimento, além de um componente informativo. A análise se baseou em medidas de tendência central e frequências absolutas e relativas usadas para descrever características sociodemográficas, processo migratório, necessidades em saúde, efetivação dos encaminhamentos em um ano de acompanhamento e resultados da pesquisa de satisfação dos usuários. Resultados. Dos 436 inscritos, 270 participaram do programa (61,9%). Destes, 80% eram mulheres e a maioria era proveniente do Peru e da Venezuela. Os principais encaminhamentos efetivados foram ao atendimento pré-natal (32,6%), planejamento familiar (30%) e serviços sociais (27,04%). Após um ano de acompanhamento, os encaminhamentos para avaliação cardiovascular foram efetivados em 100%, para atenção pré-natal em 97,7% e para serviços sociais em 87,7%. O encaminhamento à atenção de saúde mental foi o menos efetivado (11,1%). Conclusões. Esta foi uma intervenção pioneira no Chile que possibilitou acolher e instruir as populações migrantes internacionais, além de realizar encaminhamentos a serviços conforme as necessidades em saúde e promover a inserção da população imigrante no sistema de saúde chileno.

[Social determinants of the health of international migrant children in Chile: qualitative evidence.] / Determinantes sociales de la salud de niños migrantes internacionales en Chile: evidencia cualitativa.

OBJECTIVE: To explore the social determinants of health (SDH) of international migrant children, from the perceptions of caregivers, health workers and local authorities in eight municipalities in Chile. MATERIALS AND METHODS: A secondary analysis of data was conducted from a qualitative study that took place between 2014 and 2017. The original study involved semi-structured interviews and focus groups. The secondary thematic analysis of data included all emerging issues related to international migrant children and their living conditions, including use of health services. RESULTS: Findings were grouped according to the model of social determinants of health, which allow a reflection on living conditions of international migrant children and their health situation. CONCLUSIONS: This research shows the impact of SDH on international migrant children in Chile, highlighting relevant issues around this group.

OBJETIVO: Explorar los determinantes sociales de la salud (DSS) de niños migrantes, a partir de las percepciones de cuidadores y trabajadores autoridades de salud en las zonas más densas de población migrante en Chile. MATERIAL Y MÉTODOS: Se realizó un análisis de datos secundario de un estudio realizado entre los años 2014 y 2017 desde un paradigma cualitativo de investigación. El estudio original incluyó entrevistas semiestructuradas y grupos focales. El análisis temático secundario de datos contempló todos los temas emergentes referidos a niños migrantes y condiciones de vida, incluyendo utilización de servicios de salud. RESULTADOS: Los DDS fueron agrupados de acuerdo con el Modelo de Determinantes Sociales de la Salud, el cual permite reflexionar en torno a las condiciones de vida de niños migrantes y su situación de salud. CONCLUSIONES: Esta investigación muestra el impacto de los DSS en salud de niños migrantes en Chile, resaltando temáticas relevantes en torno a este grupo.

Determinantes sociales de la salud de niños migrantes internacionales en Chile: evidencia cualitativa / Social determinants of the health of international migrant children in Chile: qualitative evidence

Resumen: Objetivo: Explorar los determinantes sociales de la salud (DSS) de niños migrantes, a partir de las percepciones de cuidadores y trabajadores/autoridades de salud en las zonas más densas de población migrante en Chile. Material y métodos: Se realizó un análisis de datos secundario de un estudio realizado entre los años 2014 y 2017 desde un paradigma cualitativo de investigación. El estudio original incluyó entrevistas semiestructuradas y grupos focales. El análisis temático secundario de datos contempló todos los temas emergentes referidos a niños migrantes y condiciones de vida, incluyendo utilización de servicios de salud. Resultados: Los DDS fueron agrupados de acuerdo con el Modelo de Determinantes Sociales de la Salud, el cual permite reflexionar en torno a las condiciones de vida de niños migrantes y su situación de salud. Conclusión: Esta investigación muestra el impacto de los DSS en salud de niños migrantes en Chile, resaltando temáticas relevantes en torno a este grupo.

Abstract: Objective: To explore the social determinants of health (SDH) of international migrant children, from the perceptions of caregivers, health workers and local authorities in eight municipalities in Chile. Materials and methods: A secondary analysis of data was conducted from a qualitative study that took place between 2014 and 2017. The original study involved semi-structured interviews and focus groups. The secondary thematic analysis of data included all emerging issues related to international migrant children and their living conditions, including use of health services. Results: Findings were grouped according to the model of social determinants of health, which allow a reflection on living conditions of international migrant children and their health situation. Conclusion: This research shows the impact of SDH on international migrant children in Chile, highlighting relevant issues around this group.

Brechas de desigualdad en salud en niños migrantes versus locales en Chile / Health inequality gap in inmigrant versus local children in Chile

Resumen Introducción: Los niños y jóvenes migrantes internacionales enfrentan diferentes retos en salud en comparación con la población local, en particular si se enfrentan a ambientes inseguros o a condi ciones sociales adversas. Este estudio busca identificar brechas existentes en resultados de salud de la niñez entre población migrante internacional y chilena. Métodos: Este estudio analiza tres fuentes de información: (i)Nacer en Chile: Datos de consulta antenatal recolectados de los registros electrónicos de las mujeres usuarias del programa Chile Crece Contigo, de todos los centros de salud familiar (CESFAM) de administración municipal de la comuna de Recoleta el año 2012; (ii)Crecer en Chile: Datos de encuesta poblacional "Caracterización Socioeconómica Nacional" CASEN 2013 y (iii)En-fermar en Chile: Datos de todos los egresos hospitalarios de 2012, proporcionada por el departamento de estadística e información en salud (DEIS) del Ministerio de Salud. Resultados: (i) Nacer en Chile: Hay mayor proporción de inmigrantes con riesgo biopsicosocial (62,3% vs 50,1% en chilenas) y con ingreso tardío al programa (63,1% vs 33,4%). Hay menos cesáreas en inmigrantes que en chilenas (24,2% vs 33,6%). (ii) Crecer en Chile: Existe una mayor proporción de niños migrantes fuera del sistema escolar y una mayor proporción en pobreza multidimensional (40% vs 23,2%). (iii) Enfermar en Chile: En migrantes entre 7-14 años es más frecuente egresar hospitalariamente por traumatismos/ otras causas externas (23,6% vs 16,7% en chilenos). Conclusiones: Este estudio entrega nueva evi dencia sobre necesidades urgentes de salud de nuestros niños en Chile. Este es un imperativo ético, legal y moral, independiente de la condición migratoria.

Abstract Introduction: Children and young international migrants face different health challenges compa red with the local population, particularly if they live in insecure environments or adverse social conditions. This study seeks to identify gaps in health outcomes of children between immigrant and local population in Chile. Methods: This study analyses data from three sources: (i) Born in Chile: Electronic records of antenatal visits from all municipal antenatal clinics of Recoleta in 2012; (ii) Growing up in Chile: Population survey "National Socioeconomic Characterization" (CASEN) from 2013 and (iii) Getting sick in Chile: Data of all hospital discharges in 2012, provided by the department of statistics and health information (DEIS) of the Ministry of Health. Results: (I) Born in Chile: Im migrants more frequently have psychosocial risk (62.3% vs 50.1% in Chileans) and enter later into the program (63.1% vs 33.4% enter later than 14 weeks of pregnancy). All birth outcomes were better among immigrants (e.g. caesarean sections rates: 24.2% immigrants vs % Chileans). (ii) Growing up in Chile: A higher proportion of migrant children is outside the school system and lives in multidi mensional poverty (40% immigrants vs 23.2% Chileans). (iii) Getting sick in Chile: Injuries and other external causes were more frequent cause of hospitalisation among migrants (23.6%) than the local population (16.7%) aged between 7 and 14 years. Conclusions: Addressing the needs of the children in Chile, regardless of their immigration status, is an ethical, legal and moral imperative.

[Challenges in the health care of international migrants in Chile]. / Desafíos en la atención sanitaria de migrantes internacionales en Chile.

OBJECTIVES: To investigate the perceptions of primary health workers (PHW) about the challenges of health care for migrants. MATERIALS AND METHODS: A qualitative multicase study was conducted in eight communes of Chile, using the snowball technique, where 101 PHW and local authorities were recruited. Semi-structured interviews and focal groups were conducted, achieving information saturation. RESULTS: The findings were grouped into two major thematic axes: 1. Technical and administrative difficulties, and 2. Perception of cultural barriers. According to the PHW, although regulations have been established and health care strategies have been generated for the migrant population, these are mostly not stable or known to all PHW. They are also not easy to implement in the various realities investigated. The absence of records on the number of migrants accessing the health system makes it difficult to design specific interventions. Additionally, health care has complications, and the PHW do not necessarily have tools that allow them to provide a care that is culturally sensitive to the needs of the migrant community. CONCLUSIONS: The findings put into question the new challenges in health that Chile is facing in the face of the growing migrant population. The needs perceived by PHW are: stability and clarity in the regulations in force in relation to access and provision of services, training in regulations and the concrete way in which they should operate, and sensitization in cultural competence.

OBJETIVOS: Indagar en las percepciones de los trabajadores de salud primaria (TSP) sobre los desafíos de atención de salud para población migrante. MATERIALES Y MÉTODOS: Se realizó un estudio cualitativo de caso múltiple en ocho comunas de Chile, mediante la técnica de bola de nieve se reclutó a 101 TSP y autoridades locales. Se realizaron entrevistas semiestructuradas y grupos focales, logrando saturación de información. RESULTADOS: Los hallazgos fueron agrupados en dos grandes ejes temáticos: 1. Dificultades técnicas y administrativas, y 2. Percepción de barreras culturales. De acuerdo a los TSP, pese a que se han establecido normativas y se han generado estrategias de atención en salud para población migrante, estas, en su mayoría, no son estables ni conocidas por todos los TSP. Tampoco son fáciles de implementar en las diversas realidades investigadas. La ausencia de registros sobre el número de migrantes que accederán al sistema sanitario, dificulta el diseño de intervenciones específicas. Adicionalmente, la atención en salud presenta complicaciones, y los TSP no necesariamente poseen herramientas que les permitan brindar una atención que sea culturalmente sensible a las necesidades de la comunidad migrante. CONCLUSIONES: Los hallazgos ponen en discusión los nuevos desafíos en salud que enfrenta Chile frente a la creciente población migrante. Las necesidades percibidas por TSP son: estabilidad y claridad en las normativas vigentes en relación a acceso y prestación de servicios, capacitación en normativas y la manera concreta en la que estas deben operar, y sensibilización en competencia cultural.

Desafíos en salud primaria para migrantes internacionales: el caso de Chile / Challenges in primary health care for international migrants: The case of Chile

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Desafíos en la atención sanitaria de migrantes internacionales en Chile / Challenges in the health care of international migrants in Chile

RESUMEN Objetivos Indagar en las percepciones de los trabajadores de salud primaria (TSP) sobre los desafíos de atención de salud para población migrante. Materiales y métodos Se realizó un estudio cualitativo de caso múltiple en ocho comunas de Chile, mediante la técnica de bola de nieve se reclutó a 101 TSP y autoridades locales. Se realizaron entrevistas semiestructuradas y grupos focales, logrando saturación de información. Resultados Los hallazgos fueron agrupados en dos grandes ejes temáticos: 1. Dificultades técnicas y administrativas, y 2. Percepción de barreras culturales. De acuerdo a los TSP, pese a que se han establecido normativas y se han generado estrategias de atención en salud para población migrante, estas, en su mayoría, no son estables ni conocidas por todos los TSP. Tampoco son fáciles de implementar en las diversas realidades investigadas. La ausencia de registros sobre el número de migrantes que accederán al sistema sanitario, dificulta el diseño de intervenciones específicas. Adicionalmente, la atención en salud presenta complicaciones, y los TSP no necesariamente poseen herramientas que les permitan brindar una atención que sea culturalmente sensible a las necesidades de la comunidad migrante. Conclusiones Los hallazgos ponen en discusión los nuevos desafíos en salud que enfrenta Chile frente a la creciente población migrante. Las necesidades percibidas por TSP son: estabilidad y claridad en las normativas vigentes en relación a acceso y prestación de servicios, capacitación en normativas y la manera concreta en la que estas deben operar, y sensibilización en competencia cultural.

ABSTRACT Objectives To investigate the perceptions of primary health workers (PHW) about the challenges of health care for migrants. Materials and methods A qualitative multicase study was conducted in eight communes of Chile, using the snowball technique, where 101 PHW and local authorities were recruited. Semi-structured interviews and focal groups were conducted, achieving information saturation. Results The findings were grouped into two major thematic axes: 1. Technical and administrative difficulties, and 2. Perception of cultural barriers. According to the PHW, although regulations have been established and health care strategies have been generated for the migrant population, these are mostly not stable or known to all PHW. They are also not easy to implement in the various realities investigated. The absence of records on the number of migrants accessing the health system makes it difficult to design specific interventions. Additionally, health care has complications, and the PHW do not necessarily have tools that allow them to provide a care that is culturally sensitive to the needs of the migrant community. Conclusions The findings put into question the new challenges in health that Chile is facing in the face of the growing migrant population. The needs perceived by PHW are: stability and clarity in the regulations in force in relation to access and provision of services, training in regulations and the concrete way in which they should operate, and sensitization in cultural competence.