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

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

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

BACKGROUND: The incorporation of integrative medicine as a holistic approach increased in medical education. However, complementary and alternative medicine (CAM) formal teaching in psychiatry residency programs is limited. AIM: To assess the incorporation of CAM education in different Chilean psychiatry programs and to determine the knowledge and attitudes toward this issue. MATERIAL AND METHODS: An online survey was sent to 80 academic staff from five psychiatry programs. Forty-nine participants answered the survey (61%). Some of the questionnaire topics were the inclusion of CAM content in the program, types of CAM included, and motivation and strategies for the CAM content incorporation in their training curriculum. RESULTS: Most respondents answered that there is no formal CAM content in their program's curriculum. The main topics to incorporate CAM in a psychiatry residency are sleep hygiene, stress management, and motivational interviewing. The lack of knowledge, time constraints, and the limited resources are major barriers to include CAM in their curriculums. CONCLUSIONS: Our results suggest that many academic staff of Chilean psychiatry training programs are aware of the importance of having CAM content in their curriculum. However, some barriers hinder their incorporation and implementation.

Cognitive Outcomes in Congenital Hypothyroidism: Impact of Socioeconomic Status - A Case-Control Study.

OBJECTIVE: Chile is one of the few high-income countries in Latin America, being a pioneer in implementing a national newborn screening (NBS) program in 1992. Currently, it covers 98% of the population, but no long-term outcomes have been described so far. The aim of this study was to report the neurocognitive outcomes of children with congenital hypothyroidism (CH) diagnosed by the NBS program in Chile between 2005 and 2012 and to identify variables associated with the outcomes. METHODS: We performed a case-control study in children with CH born in the two largest regions of the country. The Leiter-R and TEVI-R tests were administered at home to 69 children with CH and 68 matched control subjects. Other variables affecting cognition were obtained. Multivariate logistic regression analyses were performed for Leiter-R and TEVI-R tests, using a model for cases alone and another model for cases and controls. RESULTS: No differences in Leiter-R and TEVI-R results were observed between children with CH and the control group. Children who performed better, regardless of whether they had CH, had a higher family income and more assets. CONCLUSIONS: These results suggest that the Chilean NBS program strategy results in children with normal language, attention, and memory development. Socioeconomic disadvantage represents a significant detriment in cognitive function.

COVID-19 and resilience of healthcare systems in ten countries.

Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have important effects on population health. In this study, we used an interrupted time series design to assess the immediate effect of the pandemic on 31 health services in two low-income (Ethiopia and Haiti), six middle-income (Ghana, Lao People's Democratic Republic, Mexico, Nepal, South Africa and Thailand) and high-income (Chile and South Korea) countries. Despite efforts to maintain health services, disruptions of varying magnitude and duration were found in every country, with no clear patterns by country income group or pandemic intensity. Disruptions in health services often preceded COVID-19 waves. Cancer screenings, TB screening and detection and HIV testing were most affected (26-96% declines). Total outpatient visits declined by 9-40% at national levels and remained lower than predicted by the end of 2020. Maternal health services were disrupted in approximately half of the countries, with declines ranging from 5% to 33%. Child vaccinations were disrupted for shorter periods, but we estimate that catch-up campaigns might not have reached all children missed. By contrast, provision of antiretrovirals for HIV was not affected. By the end of 2020, substantial disruptions remained in half of the countries. Preliminary data for 2021 indicate that disruptions likely persisted. Although a portion of the declines observed might result from decreased needs during lockdowns (from fewer infectious illnesses or injuries), a larger share likely reflects a shortfall of health system resilience. Countries must plan to compensate for missed healthcare during the current pandemic and invest in strategies for better health system resilience for future emergencies.

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

Background: The incorporation of integrative medicine as a holistic approach increased in medical education. However, complementary and alternative medicine (CAM) formal teaching in psychiatry residency programs is limited. Aim: To assess the incorporation of CAM education in different Chilean psychiatry programs and to determine the knowledge and attitudes toward this issue. Material and Methods: An online survey was sent to 80 academic staff from five psychiatry programs. Forty-nine participants answered the survey (61%). Some of the questionnaire topics were the inclusion of CAM content in the program, types of CAM included, and motivation and strategies for the CAM content incorporation in their training curriculum. Results: Most respondents answered that there is no formal CAM content in their program's curriculum. The main topics to incorporate CAM in a psychiatry residency are sleep hygiene, stress management, and motivational interviewing. The lack of knowledge, time constraints, and the limited resources are major barriers to include CAM in their curriculums. Conclusions: Our results suggest that many academic staff of Chilean psychiatry training programs are aware of the importance of having CAM content in their curriculum. However, some barriers hinder their incorporation and implementation.

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

Background: Healthcare workers' mental health was affected by SARS-CoV-2 pandemic. Aim: To evaluate healthcare workers' mental health and its associated factors during the pandemic in Chile. Material and Methods: An online self-reported questionnaire was designed including the Goldberg Health Questionnaire, the Patient Health Questionnaire, (PHQ-9), and the Columbia-Suicide Severity Rating Scale among other questions. It was sent to 28,038 healthcare workers. Results: The questionnaire was answered by 1,934 participants, with a median age of 38 years (74% women). Seventy five percent were professionals, and 48% worked at a hospital. Fifty nine percent of respondents had a risk of having a mental health disorder, and 73% had depressive symptoms. Significant associations were found with sex, workplace, and some of the relevant experiences during the pandemic. Fifty one percent reported the need for mental health support, and 38% of them received it. Conclusions: There is a high percentage of health workers with symptoms of psychological distress, depression, and suicidal ideas. The gender approach is essential to understand the important differences found. Many health workers who required mental health care did not seek or received it.

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

BACKGROUND: Healthcare workers' mental health was affected by SARS-CoV-2 pandemic. AIM: To evaluate healthcare workers' mental health and its associated factors during the pandemic in Chile. MATERIAL AND METHODS: An online self-reported questionnaire was designed including the Goldberg Health Questionnaire, the Patient Health Questionnaire, (PHQ-9), and the Columbia-Suicide Severity Rating Scale among other questions. It was sent to 28,038 healthcare workers. RESULTS: The questionnaire was answered by 1,934 participants, with a median age of 38 years (74% women). Seventy five percent were professionals, and 48% worked at a hospital. Fifty nine percent of respondents had a risk of having a mental health disorder, and 73% had depressive symptoms. Significant associations were found with sex, workplace, and some of the relevant experiences during the pandemic. Fifty one percent reported the need for mental health support, and 38% of them received it. CONCLUSIONS: There is a high percentage of health workers with symptoms of psychological distress, depression, and suicidal ideas. The gender approach is essential to understand the important differences found. Many health workers who required mental health care did not seek or received it.

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

INTRODUCCIÓN: Se ha observado un aumento en la popularidad de las dietas vegetarianas, en especial en la población adolescente y adulto joven. Estas dietas se presentan como saludables y balanceadas pero las recomendaciones son controversiales en cuanto a los potenciales déficit nutricionales. OBJETIVO: Identificar la frecuencia y tipos de dieta vegetariana utilizada, su motivación y fuentes de información. PACIENTES Y MÉTODO: Estudio transversal y analítico en universitarios de primer año de la Pontificia Universidad Católica de Chile (PUC). Se realizó una encuesta vía online obteniendo información demográfica y caracterización de dietas de aquellos que se consideraban vegetarianos. Las variables fueron analizadas mediante el software IDM SPSS Statistics® y en planilla Excel® de forma cuantitativa. RESULTADOS: 152 alumnos respondieron la encuesta (15,2% del total), siendo el 49,4% de estos vegetariano. El 32,4% inició este patrón alimentario entre los 12-18 años; sus motivaciones más frecuentes fueron las medio ambientalistas (91,9%) y animalistas (72,9%). El 52,9% de los vegetarianos reciben suplementación de vitamina b 12 pero solo un 15,9% reportó presentar este déficit. El 75,7% obtiene información relacionada acerca de las dietas vegetarianas a través de medios digitales. CONCLUSIÓN: Se encontró un alto porcentaje de estudiantes vegetarianos en las encuestas contestadas, lo que hace necesario que los profesionales de salud estén capacitados en esta área para asegurar una adecuada educación nutricional, suplementación si es necesario, y seguimiento.

INTRODUCTION: There has been an increase in the popularity of vegetarian diets, especially among adolescents and young adults. These diets seem to be healthy and balanced, but the recommendations are contro versial regarding potential nutritional deficits. OBJECTIVE: To identify the frequency and types of ve getarian diet used, their motivation, and sources of information. PATIENTS AND METHOD: Cross-sec tional analytical study in freshmen students from the Pontifical Catholic University of Chile (PUC). Through an online survey, we collected demographic information and diet characterization of those who considered themselves as vegetarians. Variables were analyzed using IDM SPSS Statistics® soft ware and in Excel® spreadsheet in a quantitative way. RESULTS: 152 students answered the survey (15.2% of the sample) and, out of these, 49.4% were vegetarian. 32.4% started this eating pattern bet ween the ages 12 and 18 and among their most frequent motivations were environmentalists (91.9%) and animalists (72.9%). 52.9% of vegetarians take vitamin B 12 supplementation but only 15.9% reported having this deficiency. 75.7% obtain information related to vegetarian diets through digital media. CONCLUSION: In the surveys answered, we found a high percentage of vegetarian students, the refore, health professionals need to be trained in this area to assure adequate nutritional education, supplementation if necessary, and follow-up.

2018 Chilean Physical Activity Report Card for Children and Adolescents: Full Report and International Comparisons.

BACKGROUND: The study summarizes the findings of the 2018 Chilean Report Card (RC) on Physical Activity (PA) for Children and Adolescents and compares the results with the first Chilean RC and with other countries from the Global Matrix 3.0. METHODS: A Research Work Group using a standardized methodology from the Global Matrix 3.0 awarded grades for 13 PA-related indicators based on the percentage of compliance for defined benchmarks. Different public data sets, government reports, and papers informed the indicators. RESULTS: The grades assigned were for (1) "behaviors that contribute to overall PA levels": overall PA, D-; organized sport participation, D-; active play, INC; and active transportation, F; (2) "factors associated with cardiometabolic risk": sedentary behavior, C-; overweight and obesity, F; fitness, D; sleep, INC; and (3) "factors that influence PA": family and peers, F; school, D; inclusion, INC; community and built environment, B; government strategies and investments, B-. CONCLUSIONS: Chile's grades remained low compared with the first RC. On the positive side, Chile is advancing in environmental and policy aspects. Our findings indicate that the implementation of new strategies should be developed through collaboration between different sectors to maximize effective investments for increasing PA and decreasing sedentary time among children and adolescents in Chile.

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

The catastrophic emergency experienced by many countries with the COVID-19 pandemic emphasized the importance of bioethics for decision-making, both at the public health (equitable and effective policies) and at the clinical level. At the clinical level, the issues are the fulfillment of medical care demand with adequate health care teams, infrastructure, and supplies, and to cover critical care demands that surpass the available resources. Therefore, ethically correct approaches are required for the allocation of life sustaining resources. There are recommendations for the allocating life support during disasters based on multiple considerations, including ethical ones. However, the ethical criteria of existing guidelines are variable. Ethical principles usually considered are saving the greatest number of lives, saving the greatest number of years of life and the principle of the life cycle or the goal to give each individual equal opportunity to live through the various phases of life. However, the centrality of the human being and the search for the common good should be considered. Knowledge of public perspectives and moral benchmarks on these issues is essential. A successful assignment effort will require everyone's trust and cooperation. Decision making should be planned and discussed in advance, since in-depth deliberation will be extremely complex during the disaster. Our goal is to help the health care teams to wisely allocate resources in shortage periods.

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

The catastrophic emergency experienced by many countries with the COVID-19 pandemic emphasized the importance of bioethics for decision-making, both at the public health (equitable and effective policies) and at the clinical level. At the clinical level, the issues are the fulfillment of medical care demand with adequate health care teams, infrastructure, and supplies, and to cover critical care demands that surpass the available resources. Therefore, ethically correct approaches are required for the allocation of life sustaining resources. There are recommendations for the allocating life support during disasters based on multiple considerations, including ethical ones. However, the ethical criteria of existing guidelines are variable. Ethical principles usually considered are saving the greatest number of lives, saving the greatest number of years of life and the principle of the life cycle or the goal to give each individual equal opportunity to live through the various phases of life. However, the centrality of the human being and the search for the common good should be considered. Knowledge of public perspectives and moral benchmarks on these issues is essential. A successful assignment effort will require everyone's trust and cooperation. Decision making should be planned and discussed in advance, since in-depth deliberation will be extremely complex during the disaster. Our goal is to help the health care teams to wisely allocate resources in shortage periods.

La compasión: clave en la renovación de la atención en salud / Compassion: key in the renewal of health care

Introducción: durante el último tiempo, las prácticas de atención en salud han experimentado un profundo cambio en la medida que los avances científicos y tecnológicos han alcanzado y modificado la clásica relación médico-paciente. El panorama moderno y las presiones e influencias económicas sobre el ejercicio profesional han conducido, además, a una manifiesta insatisfacción respecto al servicio, tanto de usuarios como de profesionales. Ante esta situación, la compasión podría constituirse en un recurso clave para redirigir nuevamente el foco de la atención hacia la persona. Material y método: se realiza una revisión bibliográfica con el propósito de ilustrar sobre esta capacidad, así como invitar a la reflexión sobre la misma. Resultados: el desarrollo de la compasión permite mejorar el trato con los pacientes al mismo tiempo que contribuye al autocuidado de los profesionales de la salud. La evidencia científica disponible al respecto ha permitido comprender la naturaleza neurobiológica de esta capacidad, así como los múltiples beneficios de su desarrollo e integración a la práctica clínica. Conclusión: existe una necesidad urgente de llevar a cabo una transformación de la atención de salud, la cual no debe plantearse de manera exclusiva a partir de los requerimientos estructurales-materialistas del sistema, sino que también debe reivindicar la importancia de implementar cambios personales y organizacionales que se direccionen hacia una humanización del servicio, para centrarlo efectivamente en la persona

Introduction: In recent times, health care has undergone a deep change in the way scientific and technological advances have reached and modified the traditional doctor-patient relationship. The modern context and the economic pressures influence how medical care is performed and have also led to dissatisfaction, both from users and professionals, with health care services. In response to these, compassion could be a key resource to redirect the attention focus back to the whole person. Material and methods: A bibliographic review was carried with the purpose to illustrate this compassionate motivation, as well as to invite to reflect about it. Results: Deve-loping compassion in healthcare professionals and institutions improve the quality of health care and, at the same time, contributes to the professional's self-care. Available scientific evidence has allowed us to understand the neurobiological basis of compassion, as well as the multiple benefits of its development and integration into clinical practice. Conclusion: It is both necessary and urgent to carry out a transformation of the health care system in the direction of compassionate care, which must not be formulated exclusively from the structural-materialistic requirements of the system, but also must to claim the importance of implementing personal and organizational changes oriented towards humanization of service.

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

INTRODUCTION: There has been an increase in the popularity of vegetarian diets, especially among adolescents and young adults. These diets seem to be healthy and balanced, but the recommendations are contro versial regarding potential nutritional deficits. OBJECTIVE: To identify the frequency and types of ve getarian diet used, their motivation, and sources of information. PATIENTS AND METHOD: Cross-sec tional analytical study in freshmen students from the Pontifical Catholic University of Chile (PUC). Through an online survey, we collected demographic information and diet characterization of those who considered themselves as vegetarians. Variables were analyzed using IDM SPSS Statistics® soft ware and in Excel® spreadsheet in a quantitative way. RESULTS: 152 students answered the survey (15.2% of the sample) and, out of these, 49.4% were vegetarian. 32.4% started this eating pattern bet ween the ages 12 and 18 and among their most frequent motivations were environmentalists (91.9%) and animalists (72.9%). 52.9% of vegetarians take vitamin B 12 supplementation but only 15.9% reported having this deficiency. 75.7% obtain information related to vegetarian diets through digital media. CONCLUSION: In the surveys answered, we found a high percentage of vegetarian students, the refore, health professionals need to be trained in this area to assure adequate nutritional education, supplementation if necessary, and follow-up.

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

INTRODUCTION: Screening for Autism Spectrum Disorders (ASD) using the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) increases early detection, allowing early interventions and improving prognosis. This tool is part of the management in case of suspected ASD in several clinical guidelines. The objective of this article was to conduct the concurrent and discrimi nant validation and the reliability analysis of M-CHAT-R/F in the Chilean population. PATIENTS AND METHOD: This is the second stage of the cross-cultural adaptation of cross-sectional design. M-CHAT- R/F was applied to a sample of 20 children with suspected ASD and 100 randomly selected healthy control children, aged between 16-30 months. Autism Diagnostic Observation Schedule (ADOS-2), considered as reference, was applied to the 20 patients of the clinical sample, to 20 children of the healthy control sample and to those cases of the healthy control sample with M-CHAT-R/F positive. Cronbach alpha was calculated, as well as M-CHAT-R/F and ADOS-2 correlation, sensitivity, and specificity analyses. RESULTS: In the healthy sample, M-CHAT-R/F was positive in two patients, with one of them positive and the other one negative for ASD with ADOS-2 test. In the clinical sample, M- CHAT-R/F was positive in all cases, three of them were negative in the ADOS-2 test. The Alfa relia bility of M-CHART-R/T was 0,889, the discriminant sensitivity and specificity were 100% and 98%, and the concurrent ones were 100% and 87.5% respectively. CONCLUSIONS: The Chilean M-CHAT- R/F version was reliable, sensitive and specific, similar to the original test, which opens the possibility for its use in clinical samples and for research. Validating M-CHAT-R/F is an ongoing process which must be further developed.

An Acceptability Study Of A Personal Portable Device Storing Critical Health Information To Ensure Treatment Continuity Of Home-Dwelling Older Adults In Case Of A Disaster.

AIMS: DEPPAS ("Dispositivo Electrónico Personal y Portable en Salud" or Personal, Portable Electronic Health Device in English) is a portable device in form of a bracelet that allows storing electronic health records of older adults experiencing chronic illnesses. The device seeks to support the vital sustainability of older adults by storing critical health information when electronic or paper records have been lost as a consequence of a disaster. Older adults are particularly vulnerable to experience negative consequences in this context. The present study explores the end-user acceptability of DEPPAS in order to inform the next design stages of the device. METHODS: Twenty home-dwelling urban male and female older adults enrolled in a chronic health management program were invited to participate in two focus groups. A prototype of DEPPAS was presented and reactions to health service disruption scenarios were explored. Focus groups were transcribed. Content analysis based on the Technology Acceptance Model was conducted. RESULTS: Older adults are acutely aware of their vulnerable health status. Participants report overall positive reactions to DEPPAS. The device was associated with feelings of relief and an increased sense of control over their health management. DEPPAS is perceived as useful, usable, and safe. Even though concerns regarding confidentiality were raised, benefits are perceived as more relevant than potential risks. Participants agree that its usefulness could be extended beyond disaster situations to everyday health care management. Implications for future development and limitations are discussed. CONCLUSION: The conceptual design DEPPAS shows a high level of acceptability by this end user and a high potential to be integrated with other complementary technologies (e.g. GPS, medication reminders) that could significantly contribute to improving health management in disaster situations.

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

INTRODUCCIÓN: El tamizaje de los Trastornos del Espectro Autista (TEA) mediante el Modified Chec klist for Autism in Toddlers - Revised with Follow Up (M-CHAT-R/F) aumenta la detección precoz, posibilitando intervenciones tempranas y mejorando el pronóstico. Este instrumento es parte del algoritmo de manejo ante la sospecha de TEA en diversas guías clínicas. El objetivo fue realizar la validación concurrente, discriminante y el análisis de confiabilidad del M-CHAT-R/F en una pobla ción chilena. PACIENTES Y MÉTODO: Esta es la segunda etapa de la adaptación transcultural, de diseño transversal. Se aplicó M-CHAT-R/F a una muestra de 20 niños con sospecha de TEA y 100 niños de control sano seleccionados al azar, de 16-30 meses de edad. Se aplicó Autism Diagnostic Observation Schedule (ADOS-2), considerado como referencia, a los 20 pacientes de la muestra clínica, a 20 niños de la muestra de control sano y a aquellos casos de la muestra de control sano con M-CHAT-R/F po sitivo. Se calculó alfa de Cronbach, análisis de correlación de M-CHAT-R/F y ADOS-2 y sensibilidad y especificidad. RESULTADOS: En el grupo de control sano, M-CHAT-R/F resultó alterado en 2 pacien tes, siendo uno positivo y otro negativo para TEA con ADOS-2. En muestra clínica el M-CHAT-R/F fue positivo en todos, con test de ADOS-2 negativo en 3 casos. La confiabilidad Alfa del M-CHAT- R/F fue =0,889, la sensibilidad y especificidad discriminante de 100 y 98% y la concurrente 100% y 87,5% respectivamente. CONCLUSIÓN: M-CHAT-R/F en su versión chilena resultó fiable, sensible y específico de manera similar al original, lo cual abre la posibilidad de su utilización en población clínica y para investigación. La validación es un proceso continuo que se debe profundizar.

INTRODUCTION: Screening for Autism Spectrum Disorders (ASD) using the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) increases early detection, allowing early interventions and improving prognosis. This tool is part of the management in case of suspected ASD in several clinical guidelines. The objective of this article was to conduct the concurrent and discrimi nant validation and the reliability analysis of M-CHAT-R/F in the Chilean population. PATIENTS AND METHOD: This is the second stage of the cross-cultural adaptation of cross-sectional design. M-CHAT- R/F was applied to a sample of 20 children with suspected ASD and 100 randomly selected healthy control children, aged between 16-30 months. Autism Diagnostic Observation Schedule (ADOS-2), considered as reference, was applied to the 20 patients of the clinical sample, to 20 children of the healthy control sample and to those cases of the healthy control sample with M-CHAT-R/F positive. Cronbach alpha was calculated, as well as M-CHAT-R/F and ADOS-2 correlation, sensitivity, and specificity analyses. RESULTS: In the healthy sample, M-CHAT-R/F was positive in two patients, with one of them positive and the other one negative for ASD with ADOS-2 test. In the clinical sample, M- CHAT-R/F was positive in all cases, three of them were negative in the ADOS-2 test. The Alfa relia bility of M-CHART-R/T was 0,889, the discriminant sensitivity and specificity were 100% and 98%, and the concurrent ones were 100% and 87.5% respectively. CONCLUSIONS: The Chilean M-CHAT- R/F version was reliable, sensitive and specific, similar to the original test, which opens the possibility for its use in clinical samples and for research. Validating M-CHAT-R/F is an ongoing process which must be further developed.

Supporting the caregiver-child dyad's relationship: An evaluation of implementation quality in the Chilean Crecer Jugando program.

This study presents an evaluation of the implementation quality of the Chilean program Crecer Jugando (CJ), a 16 weekly sessions group-based parenting program for children 0 to 4 years old and their primary caregivers aiming at promoting positive caregiver-child interaction. The implementation of CJ in two public health care centers (HCC) in Chile's Metropolitan Region was assessed based on Donabedian's theoretical model, focusing on the dimensions of the program's structure (e.g., infrastructure and supplies), processes (e.g., coordination of CJ team with the HCCs, participants' attendance, CJ team interaction with participating children), and preliminary outcomes (i.e., parenting stress, caregiver-child interaction). A total of 63 main caregiver-child dyads participated in the study, which took place over a six-month period. Results indicated that the CJ program was feasible to be implemented in two HCCs and would benefit from improving the coordination with the HCCs and the quality of interaction of the CJ team with participating children. After participation in the CJ program, caregivers showed a decrease in their parenting stress. Lessons learned are discussed.

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

INTRODUCTION: The dysregulation profile (DP) is a relevant clinical entity in the children and ado lescent area since its association with future psychopathology. DP is defined by the Child Behavior Checklist (CBCL), combining internalizing symptoms (anxiety/depression) and externalizing ones (aggressiveness, attention problems). OBJECTIVES: To study the frequency of CBCL-DP in a sample of Chilean preschoolers. PATIENTS AND METHOD: A sociodemographic survey and CBCL 1.5-5 was applied to caregivers of children aged 30 to 48 months in a national representative sample of public health system users. Frequency was estimated using the Kim et al. method and an explanatory model was made using binary logistic regression of DP using the child, caregiver, and contextual variables. RESULTS: The sample size was n = 1,429 preschool children and their caregivers. The frequency of DP was 11.6% (95% CI 9.9-13.5%). The variables that allow to classify DP in 88.6% of cases were: current depressive symptoms in the main caregiver (OR: 2.24; 95% CI 1.37-3.67); number of stressful events experienced by the main caregiver (p = 0.005); number of available elements for child development stimulation in the home (p = 0.001); number of chronic diseases of the child (p = 0.006). Conclu sions: DP has a high frequency in preschoolers, which implies a relevant mental health burden. This finding points to the need for interventions in this area and also longitudinal monitoring of this subgroup.