Being a first-time father: their experiences and meanings: a qualitative systematic review / Experiencias y significados de ser padre por primera vez: una revisión sistemática cualitativa

INTRODUCTION: Becoming a first-time father is an important change in the life of men and families. Studies on the subject show that these kinds of changes have the power to put life into perspective. Being an involved father has a deep meaning for the child and the family. OBJECTIVE: To explore the experience of becoming a first-time father during the child first year of the life. SUBJECTS AND METHODS: A qualitative systematic review was conducted in 2014 in three stages, based on the Joanna Briggs Institute Method for Qualitative Systematic Reviews (QSR). The stages used in this QSR were: establishing the question, determining the type of studies to be included, defining the evaluation criteria, and synthesizing the data. Papers that assessed clinical prognoses were considered such as first-time parenting experience and child care during the first year of life. Only primary qualitative studies including ethnography, phenomenology, narrative analysis, and action research were con sidered. RESULTS: Three meta-syntheses were obtained from the analysis: 1) fatherhood adjustment process, 2) paternal role development, and 3) being an active father. The path towards adoption and the fulfillment of the paternal role is mediated by different processes that are consolidated during the child first year of life. CONCLUSIONS: The results support the idea that fathers want to be active parti cipants in the care of their children, that public policies should consider both parents equal in terms of their parenting responsibilities, and that the protection of the family and the family environment is a priority as a health promotion intervention.

INTRODUCCIÓN: Ser padre por primera vez es un cambio importante en la vida del hombre y la familia. Los estudios en torno al tema demuestran que este tipo de cambios tienen la capacidad de poner la vida en perspectiva. Ser un padre participativo tiene un significado profundo para el niño/a y la familia. OBJETIVO: Explorar la experiencia de ser padre por primera vez durante el primer año de la vida del hijo/a. SUJETOS Y MÉTODO: Se realizó una revisión sistemática cualitativa en 2014 en 3 etapas, basado en el Joanna Briggs Institute Method para Revisiones Sistemáticas Cualitativas (QSR). Las etapas usadas en este QSR fueron: establecimiento de la pregunta, determinar el tipo de estudios a incluir, definir los criterios de evaluación, y realizar la síntesis de los datos. Se consideraron manuscritos que evaluaran los pronósticos clínicos: experiencia de ser padre por primera vez y cuidados del niños durante el primer año de vida. Solo estudios cualitativos primarios incluyendo estudios de etnografía, fenomenología, análisis de narrativa e investigación de acciones fueron considerados. RESULTADOS: Se obtuvieron tres meta-síntesis del análisis: 1) proceso de ajuste a la paternidad; 2) desarrollo del rol paterno y 3) ser un padre activo. El camino hacia la adopción y el cumplimiento del rol paterno está mediado por diversos procesos que durante el primer año de vida del niño/a se consolidan. CONCLUSIONES: Los resultados apoyan la propuesta de que los padres desean ser protagonistas del cuidado de sus hijos/as, que las políticas públicas deben considerar a ambos padres como iguales en términos de sus responsabilidades de crianza, y que la protección de la familia y el entorno familiar es una priori dad como intervención de promoción de salud.

Guías de práctica clínica en atención primaria: Una evaluación crítica / Clinical practice guidelines in primary health care: A critical appraisal

Background: There are doubts about the real usefulness of clinical guidelines to induce changes in practice, specially in primary health care. Those guidelines with inconsistent recommendations can even be misleading. Aim: To assess the quality of Chilean primary health care guidelines and to identify factors associated with high quality guidelines. Material and methods: Chilean primary care guidelines published and disseminated using any strategy 1999 and 2004 were analyzed. Each selected guideline was assessed independently by two evaluators using the Appraisal of Guidelines, Research and Evaluation (AGREE) instrument following standardized instructions. Descriptive statistics for each dimension of the AGREE instrument were calculated for each guideline. Results: A total of 33 guidelines were retrieved. Fifteen were located using a manual search and 18 from electronic sources. Twenty four did not match our definition of guidelines, therefore only nine were included in the final assessment. There were important differences in the scores obtained by each guideline in different dimensions, with relevant methodological shortcomings. However, no significant differences in scores were found when guidelines were compared by year of elaboration. Conclusions: Our results suggest that previous efforts in primary health care guideline development were misdirected and that important changes are necessary to generate high quality guidelines.

Recién nacido hijo de madre drogadicta: aspectos relevantes de su pesquisa y manejo / Addicted mother's newly born: significative aspects of searching and management

La incidencia de consumo de drogas ilícitas es alta en especial en mujeres en edad fértil. -La exposición antenatal a cocaína, alcohol y mariguana, es un marcador biológico definitivo asociado a riesgo perinatal. -Los efectos a largo plazo de los hijos de madres adictas, corresponden a causas polivalentes. -La sospecha y búsqueda de exposición prenatal a drogas debe basarse en la historia. -La confirmación del consumo puede realizarse a través de la determinación de presencia de drogas en meconio de las primeras 48 horas. -La exposición a drogas es una forma de abuso infantil y puede prevenirse. -La prevención en los jóvenes es la mejor inversión a futuro. Información y educación, son las claves de una intervención efectiva. -Las direcciones de interés en internet son: www.conace.cl; www.health.org; www.aap.org; www.nida.nih.gov; www.guideline.gov/index.asp.