Participación de los usuarios en las decisiones clínicas en la atención primaria de salud en Chile

[RESUMEN]. Objetivo. Describir la experiencia de participación en las decisiones clínicas desde la perspectiva de usuarios de Centros de Salud Familiar (CESFAM) de la Atención Primaria de Salud (APS). Métodos. Estudio de diseño cualitativo descriptivo; se realizaron grupos focales con usuarios de CESFAM del área sudeste de Santiago, Chile, y análisis temático de la información utilizando el programa Atlas.ti versión 6. Resultados. Se realizaron cinco grupos focales (n = 41). Los principales temas emergentes fueron el rol pasivo de los usuarios en las decisiones y la toma de decisión delegada, basada en la confianza en el profesional. El rol pasivo de los usuarios limita las oportunidades de participación en las decisiones clínicas y mantiene el poder en los profesionales de la salud. A pesar de ello, el establecimiento de una alianza terapéutica les permita sentirse tratados como personas únicas, escuchados y respetados por los profesionales, lo que asegura que las decisiones tomadas por el equipo de salud son confiables, pues velan por sus reales intereses. Conclusión. La participación de los usuarios en los encuentros clínicos es aún escasa en el país. Sin embargo, potenciar esta participación es esencial para aumentar la satisfacción usuaria y promover un cuidado centrado en la persona.

[ABSTRACT]. Objective. Describe users’ experience with participation in clinical decision-making at Family Health Centers (CESFAM) in the Primary Health Care (PHC) system. Methods. Qualitative descriptive study. Focus groups made up of CESFAM users were held in southeastern Santiago, Chile, and the information was thematically analyzed using Atlas.ti version 6® software. Results. Five focus groups were held (n = 41). The main themes that emerged from the discussions were the passive role of users in decisions and delegated decision-making, based on their trust in the health professional. Users’ passive role limits their opportunities for participation in clinical decision-making, ceding power to the health professional. However, establishing a therapeutic partnership allows users to feel that they are being treated as unique individuals whom the professional listens to and respects, ensuring that the decisions of the health team can be trusted, since they look out for the users’ real interests. Conclusion. Users’ participation in clinical encounters is still limited in Chile. However, bolstering that participation is essential for increasing user satisfaction and promoting people-centered care.

[RESUMO]. Objetivo. Descrever a experiência de participação nas decisões clínicas dos usuários dos Centros de Saúde Familiar (CESFAM) de atenção primária à saúde. Métodos. Estudo qualitativo descritivo conduzido em grupos de discussão formados por usuários dos CESFAM da região sudeste da cidade de Santiago, no Chile. Foi realizada uma análise temática das informações com o uso do programa de software ATLAS.ti versão 6. Resultados. Foram formados cinco grupos de discussão (n = 41). Os principais tópicos abordados foram o papel passivo dos usuários nas decisões e a tomada de decisão delegada aos profissionais na base da confiança. O papel passivo restringe as oportunidades de participação dos usuários nas decisões clínicas e mantém o poder nas mãos dos profissionais da saúde. Apesar disso, ao ser criada uma aliança terapêutica, os usuários se sentem tratados como indivíduos únicos que são ouvidos e respeitados pelos profissionais, o que assegura que as decisões tomadas pela equipe de saúde sejam confiáveis porque protegem os reais interesses dos usuários. Conclusão. Os usuários ainda têm pouca participação nas interações clínicas no Chile. Porém, é fundamental reforçar esta participação para melhorar a satisfação do usuário e promover uma atenção mais centrada na pessoa.

Formación y competencias para los equipos de atención primaria desde la mirada de expertos chilenos

[RESUMEN]. Objetivo. Describir las competencias para equipos de atención primaria en salud (APS) en distintos tópicos vinculados a la atención directa del usuario y a la gestión de los centros de salud primarios, de acuerdo a la percepción de expertos chilenos en APS. Métodos. Estudio de diseño mixto. Se realizó un Delphi electrónico con 29 expertos nacionales en APS. Resultados. Se propone una matriz de competencias específicas vinculada al trabajo directo con familias y a la gestión del centro de salud priorizados en tres niveles. Los expertos concuerdan que se requiere una masa crítica de profesionales que cuenten con competencias que le conciernen a la APS. Conclusiones. El reto de reorganizar los sistemas de salud en torno a una APS fuerte y de calidad solo puede lograrse con la participación de profesionales que comprendan y practiquen los atributos y principios fundamentales de la APS. Los resultados de este estudio dan cuenta de un perfil de competencias para profesionales de APS alineado con recomendaciones internacionales alcanzable a través de estrategias de educación continua.

[ABSTRACT]. Objective. To describe the competencies for primary health care teams (PHC) in different topics related to the direct care of the user and the management of primary health centers, according to the perception of Chilean experts in PHC. Methods. Mixed design studio. An electronic Delphi method was conducted with 29 national experts in APS. Results. A matrix of specific competences related to direct work with families and to the management of the health center prioritized in three levels is proposed. Experts agreed that a critical mass of professionals with competencies in PHC is required. Conclusions. The challenge of reorganizing health systems around a strong and quality PHC can only be achieved with the participation of professionals who understand and practice the attributes and fundamental principles of PHC. The results of this study show a competency profile for PHC professionals aligned with international recommendations achievable through continuous education strategies.

[RESUMO]. Objetivo. Descrever as habilidades para equipes de atenção primária à saúde (APS) sobre vários tópicos vinculados com a atenção direta do usuário e gestão de centros de saúde, de acordo com a percepção de especialistas chilenos na APS. Métodos. Estudo de desenho misto. Foi realizado um Delphi eletrônico com 29 especialistas nacionais em APS. Resultados. É proposta uma matriz de competências específicas vinculada ao trabalho direto com famílias e à gestão do centro de saúde priorizados em três níveis. Os especialistas concordam que se requer uma massa crítica de profissionais que contem com competências em APS. Conclusões. O desafio de reorganizar os sistemas de saúde em torno de uma APS forte e de qualidade só se pode conseguir com a participação de profissionais que entendem e pratiquem os atributos e os princípios fundamentais da APS. Os resultados deste estudo mostram um perfil de competências para profissionais de APS alinhados com recomendações internacionais que podem ser alcançadas através de estratégias de educação contínua.

Adaptación y validación del instrumento genérico CollaboRATE(TM) para medir la participación de mujeres en la toma de decisiones en salud durante el proceso reproductivo / Adapting and validating the generic instrument CollaboRATE(TM) to measure women's participation in health related decision-making during the reproductive process

Introducción: La participación en la toma de decisiones en salud (TDS) responde a un interés global por involucrar a las personas como actores activos en la búsqueda de alternativas terapéuticas y la elección de cursos de acción que les permitan mantener una mejor calidad de vida y bienestar. La mayoría de los instrumentos disponibles para evaluar el grado de participación han sido desarrollados en inglés y para países de altos ingresos. Objetivo: Adaptar y validar a la realidad chilena el instrumento CollaboRATE(TM) para medir la participación de las mujeres en decisiones vinculadas al periodo reproductivo. Diseño: Estudio transversal de adaptación y validación psicométrica del instrumento CollaboRATE(TM). Emplazamiento: Maternidades del Servicio de Salud de Santiago, Chile. Participantes: Puérperas usuarias del servicio de maternidad de tres hospitales públicos. Método: Se usó la técnica de traducción y contra traducción, seguida de evaluación de la pertinencia cultural y lingüística con grupos de usuarios y la revisión de la versión final por un grupo de expertos. Seguido de un estudio con 90 usuarias del servicio público de salud. Resultados: La versión chilena de CollaboRATE(TM) es un instrumento validado que demostró ser confiable (alfa de Cronbach ≥ 0,89) para medir el grado de participación de mujeres en la TDS relativas al proceso reproductivo. Conclusiones: Este estudio proporciona el primer instrumento para evaluar la TDS en un país de América Latina, que puede ser fundamental en futuros esfuerzos de investigación que exploren la participación de las personas en las decisiones relacionadas con su salud

Introduction: There is a worldwide interest in involving patients in health related decisions, so patients can actively search for therapeutic options and choose course of action that allows them to have better quality of life and wellbeing. The majority of the instruments available to capture the degree of participation in medical decision-making are in English and have been developed in high income countries. Objective: To adapt and validate for the Chilean context the instrument CollaboRATE(TM), to measure women's participation in medical decisions during the reproductive process. Design: Cross-sectional study to adapt and validate the instrument CollaboRATE(TM). Location: Maternity units in Santiago, Chile. Participants: Puerperal women in maternity units of three public hospitals. Method: Translation and back-translation, cultural and linguistic relevance with service users and final revision by experts. Study for validation with 90 puerperal women. Results: The Chilean version of CollaboRAT(TM) demonstrated to be a reliable instrument to capture the degree of patients' participation in medical decision-making. Cronbach alpha was above 0.89. Conclusions: This study provides the first instrument to capture the prevalence of SDM in a Latin American country. This instrument will be critical in future research efforts that seek to explore to what extent people are being involved in the decisions related to their healthcare

[Adapting and validating the generic instrument CollaboRATE™ to measure women's participation in health related decision-making during the reproductive process]. / Adaptación y validación del instrumento genérico CollaboRATE™ para medir la participación de mujeres en la toma de decisiones en salud durante el proceso reproductivo.

INTRODUCTION: There is a worldwide interest in involving patients in health related decisions, so patients can actively search for therapeutic options and choose course of action that allows them to have better quality of life and wellbeing. The majority of the instruments available to capture the degree of participation in medical decision-making are in English and have been developed in high income countries. OBJECTIVE: To adapt and validate for the Chilean context the instrument CollaboRATE™, to measure women's participation in medical decisions during the reproductive process. DESIGN: Cross-sectional study to adapt and validate the instrument CollaboRATE™. LOCATION: Maternity units in Santiago, Chile. PARTICIPANTS: Puerperal women in maternity units of three public hospitals. METHOD: Translation and back-translation, cultural and linguistic relevance with service users and final revision by experts. Study for validation with 90 puerperal women. RESULTS: The Chilean version of CollaboRATE™ demonstrated to be a reliable instrument to capture the degree of patients' participation in medical decision-making. Cronbach alpha was above 0.89. CONCLUSIONS: This study provides the first instrument to capture the prevalence of SDM in a Latin American country. This instrument will be critical in future research efforts that seek to explore to what extent people are being involved in the decisions related to their healthcare.

[User Participation in Clinical Decision-making in Primary Health Care in ChileParticipação dos usuários nas decisões clínicas na atenção primária à saúde no Chile]. / Participación de los usuarios en las decisiones clínicas en la atención primaria de salud en Chile.

OBJECTIVE: Describe users' experience with participation in clinical decision-making at Family Health Centers (CESFAM) in the Primary Health Care (PHC) system. METHODS: Qualitative descriptive study. Focus groups made up of CESFAM users were held in southeastern Santiago, Chile, and the information was thematically analyzed using Atlas.ti version 6® software. RESULTS: Five focus groups were held (n = 41). The main themes that emerged from the discussions were the passive role of users in decisions and delegated decision-making, based on their trust in the health professional. Users' passive role limits their opportunities for participation in clinical decision-making, ceding power to the health professional. However, establishing a therapeutic partnership allows users to feel that they are being treated as unique individuals whom the professional listens to and respects, ensuring that the decisions of the health team can be trusted, since they look out for the users' real interests. CONCLUSION: Users' participation in clinical encounters is still limited in Chile. However, bolstering that participation is essential for increasing user satisfaction and promoting people-centered care.

OBJETIVO: Descrever a experiência de participação nas decisões clínicas dos usuários dos Centros de Saúde Familiar (CESFAM) de atenção primária à saúde. MÉTODOS: Estudo qualitativo descritivo conduzido em grupos de discussão formados por usuários dos CESFAM da região sudeste da cidade de Santiago, no Chile. Foi realizada uma análise temática das informações com o uso do programa de software ATLAS.ti® versão 6. RESULTADOS: Foram formados cinco grupos de discussão (n = 41). Os principais tópicos abordados foram o papel passivo dos usuários nas decisões e a tomada de decisão delegada aos profissionais na base da confiança. O papel passivo restringe as oportunidades de participação dos usuários nas decisões clínicas e mantém o poder nas mãos dos profissionais da saúde. Apesar disso, ao ser criada uma aliança terapêutica, os usuários se sentem tratados como indivíduos únicos que são ouvidos e respeitados pelos profissionais, o que assegura que as decisões tomadas pela equipe de saúde sejam confiáveis porque protegem os reais interesses dos usuários. CONCLUSÃO: Os usuários ainda têm pouca participação nas interações clínicas no Chile. Porém, é fundamental reforçar esta participação para melhorar a satisfação do usuário e promover uma atenção mais centrada na pessoa.

[Training and competencies for primary care teams from the perspective of Chilean expertsTreinamento e competências para equipes de atenção primária na perspectiva de especialistas chilenos]. / Formación y competencias para los equipos de atención primaria desde la mirada de expertos chilenos.

OBJECTIVE: To describe the competencies for primary health care teams (PHC) in different topics related to the direct care of the user and the management of primary health centers, according to the perception of Chilean experts in PHC. METHODS: Mixed design studio. An electronic Delphi method was conducted with 29 national experts in APS. RESULTS: A matrix of specific competences related to direct work with families and to the management of the health center prioritized in three levels is proposed. Experts agreed that a critical mass of professionals with competencies in PHC is required. CONCLUSIONS: The challenge of reorganizing health systems around a strong and quality PHC can only be achieved with the participation of professionals who understand and practice the attributes and fundamental principles of PHC. The results of this study show a competency profile for PHC professionals aligned with international recommendations achievable through continuous education strategies.

OBJETIVO: Descrever as habilidades para equipes de atenção primária à saúde (APS) sobre vários tópicos vinculados com a atenção direta do usuário e gestão de centros de saúde, de acordo com a percepção de especialistas chilenos na APS. MÉTODOS: Estudo de desenho misto. Foi realizado um Delphi eletrônico com 29 especialistas nacionais em APS. RESULTADOS: É proposta uma matriz de competências específicas vinculada ao trabalho direto com famílias e à gestão do centro de saúde priorizados em três níveis. Os especialistas concordam que se requer uma massa crítica de profissionais que contem com competências em APS. CONCLUSÕES: O desafio de reorganizar os sistemas de saúde em torno de uma APS forte e de qualidade só se pode conseguir com a participação de profissionais que entendem e pratiquem os atributos e os princípios fundamentais da APS. Os resultados deste estudo mostram um perfil de competências para profissionais de APS alinhados com recomendações internacionais que podem ser alcançadas através de estratégias de educação contínua.

Formación y competencias para los equipos de atención primaria desde la mirada de expertos chilenos / Training and competencies for primary care teams from the perspective of Chilean experts / Treinamento e competências para equipes de atenção primária na perspectiva de especialistas chilenos

RESUMEN Objetivo Describir las competencias para equipos de atención primaria en salud (APS) en distintos tópicos vinculados a la atención directa del usuario y a la gestión de los centros de salud primarios, de acuerdo a la percepción de expertos chilenos en APS. Métodos Estudio de diseño mixto. Se realizó un Delphi electrónico con 29 expertos nacionales en APS. Resultados Se propone una matriz de competencias específicas vinculada al trabajo directo con familias y a la gestión del centro de salud priorizados en tres niveles. Los expertos concuerdan que se requiere una masa crítica de profesionales que cuenten con competencias que le conciernen a la APS. Conclusiones El reto de reorganizar los sistemas de salud en torno a una APS fuerte y de calidad solo puede lograrse con la participación de profesionales que comprendan y practiquen los atributos y principios fundamentales de la APS. Los resultados de este estudio dan cuenta de un perfil de competencias para profesionales de APS alineado con recomendaciones internacionales alcanzable a través de estrategias de educación continua.

ABSTRACT Objective To describe the competencies for primary health care teams (PHC) in different topics related to the direct care of the user and the management of primary health centers, according to the perception of Chilean experts in PHC. Methods Mixed design studio. An electronic Delphi method was conducted with 29 national experts in APS. Results A matrix of specific competences related to direct work with families and to the management of the health center prioritized in three levels is proposed. Experts agreed that a critical mass of professionals with competencies in PHC is required. Conclusions The challenge of reorganizing health systems around a strong and quality PHC can only be achieved with the participation of professionals who understand and practice the attributes and fundamental principles of PHC. The results of this study show a competency profile for PHC professionals aligned with international recommendations achievable through continuous education strategies.

RESUMO Objetivo Descrever as habilidades para equipes de atenção primária à saúde (APS) sobre vários tópicos vinculados com a atenção direta do usuário e gestão de centros de saúde, de acordo com a percepção de especialistas chilenos na APS. Métodos Estudo de desenho misto. Foi realizado um Delphi eletrônico com 29 especialistas nacionais em APS. Resultados É proposta uma matriz de competências específicas vinculada ao trabalho direto com famílias e à gestão do centro de saúde priorizados em três níveis. Os especialistas concordam que se requer uma massa crítica de profissionais que contem com competências em APS. Conclusões O desafio de reorganizar os sistemas de saúde em torno de uma APS forte e de qualidade só se pode conseguir com a participação de profissionais que entendem e pratiquem os atributos e os princípios fundamentais da APS. Os resultados deste estudo mostram um perfil de competências para profissionais de APS alinhados com recomendações internacionais que podem ser alcançadas através de estratégias de educação contínua.

Participación de los usuarios en las decisiones clínicas en la atención primaria de salud en Chile / User Participation in Clinical Decision-making in Primary Health Care in Chile / Participação dos usuários nas decisões clínicas na atenção primária à saúde no Chile

RESUMEN Objetivo Describir la experiencia de participación en las decisiones clínicas desde la perspectiva de usuarios de Centros de Salud Familiar (CESFAM) de la Atención Primaria de Salud (APS). Métodos Estudio de diseño cualitativo descriptivo; se realizaron grupos focales con usuarios de CESFAM del área sudeste de Santiago, Chile, y análisis temático de la información utilizando el programa Atlas.ti versión 6®. Resultados Se realizaron cinco grupos focales (n = 41). Los principales temas emergentes fueron el rol pasivo de los usuarios en las decisiones y la toma de decisión delegada, basada en la confianza en el profesional. El rol pasivo de los usuarios limita las oportunidades de participación en las decisiones clínicas y mantiene el poder en los profesionales de la salud. A pesar de ello, el establecimiento de una alianza terapéutica les permita sentirse tratados como personas únicas, escuchados y respetados por los profesionales, lo que asegura que las decisiones tomadas por el equipo de salud son confiables, pues velan por sus reales intereses. Conclusión La participación de los usuarios en los encuentros clínicos es aún escasa en el país. Sin embargo, potenciar esta participación es esencial para aumentar la satisfacción usuaria y promover un cuidado centrado en la persona.

ABSTRACT Objective Describe users' experience with participation in clinical decision-making at Family Health Centers (CESFAM) in the Primary Health Care (PHC) system. Methods Qualitative descriptive study. Focus groups made up of CESFAM users were held in southeastern Santiago, Chile, and the information was thematically analyzed using Atlas.ti version 6® software. Results Five focus groups were held (n = 41). The main themes that emerged from the discussions were the passive role of users in decisions and delegated decision-making, based on their trust in the health professional. Users' passive role limits their opportunities for participation in clinical decision-making, ceding power to the health professional. However, establishing a therapeutic partnership allows users to feel that they are being treated as unique individuals whom the professional listens to and respects, ensuring that the decisions of the health team can be trusted, since they look out for the users' real interests. Conclusion Users' participation in clinical encounters is still limited in Chile. However, bolstering that participation is essential for increasing user satisfaction and promoting people-centered care.

RESUMO Objetivo Descrever a experiência de participação nas decisões clínicas dos usuários dos Centros de Saúde Familiar (CESFAM) de atenção primária à saúde. Métodos Estudo qualitativo descritivo conduzido em grupos de discussão formados por usuários dos CESFAM da região sudeste da cidade de Santiago, no Chile. Foi realizada uma análise temática das informações com o uso do programa de software ATLAS.ti® versão 6. Resultados Foram formados cinco grupos de discussão (n = 41). Os principais tópicos abordados foram o papel passivo dos usuários nas decisões e a tomada de decisão delegada aos profissionais na base da confiança. O papel passivo restringe as oportunidades de participação dos usuários nas decisões clínicas e mantém o poder nas mãos dos profissionais da saúde. Apesar disso, ao ser criada uma aliança terapêutica, os usuários se sentem tratados como indivíduos únicos que são ouvidos e respeitados pelos profissionais, o que assegura que as decisões tomadas pela equipe de saúde sejam confiáveis porque protegem os reais interesses dos usuários. Conclusão Os usuários ainda têm pouca participação nas interações clínicas no Chile. Porém, é fundamental reforçar esta participação para melhorar a satisfação do usuário e promover uma atenção mais centrada na pessoa.

[Perception of users about an Integral Model of Family and Community Health care in Santiago, Chile]. / Principios orientadores del Modelo Integral de Salud Familiar y Comunitario desde la perspectiva de los usuarios.

BACKGROUND: The integral Model of Family and Community Health care is based on three essential principles: patient centered care, comprehensive care and continuity of care. AIM: To know the perception of primary care clinic users about the elements that should be considered in a patient centered integrated health care. MATERIAL AND METHODS: Ten males and 31 females aged 18 to 78 years, users of two public family primary care centers participated in focus groups, which were recorded. A qualitative descriptive research design based on content analysis according to Krippendorf was done. RESULTS: Seven issues emerged from the description of patients’ experiences: professional-patient relationship, fragmentation of care, continued care with the same professional, promotion and prevention, availability of services and patient records. CONCLUSIONS: There are difficulties to install an integral model of family and community health care. The concerns raised by participants should be considered in order to modify the design of these models.

Principios orientadores del Modelo Integral de Salud Familiar y Comunitario desde la perspectiva de los usuarios / Perception of users about an Integral Model of Family and Community Health care in Santiago, Chile

Background: The integral Model of Family and Community Health care is based on three essential principles: patient centered care, comprehensive care and continuity of care. Aim: To know the perception of primary care clinic users about the elements that should be considered in a patient centered integrated health care. Material and Methods: Ten males and 31 females aged 18 to 78 years, users of two public family primary care centers participated in focus groups, which were recorded. A qualitative descriptive research design based on content analysis according to Krippendorf was done. Results: Seven issues emerged from the description of patients’ experiences: professional-patient relationship, fragmentation of care, continued care with the same professional, promotion and prevention, availability of services and patient records. Conclusions: There are difficulties to install an integral model of family and community health care. The concerns raised by participants should be considered in order to modify the design of these models.

En busca de una salud más participativa: compartiendo decisiones de salud / Looking for a more participative healthcare: sharing medical decision making

El modelo de atención en salud paternalista está derivando hacia modelos más participativos, como lo es la toma de decisiones compartidas (TDC), en el que se considera al paciente como agente responsable y autónomo. La TDC representa un enfoque terapéutico en el que profesionales y pacientes comparten la mejor evidencia científica disponible para tomar una decisión, incorporando los valores y preferencias del paciente. Este intercambio de información puede facilitarse mediante el uso de herramientas de ayuda para la TDC, que han demostrado ser efectivas para mejorar el conocimiento, la satisfacción del paciente, y reducir el conflicto decisional. En este sentido, las habilidades comunicacionales ejercen un rol fundamental en el establecimiento de la relación profesional - paciente, facilitando el intercambio de información y preferencias de manera efectiva y respetuosa. Esta aproximación terapéutica podría apoyar la reducción de las disparidades en salud que prevalecen en Latinoamérica, al facilitar que las personas puedan participar informada y activamente en el cuidado de su salud.

The healthcare model is shifting from a paternalistic towards a more inclusive and participative approach, such as shared decision making (SDM). SDM considers patients as autonomous and responsible agents. SDM is a therapeutic approach where healthcare providers and patients share the best evidence available to make a decision according to the values and preferences of the patient. Decision aids are tools that can facilitate this information exchange. These tools help patients to increase knowledge about options, reduce decisional conflict and improve satisfaction. Additionally, communication skills play a key role within the professional-patient relationship, as they facilitate sharing information and preferences in an effective and respectful manner. This therapeutic approach could support the reduction of health inequalities that affect Latin America, as it promotes an active and informed participation of patients in their healthcare process.

[Looking for a more participative healthcare: sharing medical decision making]. / En busca de una salud más participativa: compartiendo decisiones de salud.

The healthcare model is shifting from a paternalistic towards a more inclusive and participative approach, such as shared decision making (SDM). SDM considers patients as autonomous and responsible agents. SDM is a therapeutic approach where healthcare providers and patients share the best evidence available to make a decision according to the values and preferences of the patient. Decision aids are tools that can facilitate this information exchange. These tools help patients to increase knowledge about options, reduce decisional conflict and improve satisfaction. Additionally, communication skills play a key role within the professional-patient relationship, as they facilitate sharing information and preferences in an effective and respectful manner. This therapeutic approach could support the reduction of health inequalities that affect Latin America, as it promotes an active and informed participation of patients in their healthcare process.

Factores de riesgo asociados a síntomas depresivos post parto en mujeres de bajo riesgo obstétrico atendidas en el sistema público / Risk factors for post partum depression

Background: Postpartum depression (PPD) is a public health problem with high prevalence in Chile. Many factors are associated with PPD. Aim: To analyze the factors associated with the incidence of depressive symptoms (SD) in women with low obstetric risk. Material and Methods: Cross-sectional analytical study on a sample of 105 postpartum women with low obstetric risk assessed by the Edinburgh Depression Scale at the eighth week postpartum. Results: A 37% prevalence of depressive symptoms was found. Univariate analysis showed that the perception of family functioning, overcrowding and number of siblings, were significantly associated with postpartum depressive symptoms. A multiple regression model only accepted family functioning as a predictor of depression. Conclusions: Perception of family functioning was the only variable that explained in part the presence of depressive symptoms in women with low obstetric risk.

[Risk factors for post partum depression]. / Factores de riesgo asociados a síntomas depresivos post parto en mujeres de bajo riesgo obstétrico atendidas en el sistema público.

BACKGROUND: Postpartum depression (PPD) is a public health problem with high prevalence in Chile. Many factors are associated with PPD. AIM: To analyze the factors associated with the incidence of depressive symptoms (SD) in women with low obstetric risk. MATERIAL AND METHODS: Cross-sectional analytical study on a sample of 105 postpartum women with low obstetric risk assessed by the Edinburgh Depression Scale at the eighth week postpartum. RESULTS: A 37% prevalence of depressive symptoms was found. Univariate analysis showed that the perception of family functioning, overcrowding and number of siblings, were significantly associated with postpartum depressive symptoms. A multiple regression model only accepted family functioning as a predictor of depression. CONCLUSIONS: Perception of family functioning was the only variable that explained in part the presence of depressive symptoms in women with low obstetric risk.

Early postnatal hospital discharge: the consequences of reducing length of stay for women and newborns.

The objective of this study is to examine the literature and identify most salient outcomes of early postnatal discharge for women, newborns and the health system. An electronic search strategy was designed including the following sources: Web of Science, Scopus, ProQuest and PubMed/MEDLINE, using the following terms: (early AND discharge) OR (length AND stay) AND (postpartum OR postnatal) AND (effect* OR result OR outcome). Content analysis was used to identify and summarise the findings and methods of the research papers. The evidence available is not enough to either reject or support the practice of early postnatal discharge; different studies have reported different outcomes for women and newborns. The need of systematic clinical research is discussed.

Early postnatal hospital discharge: the consequences of reducing length of stay for women and newborns / Alta pós-parto precoce: as consequências da redução do tempo de hospitalização para mulheres e recém-nascidos / Alta postparto precoz: las consecuencias de la reducción del tiempo de hospitalización para mujeres y recién nacidos

The objective of this study is to examine the literature and identify most salient outcomes of early postnatal discharge for women, newborns and the health system. An electronic search strategy was designed including the following sources: Web of Science, Scopus, ProQuest and PubMed/MEDLINE, using the following terms: (early AND discharge) OR (length AND stay) AND (postpartum OR postnatal) AND (effect* OR result OR outcome). Content analysis was used to identify and summarise the findings and methods of the research papers. The evidence available is not enough to either reject or support the practice of early postnatal discharge; different studies have reported different outcomes for women and newborns. The need of systematic clinical research is discussed.

O objetivo deste estudo é examinar a literatura e identificar os resultados mais relevantes da alta precoce pós-parto para as mulheres, recém-nascidos e o sistema de saúde. Uma estratégia de busca eletrônica foi projetada, incluindo as seguintes fontes: Web of Science, Scopus, ProQuest e PubMed/MEDLINE utilizando-se os seguintes termos: (precoce e alta hospitalar), ou (duração e permanência) e (pós-parto ou pós-natal) e (efeito de resultado ou * ou resultado). A análise de conteúdo foi utilizada para identificar e sintetizar os resultados e os métodos dos trabalhos de investigação. A evidência disponível não é suficiente para rejeitar ou apoiar a prática da alta precoce no pós-parto porque os estudos apresentaram resultados diferentes para as mulheres e os recém-nascidos. A necessidade de realizar estudos clínicos, de forma sistemática, é discutida.

Este estudio objetivó examinar la literatura e identificar los resultados más relevantes del alta precoz postparto para las mujeres, recién nacidos y el sistema de salud. Una estrategia de búsqueda electrónica fue proyectada, incluyendo las siguientes fuentes: Web of Science, Scopus, ProQuest y PubMed/MEDLINE utilizando los siguientes términos: (precoz y alta hospitalaria), o (duración y permanencia) y (postparto o post-natal) y (efecto de resultado o resultado). El análisis de contenido fue utilizado para identificar y sintetizar los resultados y los métodos de los trabajos de investigación. La evidencia disponible no es suficiente para rechazar o apoyar la práctica del alta precoz en el postparto porque los estudios presentaron resultados diferentes para las mujeres y los recién nacidos. La necesidad de realizar estudios clínicos, de forma sistemática. es discutida.

[How to implement Chile's new anti-tobacco law within the university]. / Cómo implementar la nueva ley chilena antitabaco al interior de la universidad.

On the 16th of May 2006, the Diario Oficial de la República de Chile (Official News of the Republic of Chile), published Law No. 20.105, which modified Law No. 19.419 regarding advertising and consumption of tobacco. Since it entered into force, different institutions and public spaces have had to enact its regulations. The purpose of this article is to share how the new anti-tobacco law is being implemented, with a health promotion angle, by the Pontificia Universidad Católica de Chile (UC). As such, we highlight key findings from a review of the literature on the subject and describe the implementation strategies developed and substantiated in theory as well as by how they address the concerns of the university community. The main accomplishments of the anti-tobacco implementation were: reaching a compromise between the university directorate and the student leaders, who in turn motivated the student body to participate during the large-scale roll-out of the new law; the participation of all of the UC stakeholders; utilizing the varied methods of mass communication; and lastly, providing an opportunity for reflection and analysis for those directly affected: the smokers. The challenge is to evaluate the strategies implemented in the incorporation of the new Chilean anti-tobacco law.

Cómo implementar la nueva ley chilena antitabaco al interior de la universidad / How to implement Chile’s new anti-tobacco law within the university

On the 16th of May 2006, the Diario Oficial de la República de Chile (Official News of the Republic of Chile), published Law No. 20.105, which modified Law No. 19.419 regarding advertising and consumption of tobacco. Since it entered into force, different institutions and public spaces have had to enact its regulations. The purpose of this article is to share how the new anti-tobacco law is being implemented, with a health promotion angle, by the Pontificia Universidad Católica de Chile (UC). As such, we highlight key findings from a review of the literature on the subject and describe the implementation strategies developed and substantiated in theory as well as by how they address the concerns of the university community. The main accomplishments of the anti-tobacco implementation were: reaching a compromise between the university directorate and the student leaders, who in turn motivated the student body to participate during the large-scale roll-out of the new law; the participation of all of the UC stakeholders; utilizing the varied methods of mass communication; and lastly, providing an opportunity for reflection and analysis for those directly affected: the smokers. The challenge is to evaluate the strategies implemented in the incorporation of the new Chilean anti-tobacco law.