Preventing zoonotic canine leishmaniasis in northeastern Brazil: pet attachment and adoption of community Leishmania prevention.

Visceral leishmaniasis (VL), caused by Leishmania infantum chagasi (L.i. chagasi syn. infantum) in northeastern Brazil, was responsible for 51,000 new VL cases from 1980 to 2003. Household presence of L. infantum-infected dogs is a major risk factor for human infection. Despite culling of dogs based on seropositivity, canine L. infantum seroprevalence remains near 20%, suggesting that dog culling is ineffective for preventing VL spread. We administered a cross-sectional survey to 224 households within 300 m of the homes of VL human patients diagnosed within the last year. The goal was to develop a model for voluntary preventative use based on characteristics and motivations of dog owners. We identified that owner knowledge deficiencies regarding canine transmission of L. infantum associated with increased risk of dog infection (odds ratio [OR] = 3.681, confidence interval [CI] = 1.223, 11.08). Higher owner education was associated with decreased levels of dog seropositivity (OR = 0.40, CI = 0.20, 0.81). Pet attachment (P = 0.036) and perception of risk/disease knowledge (P = 0.040) were significantly associated with willingness to voluntarily purchase canine VL prevention. These results highlight the importance of owner attachment to their pet in implementing reservoir-targeted zoonotic VL prevention.

[Effect of a tele-care model on self-management and metabolic control among patients with type 2 diabetes in primary care centers in Santiago, Chile]. / Efecto de un modelo de apoyo telefónico en el auto-manejo y control metabólico de la Diabetes tipo 2, en un Centro de Atención Primaria, Santiago, Chile.

BACKGROUND: Telephone based self-management support may improve the metabolic control of patients with type2 (DM2) diabetes if it is coordinated with primary care centers, if telephone protocols and clinical guidelines are used and if it is provided by nurses trained in motivational interviewing. AIM: To assess the efficacy of a tele-care self-management support model (ATAS) on metabolic control of patients with DM2 attending primary care centers in a low income area in Santiago, Chile. MATERIAL AND METHODS: Two primary care centers were randomly assigned to continue with usual care (control group, CG) or to receive additionally 6 telecare self-management support interventions (IG) during a 15 month period. Glycosylated hemoglobin (HbA1c) was used to measure metabolic control of DM2; the "Summary of Diabetes Self-care Activities Measure" and the "Spanish Diabetes Self-efficacy" scale were used to measure self-management and self efficacy, respectively. Changes in the use of health services were also evaluated. RESULTS: The IG maintained its HbA1c level (baseline and final levels of 8.3 +/- 2.3% and 8.5 +/- 2.2% respectively) whereas it deteriorated in the CG (baseline and final levels of 7.4 +/- 2.3 and 8.8 +/- 2.3% respectively, p < 0.001). The perception of self-efficacy in the IG improved while remaining unchanged in the CG (p < 0.001). Adherence to medication, physical activity and foot care did not change in either group. In the IG, compliance to clinic visits increased while emergency care visits decreased. CONCLUSIONS: The ATAS intervention, in low income primary care centers, significantly increased the probability of stabilizing the metabolic control of patients with DM2 and improved their use of health services.

Efecto de un modelo de apoyo telefónico en el auto-manejo y control metabólico de la Diabetes tipo 2, en un Centro de Atención Primaria, Santiago, Chile / Effect of a tele-care model on self-management and metabolic control among patients with type 2 diabetes in primary care centers in Santiago, Chile

Background: Telephone based self-management support may improve the metabolic control of patients with type 2 (DM2) diabetes if it is coordinated with primary care centers, if telephone protocols and clinical guidelines are used and if it is provided by nurses trained in motivational interviewing. Aim: To assess the efficacy ofi a tele-care self-management support model (ATAS) on metabolic control of patients with DM2 attending primary care centers in a low income area in Santiago, Chile. Material and Methods: Two primary care centers were randomly assigned to continue with usual care (control group, CG) or to receive additionally 6 telecare self-management support interventions (IG) during a 15 month period. Glycosylated hemoglobin (HbA1c) was used to measure metabolic control of DM2; the “Summary of Diabetes Self-care Activities Measure” and the “Spanish Diabetes Self-efficacy” scale were used to measure self-management and self efficacy, respectively. Changes in the use of health services were also evaluated. Results: The IG maintained its HbA1c level (baseline and final levels of 8.3 ± 2.3 percent and 8.5 ± 2.2 percent respectively) whereas it deteriorated in the CG (baseline and final levels of 7.4 ± 2.3 and 8.8 ± 2.3 percent respectively, p < 0.001). The perception of self-efficacy in the IG improved while remaining unchanged in the CG (p < 0.001). Adherence to medication, physical activity and foot care did not change in either group. In the IG, compliance to clinic visits increased while emergency care visits decreased. Conclusions: The ATAS intervention, in low income primary care centers, significantly increased the probability of stabilizing the metabolic control of patients with DM2 and improved their use of health services.

Validación de una versión en español de la Escala de Conflicto Decisional / Validation of a Spanish version of the Decisional Conflict Scale

Background: In Chile, in approximately 50 percent of nursing students, nursing was not their first choice as career. Usually, during the first year, these students must decide whether they would like to continue in the same career. A valid tool is needed to identify decisional conflicts and their contributing factors among these students and to develop an appropriate strategy to support them duríng their decision-making process. Aim: To translate into Spanish and validate the Generic Decisional Conflict Scale (DCS). Material and methods: The DCS was translated from English to Spanish and was used with 331 first-year nursing students at the Pontificia Universidad Católica de Chile. The scale was assessed for validity and reliability using statistical tests, including factor analysis and Cronbach alpha test. Results: The Spanish version of the DCS had acceptable validity and reliability. Factorial analysis identified four factors and only the item: "advice" loaded the other factors. Cronbach alpha was 0.80. Conclusions: DCS is a valid and useful instrument to identify decisional conflicts and contributing factors to continue studies among nursing students.

[Validation of a Spanish version of the Decisional Conflict scale]. / Validación de una versión en español de la Escala de Conflicto Decisional.

BACKGROUND: In Chile, in approximately 50% of nursing students, nursing was not their first choice as career. Usually, during the first year, these students must decide whether they would like to continue in the same career. A valid tool is needed to identify decisional conflicts and their contributing factors among these students and to develop an appropriate strategy to support them during their decision-making process. AIM: To translate into Spanish and validate the Generic Decisional Conflict Scale (DCS). MATERIAL AND METHODS: The DCS was translated from English to Spanish and was used with 331 first-year nursing students at the Pontificia Universidad Católica de Chile. The scale was assessed for validity and reliability using statistical tests, including factor analysis and Cronbach alpha test. RESULTS: The Spanish version of the DCS had acceptable validity and reliability. Factorial analysis identified four factors and only the item: "advice" loaded the other factors. Cronbach alpha was 0.80. CONCLUSIONS: DCS is a valid and useful instrument to identify decisional conflicts and contributing factors to continue studies among nursing students.

Use of telephone care in a cardiovascular disease management programme for type 2 diabetes patients in Santiago, Chile.

OBJECTIVES: In 2004, the Chilean National Ministry of Health instituted a cardiovascular disease (CVD) management programme aimed at improving diabetes care among patients treated in the public healthcare system. We sought to identify the characteristics of patients participating in the CVD programme and the feasibility of extending its reach through structured nurse telephone contacts between outpatient encounters. METHODS: We surveyed 569 low-income adults with type 2 diabetes treated in public clinics of Santiago, to assess patients' participation in the CVD programme and willingness to use telephone care services. Surveys were linked to information from medical records. RESULTS: One-third of patients met the target of two visits to the CVD programme in the previous 6 months, and an additional 32% made more than three visits. Use of the CVD programme was associated with greater patient satisfaction, even after controlling for potential confounders. However, 27% of patients had inadequate programme contact, and many of these patients were in poor health. Many CVD programme participants reported difficulties with lifestyle changes, and greater contact with the CVD programme was not associated with healthier behaviours. Most patients (95%) reported telephone access and 37% had used the telephone to contact their clinic. The majority of patients would be willing to use telephone care for additional behaviour change and emotional support. Patients with fewer CVD programme visits were particularly likely to report willingness to use telephone care. DISCUSSION: Clinic-based CVD disease management services reach a large number of socio-economically vulnerable Chileans with diabetes. However, barriers to access remain, and planned telephone care services may increase the reach of self-management support.