Factorial Structure and Diagnostic Accuracy of a Digital Version of the Alcohol Use Disorders Identification Test (d-AUDIT) to Detect Hazardous and Problematic Drinking in Primary Care.

OBJECTIVE: We studied the factorial structure and diagnostic performance in primary care of a digital version of the Alcohol Use Disorders Identification Test (d-AUDIT) for screening for excessive drinking. METHOD: In two primary care centers in Santiago, Chile, we conducted a cross-sectional study involving 330 people 18 years of age or older who had drunk alcohol six or more times in the last year. The d-AUDIT was developed from the paper version validated in Chile and was self-administered on 7-inch tablets. Trained psychologists evaluated the participants using a 1-year Timeline Followback and the alcohol use disorders section from the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. We used confirmatory factorial analysis to examine the structure of the d-AUDIT and areas under the receiver operating characteristic curves (AUCs) to examine the diagnostic performance of the d-AUDIT. RESULTS: A two-factor model presented good overall fit, with item loads in the 0.53-0.88 range. The correlation among factors was .74, reflecting a good discriminant validity. The total score and the Fast Alcohol Screening Test (FAST) score (i.e., bingeing, role failure, blackouts, and others' concern items) obtained the best diagnostic performance for problematic drinking, with AUCs of 0.94 (CI [0.91, 0.97]) and 0.92 (CI [0.88, 0.96]), respectively. The FAST could differentiate hazardous drinking (cut point three in men and one in women) from problematic drinking (cut point four in men and two in women). CONCLUSIONS: We replicated prior factor analysis findings of a two-factor structure for the d-AUDIT with a good discriminant validity. The FAST obtained excellent diagnostic performance and retained some ability to discriminate between hazardous and problematic drinking.

Cross-cultural adaptation of four instruments to measure stigma towards people with mental illness and substance use problems among primary care professionals in Chile.

Stigma toward people with mental illness and substance use problems is a significant global concern, and prevents people with these conditions from accessing treatment, particularly in primary health care (PHC) settings. Stigma is a cultural phenomenon that is influenced by particular contexts and can differ by country and region. The majority of stigma research focuses on Europe or North America leading to a lack of culturally relevant stigma research instruments for the Latin American context. The present study describes and discusses the methodology for cross-culturally adapting four stigma measurement scales to the Chilean context. The cross-cultural adaptation process included nine phases: (1) preparation; (2) independent translations; (3) synthesis 1 with expert committee; (4) focus groups and interviews with researchers, PHC professionals, and PHC users; (5) synthesis 2 with expert committee; (6) independent back translations; (7) synthesis 3 with expert committee; (8) pilot with PHC professionals; and (9) final revisions. The adaptation process included an array of diverse voices from the PHC context, and met three adaptation objectives defined prior to beginning the process (Understandability, Relevance, and Acceptability and Answer Options). The resulting, culturally adapted questionnaire is being validated and implemented within PHC settings across Chile to provide in-depth insight into stigma among PHC professionals in the country. The authors hope it will be useful for future research on mental illness and substance use stigma in similar settings across Latin America.

Effectiveness of a health technician-delivered brief intervention for alcohol: a Bayesian reanalysis of a clinical trial.

OBJECTIVE: To reanalyze a clinical trial on the effectiveness of a Brief Intervention (BI) delivered by non-professionals to reduce risky alcohol drinking. Our previous null-hypothesis test of the effects of the BI yielded a 'non-significant' p-value, yet remained uninformative. Here we use the Bayesian paradigm which allows for expressing the probability of different effect sizes to better inform public policy decisions. RESULTS: The posterior probability of the odds of risky drinking at follow-up favored a marked effect of the BI, with 96% of the probability mass being less than OR = 1, and 84% being less than OR = 0.8. Our findings show that there is a high probability that the BI delivered by health technicians lowered risky alcohol use. The posterior distributions of the BI's effects are presented to help contextualize the evidence for policy making in Chile.

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

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

A Health Technician-delivered Brief Intervention linked to AUDIT for reduction of alcohol use in Chilean primary care: a randomized controlled trial.

BACKGROUND: Because of the shortage of health professionals in Chilean primary care, Health Technicians (HT) are providing Brief Interventions (BI) for risky alcohol consumption. We compared the efficacy of two AUDIT-linked interventions provided by HTs: an informative leaflet and a BI plus leaflet. METHODS: This is a parallel-group randomized controlled trial with 1:1 randomization. Participants were identified through screening with the Alcohol Use Disorders Identification Test (AUDIT) at five primary care centers between March 2016 and July 2017. People older than 18 years at intermediate-risk (AUDIT score 8 to 15, inclusive) were randomized to receive either an HT-delivered BI (n = 174) or an informative leaflet (n = 168). Only data from participants (n = 294) who completed the 6-month assessment were analyzed. The leaflet was delivered without further advice. It contains alcohol consumption limits, a change planner, and strategies to decrease drinking. The BI was a 5-min discussion on the leaflet´s content plus normative feedback, tailored information on alcohol and health, and a change plan. The change in the AUDIT risk category six months after randomization (primary outcome) was compared among groups with a Chi-squared test. Changes in the secondary outcomes, which were scores on the AUDIT and the AUDIT´s consumption items (AUDIT-C), were compared with T-tests. Mixed-effects linear models adjusted for potential confounders. Outcome adjudicators were blinded to group assignment. RESULTS: At 6-month follow-up, low-risk alcohol consumption was observed in 119 (80%) participants in the BI group, and in 103 (71%) in the leaflet group, with no difference among groups ([Formula: see text] [1, N = 294] = 2.6, p = 0.1; adjusted odds ratio 0.6; 95% confidence interval [CI] 0.34, 1.05). The mean AUDIT score decreased by 5.76 points in the BI group, and by 5.07 in the leaflet group, which represents a 0.86 AUDIT point reduction attributable to the BI (secondary outcome) (T = 2.03, p = 0.043; adjusted mean difference 0.86 CI 0.06, 1.66). CONCLUSIONS: The AUDIT-linked BI delivered by HTs was not associated with a greater reduction of risky alcohol consumption than an informative leaflet. Delivering a leaflet could be more efficient than a BI when provided by HTs; however, more research on the effectiveness of the leaflet is needed. Trial registration ClinicalTrials.gov NCT02642757 (December 30, 2015) https://clinicaltrials.gov/ct2/show/NCT02642757 .

Brief motivational therapy versus enhanced usual care for alcohol use disorders in primary care in Chile: study protocol for an exploratory randomized trial.

BACKGROUND: Harmful alcohol use is a leading cause of global disability and death. However, increased detection and brief intervention capacity of more severe alcohol use disorders has not been accompanied by increased availability of treatment services. Incorporating treatment for such disorders into primary care is of paramount importance for improving access and health outcomes. This study aims to estimate the effectiveness of a Brief Motivational Treatment (BMT) applied in primary care for treatment of these disorders. METHODS: A parallel-group, single-blinded, severity-stratified, randomized clinical trial will test the superiority of BMT over enhanced usual care. Eligible participants will be those seeking treatment and who fulfill DSM-V criteria for alcohol use disorder and criteria for harmful alcohol use. With an estimated a loss to follow-up of 20%, a total of 182 participants will be recruited and equally randomized to each treatment group. The intervention group will receive an adaptation of the motivational enhancement therapy, as manualized in Project MATCH. This treatment consists of four 45-min sessions provided by a general psychologist with at least 3 years of primary care experience. The primary outcome is the change from baseline in the drinks per drinking day during the last 90 days, which will be captured using the Timeline Follow Back method. Secondary outcomes will describe the changes in alcohol use pattern, motivational status, and severity of the disorder. All participants will be analyzed according to the group they were allocated, regardless of the treatment actually received. Mean differences (MD) will be computed for continuous outcomes and relative risks (RR) and RR reductions (RRR) for dichotomous results. Linear models will deliver the subgroup analyses. Missingness is assumed to be associated with the baseline alcohol use pattern and severity, so a multiple imputation method will be used to handle missing data. DISCUSSION: This trial aims to test the superiority of BMT over enhanced usual care with a reasonable superiority margin, over which the BMT could be further considered for incorporation into PC in Chile. Its pragmatic approach ultimately aims to inform policymakers about the benefit of including a brief psychosocial treatment into PC. TRIAL REGISTRATION: ClinicalTrials.gov NCT04345302 . Registered on 28 April 2020.

Burma Terrane part of the Trans-Tethyan Arc during collision with India according to palaeomagnetic data.

Convergence between the Indian and Asian plates has reshaped large parts of Asia, changing regional climate and biodiversity. Yet geodynamic models fundamentally diverge on how convergence was accommodated since the India-Asia collision. Here we report paleomagnetic data from the Burma Terrane, at the eastern edge of the collision zone and famous for its Cretaceous amber biota, to better determine the evolution of the India-Asia collision. The Burma Terrane was part of a Trans-Tethyan island arc and stood at a near-equatorial southern latitude at ~95 Ma, suggesting island endemism for the Burmese amber biota. The Burma Terrane underwent significant clockwise rotation between ~80-50 Ma, causing its subduction margin to become hyper-oblique. Subsequently, it was translated northward on the Indian Plate, by an exceptional distance of at least 2000 km, along a dextral strike-slip fault system in the east. Our reconstructions are only compatible with geodynamic models involving a first collision of India with a near-equatorial Trans-Tethyan subduction system at ~60 Ma, followed by a later collision with the Asian margin.

Apoyo social percibido en pacientes con Hipertensión Arterial y Diabetes Mellitus tipo II en Atención Primaria y su relación con autopercepción de salud / Social support, self-rated health, treatment adherence and effectiveness in patients with type II diabetes and hypertension

Background: A high level of social support (SS) is associated with better health outcomes in many conditions, such as chronic diseases. Aim : To describe the level of SS in patients with Hypertension and type II Diabetes at Primary Health Care level in Chile and its association with self-rated health, adherence to treatment and better glycemic and blood pressure control. Material and Methods : SS was measured using a social support inventory previously validated in Chile. Self-Rated Health was assessed with a single non-comparative general question; adherence to medication was assessed using the four-item Morisky medication adherence scale. Blood glucose and blood pressure control were also assessed. A logistic regression was performed to estimate Prevalence Odds Ratio (POR) and Robust Poisson method to estimate the Prevalence Ratio (PR). Results : Eighty three percent of the 647 participants evaluated high for SS. There was a significant correlation between SS and Self-rated health (POR 2.32; 95% confidence intervals (CI) 1.19-11.23; PR 1.18; 95% CI 1.07-1.31). No statistically significant association was observed with medication adherence, glycemic or blood pressure control. Conclusions: High levels of SS were found. The association between self-rated health suggests that SS interventions targeting vulnerable subgroups would be worthwhile.

Efectividad de un modelo de manejo de pacientes con hipertensión y diabetes tipo II en atención primaria / Effectiveness of a case management intervention for high blood pressure and type II diabetes in primary health care

Background: Adequate management of high blood pressure (HBP) and Type 2 Diabetes (DM2) is a challenge to the healthcare system in Chile. Aim: To evaluate the effectiveness of a case management (CM) approach to manage HBP and DMII at Primary Healthcare (PHC) level, headed by healthcare technicians with the supervision of registered nurses. Material and Methods: Two primary health care centers were selected. In one the case management approach was used and the other continued with the usual care model. Patients with HBP or DM2 were selected to participate in both centers. The main outcomes were changes blood pressure and glycosylated hemoglobin levels. Results: Three hundred twenty-eight patients were allocated to the intervention group and 316 to control group. At the baseline evaluation, participants at the control health center had better systolic and diastolic BP levels (SBP and DBP), but no difference in glycosylated hemoglobin. After twelve months the adjusted mean difference in HBP patients for SBP was −0.93 (95% conficence intervals (CI) −5.49,3.63) and for DBP was 1.78 (95%CI −2.89,6.43). Among HBP+DMII patients, the mean difference for SBP was −0.51 (95% −0.52,0.49) and for DBP was −3.39 (95%CI −6.07, −0.7). No differences in glycosylated hemoglobin were observed. In a secondary analysis, the intervention group showed a statistically significant higher SBP and DBP reduction than the control group. Conclusions: The case management approach tested in this study had promissory results among patients with high blood pressure.

[Social support, self-rated health, treatment adherence and effectiveness in patients with type II diabetes and hypertension]. / Apoyo social percibido en pacientes con Hipertensión Arterial y Diabetes Mellitus tipo II en Atención Primaria y su relación con autopercepción de salud.

BACKGROUND: A high level of social support (SS) is associated with better health outcomes in many conditions, such as chronic diseases. AIM: To describe the level of SS in patients with Hypertension and type II Diabetes at Primary Health Care level in Chile and its association with self-rated health, adherence to treatment and better glycemic and blood pressure control. MATERIAL AND METHODS: SS was measured using a social support inventory previously validated in Chile. Self-Rated Health was assessed with a single non-comparative general question; adherence to medication was assessed using the four-item Morisky medication adherence scale. Blood glucose and blood pressure control were also assessed. A logistic regression was performed to estimate Prevalence Odds Ratio (POR) and Robust Poisson method to estimate the Prevalence Ratio (PR). RESULTS: Eighty three percent of the 647 participants evaluated high for SS. There was a significant correlation between SS and Self-rated health (POR 2.32; 95% confidence intervals (CI) 1.19-11.23; PR 1.18; 95% CI 1.07-1.31). No statistically significant association was observed with medication adherence, glycemic or blood pressure control. CONCLUSIONS: High levels of SS were found. The association between self-rated health suggests that SS interventions targeting vulnerable subgroups would be worthwhile.

[Effectiveness of a case management intervention for high blood pressure and type II diabetes in primary health care]. / Efectividad de un modelo de manejo de pacientes con hipertensión y diabetes tipo II en atención primaria.

BACKGROUND: Adequate management of high blood pressure (HBP) and Type 2 Diabetes (DM2) is a challenge to the healthcare system in Chile. AIM: To evaluate the effectiveness of a case management (CM) approach to manage HBP and DMII at Primary Healthcare (PHC) level, headed by healthcare technicians with the supervision of registered nurses. MATERIAL AND METHODS: Two primary health care centers were selected. In one the case management approach was used and the other continued with the usual care model. Patients with HBP or DM2 were selected to participate in both centers. The main outcomes were changes blood pressure and glycosylated hemoglobin levels. RESULTS: Three hundred twenty-eight patients were allocated to the intervention group and 316 to control group. At the baseline evaluation, participants at the control health center had better systolic and diastolic BP levels (SBP and DBP), but no difference in glycosylated hemoglobin. After twelve months the adjusted mean difference in HBP patients for SBP was -0.93 (95% conficence intervals (CI) -5.49,3.63) and for DBP was 1.78 (95%CI -2.89,6.43). Among HBP+DMII patients, the mean difference for SBP was -0.51 (95% -0.52,0.49) and for DBP was -3.39 (95%CI -6.07, -0.7). No differences in glycosylated hemoglobin were observed. In a secondary analysis, the intervention group showed a statistically significant higher SBP and DBP reduction than the control group. CONCLUSIONS: The case management approach tested in this study had promissory results among patients with high blood pressure.

A randomized controlled trial of a brief intervention for alcohol and drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in primary health care in Chile.

AIM: To study the effectiveness of a brief intervention (BI) associated with the ASSIST (Alcohol Smoking and Substance Involvement Screening Test) for alcohol and illicit drug use as part of a systematic screening program implemented in primary care. DESIGN: A multi-center randomized open-label trial stratified using the ASSIST-specific substance involvement score (for alcohol, scores ranged from 11 to 15 and 16 to 20; and for the other substances from 4 to 12 and 13 to 20). SETTING: A total of 19 primary care centers (n = 520), eight emergency rooms (n = 195) and five police stations (n = 91) were evaluated. PARTICIPANTS: A total of 12 217 people aged between 19 and 55 years were screened for moderate alcohol and drug use risk as defined by the ASSIST Chilean version. A total of 806 non-treatment-seekers were randomized. INTERVENTION AND COMPARISON: ASSIST-linked BI (n = 400) compared with an informational pamphlet on risk associated with substance use (n = 406). MEASUREMENTS: Total ASSIST alcohol and illicit involvement score (ASSIST-AI), and ASSIST-specific score for alcohol, cannabis and cocaine at baseline and at 3-month follow-up. FINDINGS: Sixty-two per cent of participants completed follow-up. An intention-to-treat analysis showed no difference between the two groups for the ASSIST-AI score [mean difference (MD) = - 0.17, confidence interval (CI) = -1.87, 2.20], either for specific scores alcohol (MD = 0.18, CI = -1.45, 1.10), cannabis (MD = -0.62, CI = -0.89, 2.14) or cocaine (MD = -0.79, CI = -2.89, 4.47). CONCLUSION: It is not clear whether a brief intervention associated with the Alcohol Smoking and Substance Involvement Screening Test is more effective than an informational pamphlet in reducing alcohol and illicit substance consumption in non-treatment-seeking, primary care users with moderate risk.

Apoyo social y salud cardiovascular: adaptación de una escala de apoyo social en pacientes hipertensos y diabéticos en la atención primaria chilena / Social support and cardiovascular health: Adaptation of a social support scale for hypertensive and diabetic patients in primary care, Chile

OBJETIVO: Validar un instrumento para medir el apoyo social percibido en pacientes bajo control por hipertensión arterial y diabetes mellitus tipo 2. DISEÑO: Estudio observacional, exploratorio, con métodos mixtos, cualitativos y cuantitativos. Emplazamiento: Dos centros de atención primaria de la comuna de Puente Alto, en Santiago de Chile. PARTICIPANTES: Pacientes hipertensos y/o diabéticos entre 18 y 65 años. Para el estudio cualitativo la selección fue por conveniencia. La aplicación final se realizó en una muestra aleatorizada. MÉTODOS: Se realizaron grupos focales y entrevistas semiestructuradas para explorar el constructo de apoyo social según los pacientes. Según opinión de expertos y revisión de la literatura, se seleccionó una escala de apoyo social y se realizó un piloto a 40 pacientes y se entrevistó en profundidad a algunos participantes. En estas fases se modificó el instrumento según los resultados iniciales de grupos focales y piloto. La versión final se aplicó a 250 participantes. RESULTADOS: Se verificó la existencia del constructo «apoyo social». En la adaptación se eliminó un ítem. El alfa de Cronbach fue 0,89 y el análisis factorial conservó los 4 factores descritos en el estudio original. Al agregar 9 ítems obtenidos de los grupos focales, se obtiene un alfa de Cronbach de 0,92. CONCLUSIONES: El instrumento obtenido posee buenas propiedades sicométricas y es aplicable en nuestra población. Los ítems agregados aumentan su consistencia interna pero no aportan información nueva sobre el apoyo social percibido, lo que sugiere la aplicación del instrumento en su versión original, lo cual es consistente con estudios anteriores

GOAL: Validate an instrument to measure the Perceived Social Support in outpatients who are in treatment to hypertension and/or diabetes mellitus ii. DESIGN: Observational and exploratory design with mixed methods, qualitative and quantitative. SETTING: Two community health centers from the municipality of Puente Alto (Santiago, Chile). PARTICIPANTS: Hypertensive and/or diabetic patients between 18 and 65 years old. A purposive sample was undertaken for the qualitative study, and a random sample for the final survey. METHODS: Focus groups and semi-structured interviews were conducted to explore the constructs of social support as perceived by PATIENTS: According to expert opinion and literature review, a scale of social support was selected and a pilot study was conducted in 40 patients, then we interviewed in depth to some of those PARTICIPANTS: The instrument was modified according the results of this process. The final version was applied to 250 PARTICIPANTS: RESULTS: The construct existence was verified in the population. In the adaptation, one item was eliminated. The alpha of Cronbach was 0.89 and the factorial analysis had the same four factors from the original study. Nine new items obtained from the focal groups were added to the instrument, obtaining an alpha of Cronbach of 0.92. CONCLUSIONS: The final instrument has good psychometric proprieties, and is applicable in our population. The additional items from the qualitative study improve its internal consistency, but don't add new information about Perceived Social Support. This is consistent with other studies, and suggests the application of the original version of the instrument

[Social support and cardiovascular health: Adaptation of a social support scale for hypertensive and diabetic patients in primary care, Chile]. / Apoyo social y salud cardiovascular: adaptación de una escala de apoyo social en pacientes hipertensos y diabéticos en la atención primaria chilena.

GOAL: Validate an instrument to measure the Perceived Social Support in outpatients who are in treatment to hypertension and/or diabetes mellitus ii. DESIGN: Observational and exploratory design with mixed methods, qualitative and quantitative. SETTING: Two community health centers from the municipality of Puente Alto (Santiago, Chile). PARTICIPANTS: Hypertensive and/or diabetic patients between 18 and 65 years old. A purposive sample was undertaken for the qualitative study, and a random sample for the final survey. METHODS: Focus groups and semi-structured interviews were conducted to explore the constructs of social support as perceived by patients. According to expert opinion and literature review, a scale of social support was selected and a pilot study was conducted in 40 patients, then we interviewed in depth to some of those participants. The instrument was modified according the results of this process. The final version was applied to 250 participants. RESULTS: The construct existence was verified in the population. In the adaptation, one item was eliminated. The alpha of Cronbach was 0.89 and the factorial analysis had the same four factors from the original study. Nine new items obtained from the focal groups were added to the instrument, obtaining an alpha of Cronbach of 0.92. CONCLUSION: The final instrument has good psychometric proprieties, and is applicable in our population. The additional items from the qualitative study improve its internal consistency, but don't add new information about Perceived Social Support. This is consistent with other studies, and suggests the application of the original version of the instrument.

Mayor morbilidad y uso de servicios médicos en atención primaria en pacientes con trastorno depresivo mayor y sus familiares: un estudio de cohorte retrospectivo / Increased morbidity and use of Primary Care medical services in patients with major depressive disorder and their families: A retrospective cohort study

Objetivo: Evaluar el impacto del diagnóstico del trastorno depresivo mayor (TDM) en consultas médicas no psiquiátricas de pacientes y familiares, comparado con pacientes y familiares sin este diagnóstico en atención primaria. Diseño: Estudio observacional de cohorte retrospectiva. Emplazamiento: Centro de Salud Familiar San Alberto Hurtado, Santiago-Chile. Participantes: Pacientes con el diagnóstico de TDM durante el año 2008 fueron pareados con 2 personas sanas por sexo, edad y nivel educacional. Se siguieron 206 pacientes con 310 familiares y 412 controles con 588 familiares. Mediciones principales: Se evaluaron los motivos de consulta durante un año posterior al diagnóstico del TDM en los pacientes y sus familiares, comparándose con los controles y sus familiares. Para el análisis estadístico se utilizó prueba U de Mann-Whitney, considerando diferencias significativas valores p ≤ 0,05. Resultados: El riesgo relativo de consultar por motivos no psiquiátricos en pacientes deprimidos fue de 1,43 (IC 95% 1,19-1,67), y de sus familiares 1,37 (IC 95% 1,16-1,58). Los motivos de consulta más frecuentes en pacientes fueron diagnósticos osteomusculares, respiratorios, neurológicos. Los familares consultaron por causas relacionadas con enfermedad osteomuscular, psiquiátrica y endocrina. Conclusiones: Los pacientes con TDM y sus familiares tienen una mayor tasa de consultas en atención primaria, por lo que un enfoque familiar en la atención de estos pacientes podría mejorar los resultados clínicos y contribuir a disminuir la carga asistencial en este nivel de atención(AU)

Objective: To study the impact of non-psychiatric medical visits by patients with Major Depressive Disorder (MDD) and their family members, compared to healthy people and their relatives in Primary Care. Design: Retrospective cohort observational study. Location: San Alberto Hurtado Primary Care Clinic, Santiago-Chile. Participants: Patients diagnosed with MDD during 2008 were paired by gender, age, and educational level with 2 healthy controls. We followed-up 206 patients with 310 family members and 412 controls with 588 relatives. Main measurements: During 1 year after the diagnosis, all health visits were assessed in patients and their family members and compared with healthy controls and their relatives. For statistical analysis we used U-Mann-Whitney, considering statistical significance with p values ≤0.05. Results: The relative risk of making a non-psychiatric medical visit in depressed patients was 1.43 (95% CI: 1.19-1.67) and in their family members was 1.37 (95% CI: 1.16-1.58). The most frequent health complaints in patients were trauma, respiratory, and neurological problems. Family members visited physicians due trauma, psychiatric and endocrinological complaints. Conclusions: The patients with MDD and their family members have a higher rate of medical visits in Primary Care. A family-oriented treatment of these patients could improve clinical outcomes and reduce the patient overload in this setting(AU)

[Increased morbidity and use of Primary Care medical services in patients with major depressive disorder and their families: a retrospective cohort study]. / Mayor morbilidad y uso de servicios médicos en atención primaria en pacientes con trastorno depresivo mayor y sus familiares: un estudio de cohorte retrospectivo.

OBJECTIVE: To study the impact of non-psychiatric medical visits by patients with Major Depressive Disorder (MDD) and their family members, compared to healthy people and their relatives in Primary Care. DESIGN: Retrospective cohort observational study. LOCATION: San Alberto Hurtado Primary Care Clinic, Santiago-Chile. PARTICIPANTS: Patients diagnosed with MDD during 2008 were paired by gender, age, and educational level with 2 healthy controls. We followed-up 206 patients with 310 family members and 412 controls with 588 relatives. MAIN MEASUREMENTS: During 1 year after the diagnosis, all health visits were assessed in patients and their family members and compared with healthy controls and their relatives. For statistical analysis we used U-Mann-Whitney, considering statistical significance with p values ≤0.05. RESULTS: The relative risk of making a non-psychiatric medical visit in depressed patients was 1.43 (95% CI: 1.19-1.67) and in their family members was 1.37 (95% CI: 1.16-1.58). The most frequent health complaints in patients were trauma, respiratory, and neurological problems. Family members visited physicians due trauma, psychiatric and endocrinological complaints. CONCLUSIONS: The patients with MDD and their family members have a higher rate of medical visits in Primary Care. A family-oriented treatment of these patients could improve clinical outcomes and reduce the patient overload in this setting.

[Multidimensional assessment of public health care services for adolescents in Chile]. / Evaluación multidimensional de los servicios de salud para adolescentes en centros de Atención Primaria en una comuna de Santiago.

BACKGROUND: Adolescents are an especially vulnerable age group in terms of behavioral issues and require skilled teams in health centers. AIM: To assess the quality of health services provided to teenage users in Primary Health Care. MATERIAL AND METHODS: A study of multiple cases was carried out in two family health centers in Puente Alto, Chile. Health services delivered to adolescents were evaluated from the provider's perspective, through qualitative design of focus groups and interviews to the care teams at each centre. For technical quality, comparing electronic records of two tracer conditions (prenatal care and depression) with technical standards established by Delphi methodology and from teenage users perspective, through a survey of service satisfaction. RESULTS: In both centers, providers perceived a lack of training in adolescent care, a deficient preventive approach and a limited access to care. The technical evaluation showed an inappropriate recording of both tracer conditions. The instrument used to assess user satisfaction survey was reliable and showed that the best perceived issue was medical care and treatment, and the least perceived, was the access to the services. CONCLUSIONS: Professionals working in these health care facilities, feel unprepared to provide comprehensive approach to adolescents. The surveyed teenagers complained of limited access to care. Therefore this age group continues to be as a non-priority group for health care.

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

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

[Social capital and mental health in low income urban communities in Santiago, Chile]. / Capital social y salud mental en comunidades urbanas de nivel socioeconómico bajo, en Santiago, Chile: Nuevas formas de entender la relación comunidad-salud.

BACKGROUND: Many studies suggest that social capital, defined as those intangible resources of a society or community (trust, participation and reciprocity), that might facilitate collective action, can be associated with positive health effects. AIM: To explore the relationship between social capital an the level of mental health, in urban communities of Santiago, Chile. MATERIAL AND METHODS: In a qualitative-quantitative cross-sectional design, two low income neighborhoods in the municipality of Puente Alto were selected. Interviews to key agents and focus groups, as well as surveys (407) to adults from a representative random sample of households, were conducted, measuring social capital, using a locally devised questionnaire and mental health using the General Health Questionnaire (GHQ-12 instrument). A qualitative analysis based on the grounded theory and a quantitative analysis through correlations and simple and logistic regression models were applied. RESULTS: The quantitative analysis found an association between female gender, education and having a chronic disease, with low levels of mental health. At the same time, the trust component of social capital might be associated with a better mental health status. Qualitatively, all the components of social capital were identified as important for a better mental health. CONCLUSIONS: This study suggests the existence of a positive relationship between social capital and mental health. Developing trust in a community might be a useful tool to work in mental health at the community level.