ABSTRACT
Introducción Los hospitales de día ofrecen atención especializada a usuarios con patologías psiquiátricas graves. Las actividades grupales habituales del hospital de día han demostrado efectividad en población infanto-juvenil. Existen importantes limitaciones de acceso a estos servicios y una forma de ampliar la cobertura es a través de la atención telemática. Sin embargo, no existen estudios sobre atención telemática de hospital de día en Chile. El presente estudio es parte de la fase preparatoria de un futuro ensayo clínico aleatorizado para investigar la efectividad de la adaptación telemática de las intervenciones de un hospital de día. Objetivos Explorar la percepción y experiencia subjetiva de los participantes de la versión piloto de dicha intervención identificando temáticas centrales, y evaluar la satisfacción de los participantes con la intervención. Métodos De los 13 usuarios de las actividades grupales telemáticas, 10 participaron en este estudio. Se realizaron entrevistas semi-estructuradas y encuestas de satisfacción entre agosto de 2020 y enero de 2021. Las entrevistas fueron evaluadas utilizando análisis de contenido y las encuestas se realizaron con estadísticas descriptivas. Resultados Se aprecia una especial valoración de los participantes por las interacciones sociales positivas (con pares y terapeutas). Aparece una percepción general de haber mejorado en habilidades socioemocionales y estado de ánimo. La implementación telemática resultó satisfactoria para la mayoría de los participantes, quienes proponen agregar actividades que promuevan interacciones más profundas con sus pares. Conclusiones Los elementos centrales de esta intervención serían la percepción de apoyo social (posible mecanismo terapéutico), junto con la sensación de mejorar las habilidades sociales y el estado de ánimo (posible resultado principal).
Introduction Outpatient centers offer specialized care to users with severe psychiatric disorders. The usual group activities of outpatient centers have been shown to be effective in the child and adolescent population. There are significant access limitations to these services and one way to expand coverage is through digital care. However, there are no studies on digital outpatient care services in Chile. The present study is part of the preparatory phase of a future randomized clinical trial to investigate the effectiveness of digital adaptation of outpatient centers interventions. Objectives To explore the experience and subjective perception of the pilot intervention participants by identifying central themes, and to evaluate the participant's satisfaction regarding the intervention. Methods Of the 13 users of the digital group activities, 10 participated in this study. Semi-structured interviews and satisfaction surveys were conducted between August 2020 and January 2021. The interviews were evaluated using content analysis and the surveys were conducted using descriptive statistics. Conclusions Results Participants were particularly appreciative of positive social interactions (with peers and therapists). There is a general perception of having improved socioemotional skills and mood. The digital implementation was satisfactory for most participants, who suggested adding activities that promote deeper interactions with their peers. The core elements of this intervention would be the perception of social support (a possible therapeutic mechanism), along with the feeling of improved social skills and mood (possible main outcome).
ABSTRACT
Introduction Maternal sensitivity and mentalization are fundamental for children's mental health development. These skills have been negatively associated with maternal postpartum depressive symptomatology. Moreover, its prevalence increases in low socioeconomic and psychosocial risk contexts, where the access to treatment is scarce. Even though Attachment Based Interventios, such as Video-Feedback has been internationally recognized as an effective intervention. Its cost, as well as the need for language translation and cultural adaptation makes it difficult to implement in Latinamerican countries. Aim The present study aims to assess the feasibility and acceptability of an online Video-Feedback intervention informed n mentalization aimed at mother-infant dyads with depressive symptomatology who attend Chilean public health centers. Method This is a pilot randomized clinical trial with two groups of 60 mother-infant dyads between 4 and 12 months of age. Participants will be randomly assigned to control and experimental groups in a 1:1 ratio. Even though both groups will receive usual treatment, the experimental group will also receive the present video-intervention. At the end of the study, feasibility will be assessed based on focus groups aimed at interveners and quantitative outcomes such as recruitment rate, questionnaire completion rate and intervention completeness. Acceptability will be assessed from in-depth interviews with participants. In addition, effect sizes of primary and secondary outcomes will be calculated. Expected results Results are expected to generate parameters to design a larger-scale clinical trial and to preliminary assess the effect of the reported mentalization-informed intervention on maternal sensitivity. Additionally, it seeks to contribute with a mental health intervention for low-income mother-infant dyads, which can be implemented remotely, at a low cost, and that would be suitable for implementation at a mental health care system policy. The protocol of this trial's design was registered at Clinical Trials (NCT04748731).
Introducción La sensibilidad y la mentalización materna constituyen competencias fundamentales para el desarrollo de la salud mental infantil. A su vez, dichas habilidades han sido negativamente asociadas con la presencia de sintomatología depresiva postparto, la cual aumenta su prevalencia en contextos de bajo nivel socioeconómico y riesgo psicosocial, en donde el acceso a tratamiento escasea. Paralelamente, si bien internacionalmente el video-retroalimentación constituye una herramienta efectiva en intervenciones basadas en el apego, el costo, idioma y necesidad de adaptación cultural dificultan su implementación en países latinoamericanos. Objetivo Evaluar la factibilidad y aceptabilidad de una video-intervención informada por la mentalización, dirigida a díadas madre-bebé con sintomatología depresiva, atendidas en centros públicos de atención en salud mental en Chile. Métodos Ensayo clínico aleatorio piloto con dos grupos de 60 díadas madre-bebé de entre 4 y 12 meses de edad, quienes serán asignados aleatoriamente a grupos control y experimental en una proporción de 1:1. Si bien ambos grupos recibirán el tratamiento habitual, el grupo experimental recibirá también la video-intervención. Al término del estudio se evaluará la factibilidad a partir de grupos focales dirigidos a interventores e indicadores de resultados cuantitativos tales como tasa de reclutamiento, de completación de cuestionarios y finalización de la intervención. La aceptabilidad se evaluará a partir de entrevistas en profundidad a las participantes. Adicionalmente se calculará tamaño del efecto de indicadores de resultados primarios y secundarios. Resultados esperados Se espera que los resultados del estudio generen parámetros para diseñar un ensayo clínico de mayor escala y evaluar preliminarmente el efecto de la intervención informada en la mentalización en la sensibilidad materna. Se busca además contribuir con una intervención en salud mental basada en la teoría del apego dirigida a díadas madre-bebé de bajos ingresos, que pueda ser implementada de manera remota, a bajo costo y apta para ser escalada a los sistemas de atención en salud mental.
ABSTRACT
Coaching is increasingly used to treat obesity or overweight. We conducted a systematic review to explore the intervention's characteristics, effectivity, and quality of the published studies. The search was carried out on Pubmed, Scielo and Scopus databases. We considered studies published in peer-reviewed journals between 2014 and 2019 in English and Spanish. Following PRISMA guidelines, we selected and analyzed 22 articles, 46% of which were randomized controlled trials. Most of the studies had moderate quality, according to the risk of bias assessment carried out by three independent researchers based on the Study Quality Assessment Tool. Seventy seven percent of interventions targeted adults, and their duration ranged between two and 19 months. They were delivered in both private and public contexts, with face-to-face or remote interventions and combined techniques, mainly from the United States (82%). The interventions showed a 51% effectiveness in reducing weight, increasing physical activity, and changing eating habits. We conclude that coaching might be an effective therapeutic strategy for obesity and overweight.
ABSTRACT
Resumen: Objetivo: Comprender la relación entre apego y diabetes y el rol mediador del estrés en niños con diabetes mellitus tipo 1 (DM1) y sus madres. Material y Método: Se aplicaron Instrumentos de evaluación correspondientes a Escalas de Apego (ECR-R), Estrés percibido (PSS), Seguridad (SS) y Estrés en niños (SiC), como medidas de autoreporte completadas por niños(as) y sus madres. Se analizaron variables demográficas, tiempo de inicio de diabetes, y el promedio de las ultimas 3 medi ciones de Hemoglobina glicosilada HbA1c como parámetro del control metabólico del último año. Resultados: Las estrategias de apego maternas e infantiles y el estrés materno mostraron una asocia ción significativa con los resultados de la diabetes del niño(a), aunque con importantes diferencias de género. Conclusiones: Las estrategias de apego, infantiles y maternas, son relevantes en el curso de la diabetes.
Abstract: Objective: To understand the relationship between attachment and diabetes and the role of stress mediators in children with type 1 diabetes (T1D) and their mothers. Material and Method: The following assessment instruments were applied as self-report measures: Attachment Scale (ECR- R), Perceived Stress Scale (PSS), Security Scale (SS), and the Stress in Children (SiC) questionnaire, which were completed by children and their mothers. We analyzed demographic variables, diabetes onset time, and the average of the last three glycosylated hemoglobin (HbA1c) measurements as a parameter of metabolic control in the last year. Results: Attachment strategies of both mother and child, as well as maternal stress, showed a significant association with the child's diabetes outcomes, although with important gender differences. Conclusions: Both mother and child attachment strate gies are relevant aspects of the T1D course.