Rodrigo Sepúlveda

Lessons from scaling up a depression treatment program in primary care in Chile

In Chile, the National Depression Detection and Treatment Program (Programa Nacional de Diagnóstico y Tratamiento de la Depresión, PNDTD) in primary care is a rare example of an evidence-based mental health program that was scaled up to the national level in a low- or middle-income country. This retrospective qualitative study aimed to better understand how policymakers made the decision to scale up mental health services to the national level, and to explore the elements, contexts, and processes that facilitated the decision to implement and sustain PNDTD. In-depth semistructured interviews with six key informants selected through intentional sampling were conducted in August-December 2008. Interviewees were senior officers at the Ministry of Health who were directly involved in the decision to scale up the program. Results yielded four elements pivotal to the decisionmaking process: scientific evidence, teamwork and leadership, strategic alliances, and program institutionalization. Each element contributed to building consensus, securing funding, attracting resources, and gaining lasting support from policymakers. Additionally, a review of available documentation led the authors to consider sociopolitical context and use of the media to be important factors. While research evidence for the effectiveness of mental health services in the primary care setting continues to accumulate, low- and middle-income countries should get started on the lengthy process of scaling up by incorporating the elements that led to decisionmaking and implementation of the PNDTD in Chile.

Bullying y calidad de vida relacionada con la salud en adolescentes escolares chilenos

BACKGROUND Bullying has a negative impact on the perception of adolescents of their quality of life. AIM To analyze the association between being bullied and health related quality of life in Chilean adolescents. MATERIAL AND METHODS The bullying module of the KIDSCREEN 52 survey and the KIDSCREEN 10 survey to assess health related quality of life were applied to 7737 students aged 10 to 18 years. Social and demographic data, information about disability and type of school were also gathered. RESULTS Fifteen percent of surveyed students were bullied. A lower quality of life perception increased by a factor of 2.6 among bullied students. It also increased by a factor of 4.4 among students with a low self-esteem, by a factor of 3.1 among those who perceived their health status as regular or bad and by a factor of 1.4 among women. CONCLUSIONS Bullying is associated with a lower quality of life perception among Chilean students.BACKGROUND: Bullying has a negative impact on the perception of adolescents of their quality of life. AIM: To analyze the association between being bullied and health related quality of life in Chilean adolescents. MATERIAL AND METHODS: The bullying module of the KIDSCREEN 52 survey and the KIDSCREEN 10 survey to assess health related quality of life were applied to 7737 students aged 10 to 18 years. Social and demographic data, information about disability and type of school were also gathered. RESULTS: Fifteen percent of surveyed students were bullied. A lower quality of life perception increased by a factor of 2.6 among bullied students. It also increased by a factor of 4.4 among students with a low self-esteem, by a factor of 3.1 among those who perceived their health status as regular or bad and by a factor of 1.4 among women. CONCLUSIONS: Bullying is associated with a lower quality of life perception among Chilean students. Language: es

Síndrome hemolítico urémico atípico

Atypical hemolytic uremic syndrome (aHUS) is a rare thrombotic microangiopathy, characterized by microangiopathic hemolytic anemia, thrombocytopenia and renal involvement. It causes end stage renal disease requiring dialysis in most affected patients. It mainly affects young adults (contrary to what was thought years ago). When aHUS is primary, the cause is a genetic mutation in the alternative complement pathway. Instead, secondary aHUS is caused by external factors that trigger the disease by themselves or in combination with a genetic vulnerability. The type of mutation determines the severity of the disease, prognosis, response to therapy and renal transplantation. Advances in the understanding of renal diseases associated with complement defects and the development of specific biologic therapies changed the course of this disease. Eculizumab is internationally approved for the treatment of primary aHUS. Its inhibitory action on the complement cascade leads to hematologic remission and restoration of renal function. We present a review of aHUS detailing its etiology, pathogenesis, clinical presentation, diagnosis and treatment.

Calidad de vida relacionada con la salud en estudiantes universitarios de primer año

Objetive: To evaluate the health-related quality of life (HRQoL) of first-year university students at the University of Chile in 2015 Material and Method: Observational, transversal, and analytical study of first year students, 17 to 18 years of age, attending 14 Faculties, 2 Institutes, and 1 Bachelor Program of the University of Chile. Delivery of Kidscreen-52 test by email to 3,738 students, of which 1,277 replied (34.16%). The Winsteps program model and Rasch punctuation were used. Results: The dimensions Physical Well-being, State of Mood and Emotions, and Autonomy scored less than 42 Rasch points, and the other two dimensions – Psychological Well-being and Friends and Social Support - had significantly lower scores than those found in Chilean adolescents of a comparable age, in women, in students of lower socio-economical levels in municipal public schools with a Scholar Vulnerability Index, or those with a disability, health problem, or chronic illness. The differences are greater in Faculties with heavier academic demands. Discussion: This first study gives new information in an area seldom studied, which is important for students, academics, and authorities. It is suspected that similar results would be found in other university settings. Conclusions: HRQoL studies are feasible to apply in institutions of higher education, to benefit both students and educators. This study contributes to the diagnosis and evaluation of public policies on student support, and for teaching strategies. In the near future, HRQoL instruments could be applied with other students and other members of the university community, in combination with studies on risk factors.

Erna Imperatore: la forma de mirar en la ciencia de la ocupación.

EI: Claro, lo que pasa es que la Ciencia Ocupacional o la Ciencia en Ocupacion se desarrollo a fines de los anos noventa. O sea, es relativamente nueva. Y en Terapia Ocupacional, que es una profesion practica, nosotros usabamos mucho los conocimientos que venian de otras disciplinas. La ciencia ocupacional nacio de los valores de la terapia ocupacional y presta atencion al hacer de las personas. La ocupacion como la unidad de analisis se focaliza en la forma, funcion y significado de la ocupacion humana. La forma abarca los aspectos observables de la ocupacion; la funcion se refiere a como influye en la salud y la calidad de vida de la persona, y el significado implica la experiencia subjetiva de participacion dentro del contexto de la ocupacion humana y es individual. Nosotros vemos el hacer cotidiano de la persona. Yo no fui una de las personas que desarrollo la ciencia; fui una de las primeras personas que recibio el doctorado en Ciencia de la Ocupacion en la Universidad del Sur de California con el doctor Au, porque se abrio al mismo tiempo la Ciencia de la Ocupacion y el doctorado, y se empezo a estudiar lo que tu llamas “cotidiano” y yo llamo “el hacer diario de la persona”. Algunas de las investigaciones que se hicieron en ese momento se referian al significado que el juego tiene para el ser humano, cuales son los juegos de los ninos en diferentes contextos (como dentro del hogar o el colegio) y como participan los adultos en estos juegos. Es decir, investigacion de tipo cualitativo que analiza el por que y el como. Para nosotros la Terapeuta Ocupacional egresada de la Universidad de Chile. Master of Arts en Educacion Especial en la Universidad de Columbia. PhD. en Ciencia de la Ocupacion, Universidad de Southern California. Actualmente es directora del Master de Terapia Ocupacional de la Universidad de Southern California.