Margarita Bernales

Mano a Mano-Mujer: An Effective HIV Prevention Intervention for Chilean Women

The impact of a professionally facilitated peer group intervention for HIV prevention among 400 low-income Chilean women was examined using a quasiexperimental design. At 3 months postintervention, the intervention group had higher HIV-related knowledge, more positive attitudes toward people living with HIV, fewer perceived condom use barriers, greater self- efficacy, higher HIV reduction behavioral intentions, more communication with partners about safer sex, and decreased depression symptoms. They did not, however, have increased condom use or self-esteem. More attention to gender barriers is needed. This intervention offers a model for reducing HIV for women in Chile and other Latin American countries.

Observed Use of Standard Precautions in Chilean Community Clinics

OBJECTIVESnIn 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.nnnSAMPLEnA total of 52 structured observations with potential contamination with body fluids were done.nnnRESULTSnHCWs 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.nnnCONCLUSIONSnIt 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.

Intimate Partner Violence and HIV Risk Behaviors Among Socially Disadvantaged Chilean Women

The objective of this study was to determine if a relationship exists between intimate partner v iolence (IPV) and HIV risk among socioeconomically disadvantaged Chilean women. A correlational analysis with data from the NIH-funded project, “Testing an HIV/AIDS Prevention Intervention for Chilean Women,” was conducted. Two hundred and sixty-one women were included in this analysis (n = 261). Those women who had experienced any type of IPV in the past 3 months had significantly higher risk for HIV than those who had not (t = -2.016, p < .05). Also a linear trend was found among those women who had experienced more than one type of IPV in the past 3 months and HIV risk.

Peer Group Intervention for HIV Prevention Among Health Workers in Chile

&NA; We tested the impacts of a professionally assisted peer‐group intervention on Chilean health workers HIV‐related knowledge, attitudes, and behaviors using a quasi‐experimental design with a pretest and 3‐month posttest. Two Santiago suburbs were randomly assigned to the intervention or delayed intervention control condition. Five community clinics per suburb participated. Interested workers at the intervention (n = 262) and control (n = 293) clinics participated and completed both evaluations. At posttest, intervention clinic workers had higher knowledge and more positive attitudes regarding HIV, condoms, stigmatization, and self‐efficacy for prevention. They reported more partner discussion about safer sex, less unprotected sex, and more involvement in HIV prevention activities in the clinic and the community, but they did not report fewer sexual partners or more standard precautions behaviors. Because of these positive impacts, the program will become a regular continuing education unit that can be used to meet health‐worker licensing requirements.

Effect of emotionally complex roles on HIV-related simulated patients.

Simulated patients (SPs) have participated successfully in nursing and medical education. The SPs portraying stressful situations may have psychological or physiological effects for several days after their performance; however, long-term effects have not been well documented in the literature. The purpose of this study is to investigate the impact of interpreting roles related to HIV among SPs. A qualitative descriptive approach was used for this study. Questionnaires with open-ended questions were conducted immediately after the interpretation of HIV-related roles and a year later by 10 SPs. In addition, a focus group was run a year later using a preestablished interview guide. As a result of direct content analysis, 2 major themes emerged: effects of interpreting roles relating to HIV and complexity of the roles. The findings of this study stress that interpreting an HIV-related role produces emotional, behavioral, and physical effects in SPs, at any stage during the training or performance, and has a long-term impact on their perception of their personal health and risk.

Impact of Mano a Mano-Mujer, an HIV prevention intervention, on depressive symptoms among Chilean women.

Worldwide, and in Chile, the number of women living with HIV is increasing. Depression is considered a factor that interferes with HIV prevention. Depression may reach 41% among low-income Chilean women. Depressed people are less willing to participate in behaviours that protect them against HIV. The aim of this study is to analyze the impact of Mano a Mano-Mujer (MM-M), and HIV prevention intervention, on depressive symptoms among Chilean women. A quasi-experimental design was used for this study. The research was conducted in Santiago, Chile; a total of 400 women participated in the study (intervention group, n=182; control group, n=218). The intervention was guided by the social-cognitive model and the primary health care model. The intervention consists of six 2-h sessions delivered in small groups. Sessions covered: HIV prevention, depression, partners communication, and substance abuse. Face-to-face interviews were conducted at baseline and at 3-month follow-up. Chilean women who participated in MM-M significantly decreased, at 3 months follow up, their reported depressive symptoms. MM-M provided significant benefits for womens depression symptoms. In this study nurses participated as leaders for the screening of depressive symptoms and as facilitators of community interventions.

Incorporación de los primeros auxilios psicológicos al currículum de pregrado

Sr. Editor: Nos acercamos al cuarto aniversario del terremoto del 27 de febrero de 2010 (27F) y la preocupacion por la salud mental de la poblacion expuesta a este tipo de eventos ha sido muy poca. Segun un estudio de nuestro equipo1, 11% de la poblacion nacional presento probable Trastorno de Estres Postraumatico (TEPT) en los meses posteriores al desastre, llegando al 23% en las regiones declaradas en estado de catastrofe, con especial impacto en los mas pobres. Un tercio de quienes desarrollaron un TEPT aun podrian estar presentando alguna sintomatologia. A pesar de la tragica experiencia vivida, seguimos sin una adecuada preparacion para enfrentar los desastres, en especial en lo que respecta a salud mental2. nChile es un pais que constantemente se ve expuesto a terremotos, inundaciones, aluviones y erupciones volcanicas, entre otros desastres naturales. Adicionalmente, desastres antropicos, como accidentes de transito masivos o incendios, abultan los danos ocasionados por este tipo de eventos. Es indispensable que los trabajadores de la salud estemos preparados para operar en estos escenarios mas alla de nuestra especialidad. n?Como debemos asistir a las personas y comunidades conmocionadas por eventos traumaticos como emergencias y desastres? ?Cuales son las estrategias mas adecuadas para brindar ayuda humanitaria segura y efectiva, que ademas de brindar consuelo y alivio emocional prevengan el desarrollo de secuelas psicologicas? ?Quienes deberian ser los encargados de brindar el apoyo emocional en situaciones de desastre? De acuerdo a lo observado durante el 27F queda claro que no existe un acuerdo entre los profesionales de la salud mental en Chile, y menos entre el personal de primera respuesta en emergencias nLeer mas...

¿Cuántas personas fuman?: Percepción del nivel de consumo y su relación con el consumo de cigarrillos en adolescentes chilenos

BACKGROUNDnCigarette smoking among adolescents is a major health problem in Chile, which is determined by several factors. Among these, it is important the role of perceived norms regarding cigarette use among peers and the general population.nnnAIMnTo study the social norms about the perceived prevalence of smoking and its relationship with cigarette smoking among Chilean adolescents.nnnMATERIAL AND METHODSnParticipants were 480 adolescents of educational institutions from the South-East area of the Metropolitan Region, who completed a questionnaire that included questions regarding cigarette use and the perceived prevalence of cigarette use among peers and adults.nnnRESULTSnAdolescents overestimated the percentage of smokers compared to national statistics regarding their peers and adult population. The perception of adolescents regarding the rates of use among peers predicted both current and future use.nnnCONCLUSIONSnCigarette smoking is influenced by perceived norms regarding use and, despite the current smoking restrictions in place, youth continue to perceive that smoking is a common behavior.Background: Cigarette smoking among adolescents is a major health problem in Chile, which is determined by several factors. Among these, it is important the role of perceived norms regarding cigarette use among peers and the general population. Aim: To study the social norms about the perceived prevalence of smoking and its relationship with cigarette smoking among Chilean adolescents. Material and Methods: Participants were 480 adolescents of educational institutions from the South-East area of the Metropolitan Region, who completed a questionnaire that included questions regarding cigarette use and the perceived prevalence of cigarette use among peers and adults. Results: Adolescents overestimated the percentage of smokers compared to national statistics regarding their peers and adult population. The perception of adolescents regarding the rates of use among peers predicted both current and future use. Conclusions: Cigarette smoking is influenced by perceived norms regarding use and, despite the current smoking restrictions in place, youth continue to perceive that smoking is a common behavior.

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

BACKGROUNDnIn 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.nnnAIMnTo 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.nnnMATERIAL AND METHODSnHealthcare 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.nnnRESULTSnThe 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).nnnCONCLUSIONSnThe educational intervention was effective in improving knowledge of the HIV/AIDS Law among Chilean healthcare workers.

Competencia Cultural en Salud: una necesidad urgente en trabajadores de la salud

efectivas para el logro de la competencia cultural. a PhD. b Enfermero, Mg.(C). c Enfermera, Magíster en Psicología de la Salud.Sr. Editor: La competencia cultural es entendida en el ambito de la salud como la habilidad que deben poseer los trabajadores de la salud (TS) para incorporar una vision del contexto social y cultural de cada usuario, incrementando asi la posibilidad de lograr una real comunicacion con este ultimo. Habitualmente, la necesidad de desarrollar la competencia cultural es entendida en la interaccion que establecen los TS con la poblacion de origen etnico o incluso en la interaccion con inmigrantes internacionales, grupos en los cuales resulta mas evidente la posible diferencia en el background cultural entre TS y usuario. Sin embargo, algunos autores(1-3) plantean que cada interaccion en el ambito de la salud debiera considerar una adaptacion cultural de las estrategias, de tal forma que las intervenciones contemplen la individualidad y el contexto social de los usuarios, apostando de esta forma al exito en la implementacion de dichas intervenciones. nConsiderando el perfil epidemiologico actual de nuestro pais, en que predominan condiciones cronicas de salud, dos de los grandes desafios que enfrentan los TS son la comunicacion efectiva con los usuarios y la adherencia a las intervenciones sugeridas. Tomando como referencia el modelo de determinantes sociales de la salud(4), es posible establecer que variables tales como genero, edad, nivel educacional, situacion laboral, nivel de ingresos, etnia o condicion de migrante, situan a cada individuo en un entramado social complejo, el cual influye en sus decisiones de salud. Necesariamente estas variables debieran ser tomadas en cuenta por los TS para el diseno de estrategias que apunten al exito y adherencia deseados. nLeer mas....