Shared Components of Worldwide Successful Sexuality Education Interventions for Adolescents: A Systematic Review of Randomized Trials.

A crucial aspect of human development is sexuality which has implications for health, particularly in adolescence, since unfavorable sexual experiences may result in physical and mental problems. Sexuality education interventions (SEI) are one of the most used actions to promote sexual health in adolescents. Nevertheless, there is variability across their components; therefore, key elements for an effective SEI targeted at adolescents (A-SEI) are not well known. Based on this background, this study aims to identify the shared components of successful A-SEI through a systematic review of randomized controlled trials (RCT). This study followed the preferred reporting items for systematic reviews and meta-analyses statement. A search was conducted in CINAHL, PsycInfo, PubMed, and Web of Science between November and December 2021. A total of 21 studies passed the inclusion test after the review of 8318 reports. A total of 18 A-SEIs were identified in these studies. The components analyzed were the intervention's approach, dose, type of intervention, theoretical framework, facilitators' training, and intervention methodology. The results established that components that should be present in the design of an effective A-SEI are behavior change theoretical models, the use of participatory methodology, be targeted at mixed-sex groups, facilitators' training, and at least ten hours of weekly intervention.

Implementation and Outcomes of a National School-Based Mental Health Program for Middle School Students in Chile.

Background: Chile's national school-based mental health program, Skills for Life (SFL), has demonstrated effectiveness in improving behavioral and academic outcomes in first- through third-grade students. The current study assessed the feasibility and outcomes of SFL's program for sixth- through eighth-grade students. Methods: We assessed the percentage of students who participated in the program and longitudinal changes on teacher-reported Teacher Observation of Classroom Adaptation Re-Revised (TOCA-RR) scores, youth-reported Pediatric Symptom Checklist-Chile (PSC-Y-CL) scores, grade-point average, and school attendance from sixth to eighth grade (2016-2018) for SFL's workshop intervention. Linear mixed effects models analyzed the association between outcome variables and workshop attendance. Results: Of the 30,649 sixth graders who attended the 754 participating schools in 2016, 28,204 (92.0%) were screened with the TOCA-RR. Of the 1829 students who screened at risk, 1344 had available workshop data for seventh grade, with 86.9% of them participating in most (≥ 7) workshop sessions. Workshop attendance was significantly associated with improvements in school attendance and peer relationships (a TOCA-RR subscale) in eighth grade. Conclusions: With high rates of behavioral health screening and workshop attendance, this study demonstrated the feasibility of implementing SFL's middle school program on a national scale. Higher workshop attendance by at-risk students was associated with better school attendance and peer relationships in eighth grade, as well as better but not significantly different outcomes on other measures (e.g., teacher-rated school performance and aggressive behavior in the classroom). Overall, these findings provide preliminary evidence of the feasibility and benefits of SFL's middle school program.

Illness Experience and Quality of Life in Sjögren Syndrome Patients.

Sjögren's syndrome (SS) is a disease with autoimmune features that affects mainly women and compromises the health-related quality of Life (HRQoL); it is important to evaluate illness experience for a better understanding of the life situation of the patient. The aim of the study was to summarize the individual life experiences and determine the impact of HRQoL and oral health-related quality of life (OHRQoL) and their correlation with health self-assessment in women with SS. The life experiences evaluation employed a concept mapping design to structure qualitative content obtained from semi-structured interviews. Hierarchical cluster analysis was used to analyze the patient's experiences. EQ-5D-5L and OHIP-14Sp were used. The correlation between appreciation of the general health status and OHIP-14 was evaluated. The experience classification by patients were analyzed and a dendrogram was obtained, identifying 10 clusters of disease experiences of SS, being limitations, pain and difficulties, coping and attitudes towards treatment the most common. Pain/discomfort in EQ-5D-5L and physical pain and psychological discomfort in OHIP-14 were the most affected dimensions in the patients. The results support the theoretical perspective that the experience of illness is relevant to describing the main difficulties of patients with SS and how it affects their quality of life.

Earthquake exposure, adverse childhood experiences, and psychosocial functioning in Chilean children: A longitudinal study.

The impact of an 8.8 magnitude Chilean earthquake on elementary school students' psychosocial functioning was assessed along with exposure to adverse childhood experiences (ACEs). Skills for Life, a national school-based mental health program in Chile, routinely assesses first- and third-grade students' psychosocial functioning and classroom adaptation. Students (N = 19,627) were screened before (2009) and after (2011) the 2010 earthquake with parent- and teacher-report measures and with a parent-report of four ACEs (family psychopathology, child chronic illness, family social isolation, father absence). Earthquake exposure was categorized as mild, moderate, or severe for Chile's 15 regions. Multilevel models analyzed the unadjusted and adjusted impacts of earthquake exposure and ACEs on functioning while clustering for school- and district-level effects. In covariate-adjusted models, earthquake exposure and three ACEs were significantly associated with worsened psychosocial functioning; earthquake exposure and all four ACEs were significantly associated with worsened classroom adaptation. New family psychopathology, B = 1.90, p < .001; chronic illness, B = 2.25, p < .001; and severe earthquake impact, B = 1.29, p < .001, held the strongest negative effects on psychosocial well-being. Moderate, B = 3.04, p = .011, and severe earthquake exposure, B = 2.53, p = .047, and new family psychopathology, B = 1.99, p < .001, were associated with the worst classroom functioning 1-year postdisaster. Findings suggest that both exogenous and home-based stressors can have significant consequences for children's psychosocial functioning and classroom adaptation, and routine screening helps quantify how individual students are affected by chronic versus acute stressors.

Implementation of a national mental health intervention in educational communities: What do successful teams do differently?

This study aimed to identify the elements that characterize local teams which implement a nationwide preventive mental health intervention in schools and achieve better results. A mixed-methods sequential explanatory design was conducted in two phases: (a) teams were characterized according to their level of achievement in the preventive intervention through latent class analysis; and (b) case studies of three teams with different implementation results were conducted by performing content analysis on interviews, observations, and documents. It was established that the more effective teams have better planning, the more they are familiar with the intervention, and more aware of their strengths and weaknesses. This team also implement culturally pertinent actions aimed at increasing knowledge about the intervention, which causes schools to experience it as part of their community, since they include the intervention in their regular dynamics. Lastly, the importance and relevance of these elements when working in educational communities is discussed.

Illness Experiences of Chilean Women With Sjögren's Syndrome: The Patient Perspective.

OBJECTIVE: Sjögren's syndrome (SS) challenges everyday functioning and well-being. The aim of this study was to structure and summarize the life experiences of Chilean women with SS in an integrated model. METHODS: Interviews from a previous study yielded 75 experiences of living with SS. A sample of 30 women with SS sorted these experiences by content and rated their level of agreement with each experience. A hierarchical cluster analysis was used to structure the experiences of the participants with SS in a comprehensive overview. A team-based consensus analysis was used to define the number of clusters. The level of agreement was examined with Wilcoxon's signed rank test. RESULTS: Ten clusters were identified and grouped into 6 main categories: symptoms (clusters: mucosal dryness and related symptoms), social environment, emotion management (clusters: fears and sadness), information (clusters: uncertainty and lack of knowledge), coping strategy (clusters: resilience and self-care), and health staff relationship. The clusters that describe the more common experiences among patients were resilience, self-care, uncertainty, lack of knowledge, health staff relationship, and mucosal dryness. CONCLUSION: This study provided an integrated and structured overview of disease experiences comprising both biomedical and psychosocial aspects as being of vital importance for the health of patients with SS. The overview can be used to get a quick impression of disease experiences that are important for an individual patient, in a therapeutic goal setting, and in the construction and evaluation of medical and nonmedical interventions or education.

Identifying Adjustment Difficulties in Chilean Schools: Psychometric Properties of the Teacher Observation of Classroom / La detección de las dificultades de ajuste en las escuelas chilenas: propiedades psicométricas de la entrevista de observación de los profesores en clase

For preventive interventions in school mental health to be effective, it is essential to have valid and reliable screening instruments that can detect students in need of more support. In order to do this, the present study is aimed at assessing the psychometric properties of the Teacher Observation of Classroom Adaptation, an interview for teachers that measures school adjustment difficulties. The study evaluated 10,287 adolescents participating in a Chilean public program for improving mental health in schools. Of the total sample, 5,815 (56.5%) students were in 6th grade and were 12.91 years old on average (SD = 1.391). Exploratory factor analyses were used to identify four dimensions (behavioral, learning, social, and autonomyrelated difficulties), which were tested using structural equations. Reliability analyses show that all factors have high levels of internal consistency and differ according to age, grade, and extreme poverty. The article discusses the results obtained, their implications, and the importance of performing screening in schools through rigorously assessed psychometric instruments

Para que las intervenciones preventivas en salud mental escolar sean efectivas es esencial contar con instrumentos de detección válidos y confiables, que puedan identificar a los estudiantes que necesitan apoyo. Por ello, este estudio tuvo como objetivo evaluar las propiedades psicométricas del Teacher Observation of Classroom, entrevista para maestros que mide las dificultades de ajuste escolar. El estudio evaluó a 10,287 adolescentes que participaban en un programa público chileno para mejorar la salud mental en las escuelas. Del total de la muestra, 5,815 (56.5%) estudiantes estaban en sexto grado y tenían un promedio de 12.91 años (DE = 1.391). Se llevaron a cabo análisis factoriales exploratorios para identificar cuatro dimensiones (dificultades relacionadas con el comportamiento, el aprendizaje, las relaciones sociales y la autonomía), las cuales fueron confirmadas a través de ecuaciones estructurales. Los análisis de confiabilidad mostraron que todos los factores tenían un elevado nivel de consistencia interna y diferían según la edad, el grado y la pobreza extrema. El manuscrito analiza los resultados obtenidos, sus implicaciones y la importancia de realizar pruebas de detección en las escuelas a través de instrumentos psicométricos rigurosamente evaluados

Effects of Psychosocial Adversity on School Maladjustment: A Follow-up of Primary School Students / El efecto de la adversidad psicosocial en la desadaptación escolar: un seguimiento de los alumnos de educación primaria

School maladjustment (SM) is understood as a set of behavioral, social, and emotional difficulties that prevent students from meeting the expectations of their school context. Its appearance during the first years of schooling is linked to school failure and dropout, violent behaviors, mental health problems, and maladaptive trajectories that persist for the rest of an individual’s life. The goal of this study was to identify psychosocial adversity variables capable of predicting the appearance of SM during the first three years of school. By collecting data on school maladjustment, adverse childhood experiences and psychosocial dysfunction, a longitudinal follow-up process was applied to a cohort of 26,108 Chilean students (50.7% female) from the start of their schooling (6.3 years of age in 1st grade) until two years later (8.4 year age mean in 3st grade). Through binary logistic regressions, the results obtained show that mother’s adolescent pregnancy, biological father's absence, mental pathology in a relative, psychosocial dysfunction, and teacher's negative perception of students’ academic and behavioral performance predict the appearance of SM after three years in the school system. The article discusses these results and their implications for the development of preventive programs aimed at reducing SM and mental health problems during childhood

La inadaptación escolar (IE) se entiende como un conjunto de dificultades de comportamiento, sociales y emocionales que impiden que los estudiantes cumplan con las expectativas de su contexto escolar. Su aparición durante los primeros años de escolaridad está relacionada con el fracaso y el abandono escolar, los comportamientos violentos, los problemas de salud mental y las trayectorias de mala adaptación que persisten durante el resto de la vida del individuo. El objetivo de este estudio fue identificar variables de adversidad psicosocial capaces de predecir la aparición de inadaptación escolar durante los primeros tres años de escolarización. Al recopilar datos sobre el desajuste escolar, las experiencias adversas en la infancia y la disfunción psicosocial, se aplicó un proceso de seguimiento longitudinal a una cohorte de 26,108 estudiantes chilenos (50.7% mujeres) desde el inicio de sus estudios (6.3 años de edad en primer grado) hasta dos años más tarde (8.4 años de edad en tercer grado). A través de regresiones logísticas binarias, los resultados obtenidos muestran que el embarazo adolescente de la madre, la ausencia biológica del padre, la patología mental en un familiar, la disfunción psicosocial y la percepción negativa del profesor del desempeño académico y del comportamiento de los estudiantes predicen la aparición de inadaptación escolar después de tres años en el sistema escolar. El artículo analiza estos resultados y sus implicaciones para el desarrollo de programas preventivos dirigidos a reducir los problemas de inadaptación escolar y de salud mental durante la infancia

Intervención preventiva de salud mental escolar en adolescentes: desafíos para un programa público en comunidades educativas / Preventive Intervention School Mental Health in Adolescents: Challenges for a Public Program in the Educational Communities

Se presenta la contribución del "Programa Habilidades para la Vida" a las prácticas de prevención de salud mental adolescente en escuelas de Chile. Se evalúa la intervención preventiva del programa, en particular observando si adolescentes que asistieron al taller preventivo (N = 212) muestran cambio en las variables desadaptación escolar (DE) y disfunción psicosocial (DP), según su asistencia y la de sus padres. El diseño fue expost facto, longitudinal prospectivo, con mediciones pre y post. El análisis consideró ANOVA de medidas repetidas y pruebas t para muestras relacionadas. Los resultados indican disminución en algunos factores de riesgo asociados a DE y la estabilidad de la DP de los adolescentes. Se discuten las implicancias de este estudio para la ciencia preventiva y las políticas públicas.

This paper shows the contribution of "Skills for Life Program" to prevention practices adolescent mental health in schools in Chile. Study included a sample of adolescents (N = 212) who participated in the preventive intervention of the program. The goal was to examine changes in variables of school maladjustment (SM) and psychosocial dysfunction (PD) based on their attendance and their parents to the preventive intervention. Design was ex-post-facto, longitudinal prospective, pre and post measurements. Analysis considered repeated measures ANOVA and t tests for related samples. Results indicate a decrease in risk factors associated with SM and PD stability of adolescents. Study implications will be discussed for preventive science and public policy.

Facilitators and barriers to the adoption of healthy lifestyles after first myocardial infarction in Chile: a qualitative study / Facilitadores y barreras para la adopción de estilos de vida saludable después de un primer infarto del miocardio en Chile: estudio cualitativo

Factors associated with therapeutic lifestyle change (TLC) after myocardial infarction (MI) have not been fully investigated in Chile. This study aimed to provide a descriptive examination of facilitators and barriers to TLC after first MI. Methods: Qualitative study based on in-depth interviews and focus groups with cardiologists and patients who had first MI one-year±2 months before the begin-ning of the study. Grounded theory research methods were used to guide sampling and coding of data. Results: Twenty-one patients who had first myocardial infarction and 14 cardiologists participated in in-depth interviews and focus groups until the point of theoretical saturation. Facilitators for TLC included optimism, self-efficacy, faith-based life purpose, positive attitudes by family and friends, social participation, good patient-physician relationship, and positive medical advice. Barriers were: individual (older age, female sex, lower educational level, limiting beliefs, ambi val ence, depressive mood, lack of knowledge on strategies to achieve TLC, financial constraints), family (family crisis, overprotection, im-posing attitudes, unhealthy habits at home), work (work overload and competition between work recovery and TLC), socio-environmental (neighborhood unsafety), and health provider-related (poor patient-physician re-lationship, limiting beliefs among physicians, medical advice centered on restrictions or imprecise, medical training focused on pharmacological therapies and in-terventional procedures over preventive care, and orga-nizational issues). Conclusions: Reported facilitators and barriers enhance understanding of the process of lifestyle change after first myocardial infarction, and might be targets for optimization of secondary preventive strategies among Chilean patients.

Los factores asociados con el cambio terapéutico de estilos de vida (TLC) después de un infarto agudo al miocardio (IAM) no han sido suficientemente investigados en Chile. El objetivo de este estudio fue explorar y describir los facilitadores y barreras para la adopción de TLC en pacientes que han sufrido un primer IAM. Métodos: Estudio cualitativo basado en entrevistas en profundidad y grupos focales con cardiólogos y pacientes que tuvieron un primer IAM un año ± 2 meses antes del inicio del estudio. Se usó metodología de Teoría Fundada para guiar el muestreo y la codificación de los datos. Resultados: Veintiún pacientes con un primer IAM y 14 cardiólogos participaron en las entrevistas en profundidad y grupos focales, hasta el punto de saturación teórica. Facilitadores para TLC incluyeron optimismo, autoeficacia, propósito de vida basado en la fe, actitudes positivas por familiares y amigos, participación social, buena relación médico-paciente, y un consejo médico positivo. Las barreras fueron: individuales (edad avanzada, sexo femenino, bajo nivel educacional, creencias limitantes entre los pacientes, ambivalencia, estado de ánimo depresivo, falta de conocimiento sobre estrategias para lograr TLC, limitaciones financieras), a nivel familiar (crisis de la familia, sobreprotección, imposición de actitudes, hábitos no saludables en el hogar), a nivel laboral (sobrecarga de trabajo y competencia entre la recuperación del trabajo y la adopción de TLC), a nivel socio-ambiental (inseguridad del barrio), y a nivel del proveedor de salud (mala relación médico-paciente, creencias limitantes entre los médicos, consejo médico impreciso o basado en restricciones, formación médica centrada en aspectos farmacológicos e intervencionales por sobre lo preventivo, y problemas de organización). Conclusiones: Los facilitadores y barreras reportados mejoran la comprensión del proceso de cambio de estilos de vida después del primer infarto agudo al miocardio, y pueden contribuir a la optimización de estrategias de prevención cardiovascular secundaria en pacientes chilenos.

[Impact beyond the objectives: a qualitative study of a faculty development program in medical education]. / Logros más alla de los objetivos: evaluación cualitativa de un programa de formación en educación médica.

BACKGROUND: In medical education there has been increasing emphasis on faculty development programs aimed at the professionalization of teaching and increasing students' learning. However, these programs have been shown to have an impact beyond improvement in teaching skills. The medical school of the Pontificia Universidad Católica de Chile (EMUC) has been running a faculty development program (DEM) since 2000. AIM: To explore the perception of graduates on the effects of having participated in DEM on their development as teachers and clinicians. MATERIAL AND METHODS: Using an exploratory, descriptive and qualitative design, the 79 teachers who graduated from DEM from 2004-2008 were sent a questionnaire containing three open questions. Their answers were analyzed using the Constant Comparative Method of Qualitative Analysis of Glaser and Strauss by four researchers. RESULTS: Faculty development, becoming a better clinician, personal development, appreciation of the value of teaching and strengthening of the academic community were the five categories that emerged from the answers. Graduates felt that, besides learning new educational skills, they changed their attitude towards teaching. DEM was perceived as facilitating self-awareness and reflection about the graduates' role as doctors and teachers. The graduates also valued meeting other faculty. CONCLUSIONS: Faculty development programs can have an impact far beyond the learning objectives. The planning and design of programs contributes to their wider impact. This should be taken into consideration in the design, planning, and evaluation of faculty development programs. Care should be taken to protect time for participation, reflection and for interaction with other academics.

Logros más alla de los objetivos: evaluación cualitativa de un programa de formación en educación médica / Impact beyond the objectives: a qualitative study of a faculty development program in medical education

Background: In medical education there has been increasing emphasis on faculty development programs aimed at the professionalization of teaching and increasing students' learning. However, these programs have been shown to have an impact beyond improvement in teaching skills. The medical school of the Pontificia Universidad Católica de Chile (EMUC) has been running a faculty development program (DEM) since 2000. Aim: To explore the perception of graduates on the effects of having participated in DEM on their development as teachers and clinicians. Material and Methods: Using an exploratory, descriptive and qualitative design, the 79 teachers who graduated from DEM from 2004-2008 were sent a questionnaire containing three open questions. Their answers were analyzed using the Constant Comparative Method of Qualitative Analysis of Glaser and Strauss by four researchers. Results: Faculty development, becoming a better clinician, personal development, appreciation of the value of teaching and strengthening of the academic community were the five categories that emerged from the answers. Graduates felt that, besides learning new educational skills, they changed their attitude towards teaching. DEM was perceived as facilitating self-awareness and refection about the graduates' role as doctors and teachers. The graduates also valued meeting other faculty. Conclusions: Faculty development programs can have an impact far beyond the learning objectives. The planning and design of programs contributes to their wider impact. This should be taken into consideration in the design, planning, and evaluation of faculty development programs. Care should be taken to protect time for participation, refection and for interaction with other academics.

Barreras para la formación en docencia de los profesores de medicina: una aproximación cualitativa / Barriers for faculty development in medical education: a qualitative study

Background: Since 2000, the medical school of the Catholic University of Chile (EMUC) has offered courses for its faculty as part of a Diploma in Medical Education (DEM). However by 2009, 41% of faculty had never taken any courses. Aim: To explore the reasons why faculty choose not to participate in these courses. Material and Methods: Semi-structured interviews to seven faculty members, all of whom have an active role in teaching but who had not taken any DEM courses. The sampling was intentional and guided by theory. Based on Grounded theory, the data was analyzed using open, axial and selective coding. Results: Three categories emerged from the analysis. First, the characteristics of a "good teacher" and what it means to be a good teacher. Second, the current status of teaching. Third, the barriers to participate in courses of DEM. Non-attendance is multifactorial; teaching is seen as a natural skill that is difficult to be trained, teaching has a lower priority than other activities, and there are many barriers perceived for attendance. Conclusions: With these results we developed a model to explain the reasons why faculty choose not to participate in these courses. The lower value of teaching and the multiple roles that teachers have, are highlighted.

[Barriers for faculty development in medical education: a qualitative study]. / Barreras para la formación en docencia de los profesores de medicina: una aproximación cualitativa.

BACKGROUND: Since 2000, the medical school of the Catholic University of Chile (EMUC) has offered courses for its faculty as part of a Diploma in Medical Education (DEM). However by 2009, 41% of faculty had never taken any courses. AIM: To explore the reasons why faculty choose not to participate in these courses. MATERIAL AND METHODS: Semi-structured interviews to seven faculty members, all of whom have an active role in teaching but who had not taken any DEM courses. The sampling was intentional and guided by theory. Based on Grounded theory, the data was analyzed using open, axial and selective coding. RESULTS: Three categories emerged from the analysis. First, the characteristics of a "good teacher" and what it means to be a good teacher. Second, the current status of teaching. Third, the barriers to participate in courses of DEM. Non-attendance is multifactorial; teaching is seen as a natural skill that is difficult to be trained, teaching has a lower priority than other activities, and there are many barriers perceived for attendance. CONCLUSIONS: With these results we developed a model to explain the reasons why faculty choose not to participate in these courses. The lower value of teaching and the multiple roles that teachers have, are highlighted.

[Effectiveness of a home visit program for adolescent mothers and their children]. / Evaluación de la efectividad de programas de visitas domiciliarias para madres adolescentes y sus hijos/as.

BACKGROUND: Home visiting is effective for the promotion and prevention of mother-child health in other countries, especially in vulnerable populations such as pregnant teenagers. AIM: To evaluate the association between receiving a home visiting program during pregnancy and child development during the first year of life, maternal mental health, perception of social support and school attendance. MATERIAL AND METHODS: Cross sectional assessment of 132 teenage mother-sibling pairs. Of these, 87 received home visits and 45 were randomly assigned to a control group. The assessed variables were maternal mental health, perception of social support, life satisfaction, incorporation of mothers to school after delivery, child development and frequency of child abuse and neglect. RESULTS: Mothers that received home visits had a better mental health and went back to school in a higher proportion. No significant differences between groups were observed on perception of social support or child development. CONCLUSIONS: These results suggest the effectiveness of domiciliary visits performed by non-professionals, to improve mental health and social integration of teenage mothers.

Evaluación de la efectividad de programas de visitas domiciliarias para madres adolescentes y sus hijos/as / Effectiveness of a home visit program for adolescent mothers and their children

Background: Home visiting is effective for the promotion and prevention of mother-child health in other countries, especially in vulnerable populations such as pregnant teenagers. Aim: To evalúate the association between receiving a home visiting program duringpregnancy and child development during thefirstyear oflife, maternal mental health, perception of social support and school attendance. Material and Methods: Cross sectional assessment of 132 teenage mother-sibling pairs. Ofthese, 87 received home visits and 45 were randomly assigned to a control group. The assessed variables were maternal mental health, perception of social support, Ufe satisfaction, incorporation of mothers to school after delivery, child development and frequency of child abuse and neglect. Results: Mothers that received home visits had a better mental health and went back to school in a higherproportion. No significant differences between groups were observed on perception of social support or child development. Conclusions: These results suggest the effectiveness of domiciliary visits performed by non-professionals, to improve mental health and social integration of teenage mothers.