Alejandra Araya

Observed Use of Standard Precautions in Chilean Community Clinics

OBJECTIVES In Chile, little information about the use of standard precautions (SP) among health care workers (HCWs) exists. As part of a larger study to tailor and test an HIV prevention intervention for community HCWs, this study describes the observed frequency with which appropriate SP were used by HCWs in low-income community clinics of Santiago. Also, the availability of supplies is described. SAMPLE A total of 52 structured observations with potential contamination with body fluids were done. RESULTS HCWs used SP inconsistently, especially neglecting hand washing, surface cleaning, and cleaning of shared materials. Lack of materials contributed in some instances of failure to use SPs, especially wiping surfaces and safe disposal of sharp instruments, as shown by a positive correlation between use of SP and availability of materials. Essential materials were usually available. Although more education should relate to a better understanding of the importance of SP, no difference was found between professionals and paraprofessionals in the use of SP. CONCLUSIONS It is clear that the initial training, continuing education, and ongoing support for practicing SP are not adequate. Training should be offered to HCWs involved in caring for clients at community clinics to stop the spread of HIV or other infectious diseases in health care settings.

Facilitadores y barreras que enfrentan las personas al tomarse el test de ELISA para el diagnóstico del VIH: revisión de la literatura

Introduccion: El diagnostico tardio de la infeccion por VIH es un problema universal. A pesar de la disponibilidad del test de ELISA para el diagnostico de esta infeccion en la atencion primaria de salud, las personas continuan tomandoselo tardiamente. Objetivo: Conocer los factores que facilitan o dificultan que las personas accedan oportunamente al examen en la atencion primaria de salud. Metodos: Cuatro bases de datos del area de la enfermeria, psicologica, salud biomedica y profesiones afines (anos 2001-2012) fueron examinadas con un protocolo de revision. Resultados: De 195 articulos detectados, 15 cumplieron con los criterios de inclusion y fueron agrupados en dos grandes temas: elementos facilitadores y elementos obstaculizadores de la persona, de los profesionales y de los centros de atencion primaria de salud. Percepcion de conductas de riesgo, autocuidado, apoyo social, la confianza, confidencialidad del examen, el ofrecimiento del examen y el conocimiento de un tratamiento oportuno han sido reconocidos como uno de los elementos facilitadores para la toma del examen. La falta de informacion sobre el test y la enfermedad son reconocidas como los principales obstaculizadores para acceder al test. Discusion: La informacion obtenida es un pilar fundamental para disenar e implementar estrategias destinadas a aumentar el numero de personas que solicitan voluntariamente al examen.

HIV Issues and Mapuches in Chile

Chile is a country with an incipient HIV epidemic. Just as in other countries, disadvantaged groups in Chile are contributing to the increased incidence of the disease. The Mapuche indigenous population is one such group that has been affected by the spread of HIV. However, no prevention programs are tailored to the culturally specific needs of this community. In recognition of this discrepancy, an academic‐community partnership was formed to develop an HIV educational module for a Mapuche community. The module was developed for use as part of an already established health‐related program. The aims of the module were to identify perceptions about HIV among Mapuches and present information specific to HIV and its prevention. Focus was placed on cultural sensitivity. A total of 16 Mapuches participated voluntarily and showed some knowledge regarding HIV, but they lacked an overall understanding as to how it is transmitted and why prevention strategies are effective. Continued collaboration between academia and affected communities as well as incorporating HIV information into established programs are effective strategies for delivering prevention information to disadvantaged populations and for further understanding their perceptions and health care needs.

Validation of the Spanish-language version of the Prolapse Quality of Life Questionnaire in Chilean women

Introduction and hypothesisThe Prolapse Quality of Life (P-QOL) questionnaire is a specific health-related quality of life (HRQL) instrument to assess the impact of POP on women. It has been validated in English-speaking women and to date has been translated into several other languages. However, currently there is no Spanish translation of the P-QOL questionnaire. The aim of this study was to translate the P-QOL questionnaire into Spanish and to assess its feasibility, validity, and reliability.MethodsFollowing a forward- and back-translation of the original English P-QOL questionnaire into Spanish language, the translated questionnaire was reviewed by a group of patients as well as an expert panel to assess its comprehensibility. In this cross-sectional study women with POP symptoms were recruited from a tertiary referral teaching hospital. Women were defined as symptomatic if they report feeling a lump/bulge/pressure in the vagina. The Spanish translated P-QOL questionnaire was self-administered to all women. Reliability, content, and construct validity were evaluated using the Cronbach’s alpha coefficient, ANOVA, and Spearman’s correlation tests.ResultsOne hundred and twenty-eight women were studied. There were no missing items. The Cronbach’s alpha ranged from 0.626 to 0.866 across domains, demonstrating the good reliability of the Spanish P-QOL. The severity of symptoms was related to the worst quality of life, but the severity of POP was not related to poorer QoL.ConclusionsThe Spanish translated version of the P-QOL is a reliable, consistent and valid instrument to assess symptom severity and QoL impact in Chilean women with POP.

Effectiveness of an educational program about the Chilean AIDS law in primary care health workers

BACKGROUND In Chile, members of the civil society and government achieved the passing of the HIV/AIDS Law (19.779). The level of knowledge of the law held by healthcare workers in Chile is not well known. AIM To analyze the effect of an intervention on knowledge of the existence of the law and its application in clinical practice among primary healthcare workers in southeastern Santiago. MATERIAL AND METHODS Healthcare workers of primary care centers were invited to participate in the study. One group received an educational intervention lasting a total of 16 hours, about AIDS physiopathology, sexually transmitted diseases, communication with patients and current legislation. A control group did not receive the educational intervention. Both groups answered a self-administered questionnaire about the HIV/AIDS law at baseline and three months after the intervention. RESULTS The intervention was carried out in 262 workers and 293 participated as controls. The initial evaluation revealed that only 16.3% (n = 89) had heard of the law, without any significant difference between intervention and control groups. The knowledge about the law improved by 65% in the intervention group and did not change in controls. At the end of the education period, the intervention and control groups improved their global knowledge by 29 and 3%, respectively (p < 0.05). CONCLUSIONS The educational intervention was effective in improving knowledge of the HIV/AIDS Law among Chilean healthcare workers.

Preocupación a caer: validación de un instrumento de medición en personas mayores chilenas que viven en la comunidad

INTRODUCCIóN: Fear of falling, with or without previous falls history, is a risk factor for decreased mobility, disability, as well as a decreased quality of life, and can trigger the self-restriction of activities with loss of independence and functionality. Validated tools for measuring the fear of falling in the Chilean population is a needed to detect those at risk. There are currently no validated instruments to measure this phenomenon in Chile. The aim of this study is to validate the Spanish version of the short «Falls Efficacy Scale-International» (FES-I) in an elderly population living in the community in Chile. MATERIAL AND METHOD A cross-sectional study was performed using applications at baseline and 4 weeks. The short FES-I was translated using the back-translation method, evaluated by a panel of experts, and piloted in 10 older adults. After the pilot study, the final version was applied to a sample of 113 elderly persons. Data analysis used measures of central tendency, and reliability and confirmatory factor analysis was used. RESULTS The Spanish version of the short FES-I showed good reliability and validity in an elderly Chilean population. CONCLUSIONS This falls risks measurement tool can be used by clinicians and researchers in order to determine the magnitude of the problem and the impact of fear of falling on falls, functionality, and quality of life of the elderly who live in the community.

Why Do Chilean Women Choose to Have or Not Have Pap Tests

Objective To describe the perceptions of Chilean women about why women choose to have or not have Pap test screening. Design Qualitative research using content analysis according to Krippendorf. Setting Four urban health clinics in Santiago, Chile. Participants Fifty‐seven Chilean women. Methods Audiotaped focus groups. Results Six themes emerged: Reasons that make it difficult for women to schedule appointments, Characteristics of health professionals that make it difficult to have a Pap test, Characteristics of the test that are barriers to having a Pap test, The relationship of the test with cancer, Family context, and Each womans personal characteristics. Conclusion Primary health care providers play an important role in promoting adherence to cervical cancer screening. Nurses should proactively address womens perceptions and knowledge about screening and openly and uniformly discuss the importance and benefits of Pap test screening.

Evaluación de la funcionalidad y fragilidad de las personas mayores asistentes a centros de día

BACKGROUND Older people attending day care centers improve their social activities, perception of quality of life and reduce their institutionalization rate and risk of mortality in the medium term. AIM To evaluate the changes in the integral geriatric assessment and frailty of a group of older people attending a day care center in Santiago. MATERIAL AND METHODS Health self-perception, integral geriatric assessment, Barthel scale, frailty indicators, mini-mental state scale, Yesavage depression score and a scale about solitude perception were evaluated in 35 participants aged 73 ± 6 years on admission and at discharge from a day care center for older people. RESULTS At discharge, significant improvements were observed for depression, perception of social support and physical frailty. However, no changes in functional status, cognitive function and perception of solitude were observed. CONCLUSIONS Older people attending improve their perception of social support and decrease their frailty and depression scores.

Menopause, the beginning of aging for Chilean women: A qualitative study

OBJECTIVES To develop the meaning of menopause of a group of post-menopausal women and their relationship with aging. METHODS Qualitative descriptive study on 15 Chilean women that completed a taped face-to-face in depth interview that were interpreted according to Krippendorff. RESULTS A qualitative content analysis revealed the presence of two themes: (a) Cessation of women´s reproductive stage and (b) a life transition to aging. CONCLUSIONS Women perceived their menopause as the beginning of aging focusing on the end of fertility and the social connotation that this new role implies. Feeling old 10 years before the customary beginning of old age is an important starting point to be incorporated in womens health education.

Barreras en la comunicación percibidas por un grupo de mujeres histerectomizadas: Un desafío para entregar una educación apropiada

Antecedentes: La destreza comunicacional del profesional de la salud es reconocida como un aspecto crucial que facilita la educacion a los pacientes. Objetivo: Describir las barreras que la mujer histerectomizada percibe en relacion a la comunicacion durante el proceso quirurgico. Metodo: Estudio cualitativo realizado en 15 mujeres histerectomizadas. Para la recoleccion de los datos se utilizaron entrevistas en profundidad las que fueron analizadas con analisis de contenido. Resultados: Las mujeres identifican diferentes barreras tanto de ellas como de los profesionales que dificultan la comunicacion y por ende la educacion que ellas reciben en relacion al proceso quirurgico. Las barreras de los profesionales son el lenguaje tecnico, falta de tiempo, enojo, contradicciones en las indicaciones y lejania. Las barreras en las mujeres son la timidez, la verguenza, la falta de confianza, el miedo y la conformidad. Conclusion: Los profesionales de salud deben enfocarse en desarrollar tecnicas de comunicacion que ayuden a los pacientes a disminuir las barreras y por ende mejorar los resultados en salud; deben entregar la informacion de forma clara y simple, verificando que lo comunicado ha sido entendido.