A Psychological Examination of the Status Syndrome and Its Application for Promoting Well-Being.

The status syndrome proposed by Marmot is located at the closest level of influence within the Social Determinants of Health (SDH) framework, connecting the body's response to the mental states that arise from the subjective experience of social status. Marmot defines these psychological states through concepts of autonomy and social integration articulated in the Capability Approach (CA). These elements are further explored and expanded upon with the Self-Determination Theory (SDT), an empirically based framework with an extensive tradition of practical application. This lays the groundwork not only for understanding what makes a social environment conducive to well-being but also for shedding light on ways to promote it. The article goes beyond theoretical discussions by introducing a structured model based on the principles of the SDT for health promotion interventions. The model emphasizes the importance of providing a supportive atmosphere and is organized into four distinct phases aimed at aligning interventions with individual motivations, and cultural contexts. Ultimately, the goal is to engage individuals to actively participate in their own well-being while addressing the complexities associated with social inequalities in developed societies.

The influence of risk awareness and government trust on risk perception and preparedness for natural hazards.

Risk perception is considered the primary motivator for taking preparedness actions. But people with prior experience and a high-risk perception are not necessarily more prepared. This relationship is even more complex when assessing preparedness levels for hazards with different characteristics. These inconsistent findings can be explained by how preparedness has been measured and the influence of other factors, such as trust and risk awareness. Thus, the main goal of this study was to analyze the role of risk awareness and trust in authorities on risk perception and intention to prepare for natural hazards in a coastal city in Chile. A representative sample of the city of Concepción, located in the center-south zone of Chile (n = 585), completed a survey. We measured risk awareness, risk perception, trust in authorities, and intention to prepare for two hazards: earthquakes/tsunamis and floods. Through structural equation models, we tested five hypotheses. We found that the perception of risk maintained a direct and positive influence on the intention to prepare for both hazards. The results showed that awareness and risk perception influence the intention to prepare and should be considered different concepts. Finally, trust did not significantly influence risk perception when faced with known hazards for the population. Implications for understanding the relationship between risk perception and direct experience are discussed.

Improve sleep in critically ill patients: Study protocol for a randomized controlled trial for a multi-component intervention of environment control in the ICU.

INTRODUCTION: In critically ill patients, sleep and circadian rhythms are greatly altered. These disturbances have been associated with adverse consequences, including increased mortality. Factors associated with the ICU environment, such as exposure to inadequate light and noise levels during the day and night or inflexible schedules of daily care activities, have been described as playing an essential role in sleep disturbances. The main objective of this study is to evaluate the impact of the use of a multifaceted environmental control intervention in the ICU on the quantity and quality of sleep, delirium, and post-intensive care neuropsychological impairment in critically ill patients. METHODS: This is a prospective, parallel-group, randomized trial in 56 critically ill patients once they are starting to recover from their acute illness. Patients will be randomized to receive a multifaceted intervention of environmental control in the ICU (dynamic light therapy, auditory masking, and rationalization of ICU nocturnal patient care activities) or standard care. The protocol will be applied from enrollment until ICU discharge. Baseline parameters, light and noise levels, polysomnography and actigraphy, daily oscillation of plasma concentrations of Melatonin and Cortisol, and questionnaires for the qualitative evaluation of sleep, will be assessed during the study. In addition, all patients will undergo standardized follow-up before hospital discharge and at 6 months to evaluate neuropsychological impairment. DISCUSSION: This study is the first randomized clinical trial in critically ill patients to evaluate the effect of a multicomponent, non-pharmacological environmental control intervention on sleep improvement in ICU patients. The results will provide data about the potential synergistic effects of a combined multi-component environmental intervention in ICU on outcomes in the ICU and long term, and the mechanism of action. TRIAL REGISTRATION: ClinicalTrials.gov, NCT. Registered on January 10, 2023. Last updated on 24 Jan 2023.

Government Trust and Motivational Factors on Health Protective Behaviors to Prevent COVID-19 Among Young Adults.

Objective: The purpose of this study was to determine the influence of government trust on young adults' adoption of health behaviors to prevent infection with the SARS-CoV-2 virus. Method: We tested the hypothesis that government trust would directly and indirectly (through worry/fear and subjective norms) influence the adoption of health-protective behaviors. A sample of 1,136 university students completed a web survey after Chile's first wave of infections. Results: The results indicate that low government trust only indirectly (through subjective norms) influenced health-protective behaviors. Conversely, worry/fear was the primary motivating factor for adopting health-protective behaviors in young adults, followed by subjective norms. Conclusion: In scenarios where people perceive low government trust, emotions and social norms are the motivational factors with the most significant predictive power on the adoption of health-protective behaviors.

The ABCDE psychological first aid intervention decreases early PTSD symptoms but does not prevent it: results of a randomized-controlled trial.

BACKGROUND: Early Psychological First Aid (PFA) has been widely recommended for preventing posttraumatic stress disorder (PTSD). However, its lack of empirical evidence of safety and effectiveness has been criticized. OBJECTIVES: To assess the effectiveness of PFA-ABCDE, an original PFA protocol, for preventing PTSD one month after the intervention and decreasing PTSD symptoms at one and six months of follow up. METHODS: We assessed the eligibility of 1,140 adult survivors of recent trauma (≤ 72 hours) consulting five emergency departments in Chile. Two hundred twenty-one were randomized to receive either PFA-ABCDE (active listening, breathing retraining, categorization of needs, referral to ancillary services, and psychoeducation) or only psychoeducation. We used the Composite International Diagnostic Interview (CIDI) to assess PTSD diagnosis. The Posttraumatic Checklist (PCL), the Beck Depression Inventory-II (BDI-II), and a 0-10 points analogue visual scale were used to assess PTSD symptoms, depressive symptoms, and immediate distress relief after the intervention. RESULTS: We found no difference between the experimental and control groups in the frequency of PTSD one month after the intervention (PFA-ABCDE = 23/76 [30.3%], psychoeducation = 18/75 [24.0%], adjusted odds ratio = 1.39, 95% confidence interval = 0.63-3.07, p = .408). Immediately after the intervention, participants who received PFA-ABCDE reported greater distress relief (PFA-ABCDE mean = 9.06, psychoeducation mean = 8.55, Cohen's d = 0.30, p = .038). Fewer PTSD symptoms were reported by those who received PFA-ABCDE one month after the intervention (PFA-ABCDE mean = 36.26, psychoeducation mean = 43.62, Cohen's d = 0.42, p = .033). We found no difference in depressive symptoms at one-month follow up (p = .713) nor in PTSD symptoms six months after the intervention (p = .986). CONCLUSIONS: PFA-ABCDE does not prevent PTSD diagnosis, but it provides immediate distress relief and decreases PTSD symptoms in the short term.

Antecedentes: Los Primeros Auxilios Psicológicos (PAP) han sido recomendados para prevenir el Trastorno de Estrés Postraumático (TEPT) en supervivientes de trauma. A pesar de su popularidad, la escasez de evidencia empírica sobre su seguridad y efectividad ha sido criticada.Objetivos: Evaluar la efectividad de los PAP-ABCDE, un protocolo original de PAP, para prevenir el TEPT al mes de seguimiento y disminuir los síntomas de TEPT luego de uno y seis meses de seguimiento.Métodos: Evaluamos elegibilidad de 1.140 adultos supervivientes de trauma reciente (≤ 72 horas) que consultaron cinco servicios de urgencia en Chile. Doscientos veintiún fueron aleatorizados a recibir PAP-ABCDE (escucha activa, reentrenamiento de la respiración, categorización de necesidades, derivación a redes de apoyo, y psicoeducación) o sólo psicoeducación. Utilizamos la Composite International Diagnostic Interview (CIDI) para evaluar el diagnóstico de TEPT. La Posttraumatic Checklist (PCL), la Beck Depression Inventory-II (BDI-II), y una escala visual análoga de 0-10 puntos fueron utilizadas para evaluar síntomas de TEPT, síntomas depresivos, y alivio inmediato de distrés luego de la intervención.Resultados: No encontramos diferencia entre el grupo experimental y el grupo control en la frecuencia de TEPT un mes después de la intervención (PAP-ABCDE = 23/76 [30,3%], psicoeducación = 18/75 [24,0%], odds ratio ajustado = 1,39, intervalo de confianza 95% = 0,63-3,07, p = ,408). Inmediatamente después de la intervención los participantes que recibieron PAP-ABCDE reportaron un mayor alivio de distrés (media en PAP = 9,06, media en psicoeducación = 8,55, d de Cohen = 0,30, p = ,038). Menos síntomas de TEPT fueron reportados un mes después de la intervención por aquellos que recibieron PAP-ABCDE (media de PAP-ABCDE = 36,26, media de psicoeducación = 43,62, d de Cohen = 0,42, p = ,033). No encontramos diferencias en síntomas depresivos al mes de seguimiento (p = ,713) ni en síntomas de TEPT seis meses después de la intervención (p = ,986).Conclusiones: Los PAP-ABCDE no previenen el diagnóstico de TEPT, pero brindan alivio inmediato del distrés y disminuyen la severidad de los síntomas del TEPT en el corto plazo.

Disentangling socioeconomic inequalities of type 2 diabetes mellitus in Chile: A population-based analysis.

INTRODUCTION: Chile experiences a growing prevalence of DM2 in its adult population over time. The country has prioritised the diagnosis and treatment of DM2 through a universal health care package, largely focused on the clinical dimensions of the disease. We analysed the significance of socioeconomic variables in the prevalence of DM2, as well as its related dimensions of presence of complications (diabetic foot and ophthalmologic complications), attendance to health checks and acquisition of recommended lifestyle changes due to this condition. METHODS: Secondary analysis of the national health survey (ENS) 2016-2017 (n = 6,233 respondents). Crude and income-adjusted odds of reporting DM2 was estimated, as well as the relationship between complications due to diabetes and a number of clinical and sociodemographic variables using weighted log-linear multiple regression models. RESULTS: We found a clear social gradient of the prevalence of DM2 by household income quintiles and educational level in the adult population. Income quintile and educational level gradients remained significantly associated with the presence of complications and attendance to health checks. We found no significant association, however; between income quintile and reported lifestyle change. The association between complications due to DM2 and socioeconomic variables, particularly income, remained relevant even after adjusting for all sociodemographic variables. CONCLUSION: This is the first study to analyse the association between DM2 and socioeconomic variables in Chile, useful for monitoring and policy planning. Income was strongly associated with DM2 prevalence and with related clinical variables (complications and attendance to health checks). Age, health care provision and educational level were also relevant factors, but lost significance in the fully adjusted model.

Understanding the Relationship Between Direct Experience and Risk Perception of Natural Hazards.

Risk perception has been largely examined in studies that have aimed to explain and predict preparedness behavior in the context of natural hazards. Findings from studies on the relationship between previous experience, preparedness, and risk perception in disaster situations have been inconsistent. Hence, the main goal of this work was to explore the influence of physical and emotional experience on risk perception regarding natural hazards. This study was conducted in a statistically representative sample of the city of Iquique, in northern Chile (n = 701), who completed a survey one month after the occurrence of an earthquake and tsunami (8.2 Mw). The survey assessed the experience and preparation actions of survivors in relation to this event. Using a structural equation model, we examined nine proposed relationships, six of which were significant. The final model had an adequate fit (χ² = 752.23, df = 283, comparative fit index [CFI] = 0.90, root mean square error of approximation [RMSEA] = 0.049). Direct experience showed the greatest influence on risk perception: while direct physical experience (i.e., the physical and material consequences associated with the earthquake) maintained a direct positive effect on risk perception, direct emotional experience (i.e., the fear of experiencing an earthquake) produced an indirect positive effect (through worry). Emotional experience, however, did not directly influence current preparedness and risk perception. Implications for understanding the relationship between risk perception and direct experience are discussed.

Natural disaster preparedness in a multi-hazard environment: Characterizing the sociodemographic profile of those better (worse) prepared.

The growing multi-hazard environment to which millions of people in the world are exposed highlights the importance of making sure that populations are increasingly better prepared. The objective of this study was to report the levels of preparedness of a community exposed to two natural hazards and identify the primary sociodemographic characteristics of groups with different preparedness levels. A survey was conducted on 476 participants from two localities of the Atacama Region in the north of Chile during the spring of 2015. Their level of preparedness at home and work was assessed to face two types of natural hazards: earthquakes and floods.The findings show that participants are significantly better prepared to face earthquakes than floods, which sends a serious warning to local authorities, given that floods have caused the greatest human and material losses in the region's recent history of natural disasters. Men claimed to be more prepared than women to face floods, something that the authors attribute to the particular characteristics of the main employment sectors for men and women in the region. The potential contribution of large companies on preparedness levels of communities in the areas in which they operate is discussed. The sociodemographic profile of individuals with the highest levels of preparedness in an environment with multiple natural hazards are people between 30 and 59 years of age, living with their partner and school-age children. The implications of the results pertaining to institutions responsible for developing disaster risk reduction plans, policies and programs in a multi-hazard environment are discussed.

Extinction cues do not reduce recovery of extinguished conditioned fear in humans

We evaluated whether an extinction cue can reduce (or prevent) the recovery of previously extinguished fear conditioning using an ABC renewal design in humans. Two experiments were carried out. In Experiment 1, two groups were presented with geometric shapes as conditioned stimulus (CS), followed by a small electric shock as unconditioned stimulus (US) during the acquisition phase. Conditioned fear was measured as ratings of US expectancy and changes in skin conductance response (SCR). During the extinction phase, both groups received presentations of the CS without the US, while an extinction cue (EC) was presented. Both groups were tested in both the extinction context (extinction test) and a new context (renewal test) immediately and 48 hours after the end of the extinction phase (spontaneous recovery). Half of the subjects were tested in the presence of the EC (Group Extinction cue) while the other half were tested in the presence of a neutral cue (Group Neutral cue). The results suggested that the EC reduced the recovery of fear produced by a context change, but that this reduction was not maintained over time. Experiment 2 increased the salience of the EC and the contexts, however, results showed that the EC was unable to reduce the renewal of fear conditioning. These results are discussed as a function of the experimental manipulations performed, and their theoretical and practical implications (AU)

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Hazard proximity and risk perception of tsunamis in coastal cities: Are people able to identify their risk?

Researchers have previously reported that hazard proximity can influence risk perception among individuals exposed to potential hazards. Understanding this relationship among coastline communities at risk of flood events caused by storms and/or tsunamis, is important because hazard proximity, should be recognized when planning and implementing preparation and mitigation actions against these events. Yet, we are not aware of studies that have examined this relationship among coastline inhabitants facing the risk of a tsunami. Consequently, the aim of this study was to examine the relationship between hazard proximity and perceived risk from tsunamis among coastline inhabitants. Participants were 487 residents of the coastal city of Iquique, Chile. They completed a survey during the spring of 2013 that assessed their perceived risk from several natural and non-natural hazards. We found that hazard proximity maintains a negative relationship with the perception of tsunami risk among coastline inhabitants. While this result confirms the general trend obtained in previous studies, this one is conclusive and significant. In contradiction with previous findings, we found that participants from the highest socioeconomic status reported the highest levels of risk perception. This finding can be explained by the fact that most participants from the highest socioeconomic status live closer to the coastline areas, so their risk perception reflects the place where they live, that is in a tsunami inundation zone. Once again, hazard proximity proved to be a determinant factor of risk perception. Our findings have important implications for the development of plans and programs for tsunami preparedness and mitigation. These indicate that individuals do use environmental cues to evaluate their own risk and can potentially make correct choices when having or not to evacuate. Also suggest that preparedness should incorporate how hazard proximity is recognized by individuals and communities at risk.

"In our own words": Defining medical professionalism from a Latin American perspective.

BACKGROUND: Latin America has experienced a tremendous growth in a number of medical schools, and there are concerns about their quality of training in critical areas such as professionalism. Medical professionalism is a cultural construct. The aim of the study was to compare published definitions of medical professionalism from Latin American and non-Latin American regions and to design an original and culturally sound definition. METHODS: A mixed methods approach was used with three phases. First, a systematic search and thematic analysis of the literature were conducted. Second, a Delphi methodology was used to design a local definition of medical professionalism. Third, we used a qualitative approach that combined focus groups and personal interviews with students and deans from four medical schools in Chile to understand various aspects of professionalism education. The data were analyzed using NVivo software. RESULTS: A total of 115 nonrepeated articles were identified in the three databases searched. No original definitions of medical professionalism from Latin America were found. Twenty-six articles met at least one of the three decisional criteria defined and were fully reviewed. Three theoretical perspectives were identified: contractualism, personalism, and deontology. Attributes of medical professionalism were classified in five dimensions: personal, interpersonal, societal, formative, and practical. Participants of the Delphi panel, focus groups, and personal interviews included 36 medical students, 12 faculties, and four deans. They took a personalistic approach to design an original definition of medical professionalism and highlighted the relevance of respecting life, human dignity, and the virtue of prudence in medical practice. Students and scholars differed on the value given to empathy and compassion. DISCUSSION: This study provides an original and culturally sound definition of medical professionalism that could be useful in Latin American medical schools. The methodology used in the study could be applied in other regions as a basis to develop culturally appropriate definitions of medical professionalism.

Exploring the Masculine Identity in the Context of HIV Prevention in Chile.

PURPOSE: This study aims to describe human immunodeficiency virus (HIV)-related knowledge and beliefs, as well as understanding attitudes towards masculinity in the context of HIV prevention, held among Chilean men. DESIGN: This study reports the qualitative findings of a sequential qualitative-quantitative mixed methodology study: Bringing men into HIV Prevention in Chile, NIH R01 TW007674-03. METHODS: Twenty in-depth interviews using a qualitative, descriptive approach to elicit information for the study were conducted among men residing in two communities of low socio-economic status in Santiago, Chile. FINDINGS: Content analysis of interviews revealed three main themes regarding machismo and how it relates to HIV: sexuality and machismo, the changing nature of machismo, and violence against women. CONCLUSIONS: Addressing HIV and intimate partner violence through developing education programs tailored to meet the needs of Chilean men are needed to include men in HIV prevention efforts. CLINICAL RELEVANCE: Specifically, incorporating ideas of what men consider healthy masculinity and working to destigmatize men who have sex with men are important steps in addressing the negative aspects of machismo.

Do frequent moderate exacerbations contribute to progression of chronic obstructive pulmonary disease in patients who are ex-smokers?

BACKGROUND: In addition to smoking, acute exacerbations are considered to be a contributing factor to progression of chronic obstructive pulmonary disease (COPD). However, these findings come from studies including active smokers, while results in ex-smokers are scarce and contradictory. The purpose of this study was to evaluate if frequent acute moderate exacerbations are associated with an accelerated decline in forced expiratory volume in one second (FEV1) and impairment of functional and clinical outcomes in ex-smoking COPD patients. METHODS: A cohort of 100 ex-smoking patients recruited for a 2-year follow-up study was evaluated at inclusion and at 6-monthly scheduled visits while in a stable condition. Evaluation included anthropometry, spirometry, inspiratory capacity, peripheral capillary oxygen saturation, severity of dyspnea, a 6-minute walking test, BODE (Body mass index, airflow Obstruction, Dyspnea, Exercise performance) index, and quality of life (St George's Respiratory Questionnaire and Chronic Respiratory Disease Questionnaire). Severity of exacerbation was graded as moderate or severe according to health care utilization. Patients were classified as infrequent exacerbators if they had no or one acute exacerbation/year and frequent exacerbators if they had two or more acute exacerbations/year. Random effects modeling, within hierarchical linear modeling, was used for analysis. RESULTS: During follow-up, 419 (96% moderate) acute exacerbations were registered. At baseline, frequent exacerbators had more severe disease than infrequent exacerbators according to their FEV1 and BODE index, and also showed greater impairment in inspiratory capacity, forced vital capacity, peripheral capillary oxygen saturation, 6-minute walking test, and quality of life. However, no significant difference in FEV1 decline over time was found between the two groups (54.7±13 mL/year versus 85.4±15.9 mL/year in frequent exacerbators and infrequent exacerbators, respectively). This was also the case for all other measurements. CONCLUSION: Our results suggest that frequent moderate exacerbations do not contribute to accelerated clinical and functional decline in COPD patients who are ex-smokers.

[Parental practices and pedestrian risk behaviors in Chilean adolescents]. / Prácticas parentales y conductas de riesgo del peatón en una muestra de adolescentes chilenos.

BACKGROUND: Traffic accidents are the second leading cause of death among adolescents and young adults in Chile. However, few studies have examined this behavior among this age group. Parental practices have a great influence on risk behaviors in adolescents, such as substance use, sexuality and violence, among others. Specifically, we propose that these practices will influence pedestrian risk behaviors among adolescents. AIM: To study the role of parental practices such as mother and father support, and behavioral control (monitoring and presence of rules) in pedestrian risk behaviors of teenagers. MATERIAL AND METHODS: A sample of 470 adolescents attending schools in the Metropolitan Region of Santiago, Chile were studied. They answered a self-administered questionnaire in which they were asked about parental practices and pedestrian risk behaviors. Analyses were performed using descriptive and inferential statistics, using multiple regression. RESULTS: Paternal support and the presence of rules were protective factors for pedestrian risky behaviors. However, maternal support or monitoring did not influence these behaviors. CONCLUSIONS: Parental practices influence pedestrian behaviors of teenagers. The study provides further evidence for the importance of these practices in the development of behavioral self-regulation.

Prácticas parentales y conductas de riesgo del peatón en una muestra de adolescentes chilenos / Parental practices and pedestrian risk behaviors in Chilean adolescents

Background: Traffic accidents are the second leading cause of death among adolescents and young adults in Chile. However, few studies have examined this behavior among this age group. Parental practices have a great influence on risk behaviors in adolescents, such as substance use, sexuality and violence, among others. Specifically, we propose that these practices will influence pedestrian risk behaviors among adolescents. Aim: To study the role of parental practices such as mother and father support, and behavioral control (monitoring and presence of rules) in pedestrian risk behaviors of teenagers. Material and Methods: A sample of 470 adolescents attending schools in the Metropolitan Region of Santiago, Chile were studied. They answered a self-administered questionnaire in which they were asked about parental practices and pedestrian risk behaviors. Analyses were performed using descriptive and inferential statistics, using multiple regression. Results: Paternal support and the presence of rules were protective factors for pedestrian risky behaviors. However, maternal support or monitoring did not influence these behaviors. Conclusions: Parental practices influence pedestrian behaviors of teenagers. The study provides further evidence for the importance of these practices in the development of behavioral self-regulation.

Insatisfacción corporal, creencias sobre control del peso y consumo de cigarrillos en jóvenes / Body dissatisfaction, beliefs about weight control, and cigarette use among youth

En diversos estudios los investigadores han encontrado una relación entre insatisfacción corporal, creencias de control de peso asociadas al consumo de cigarrillos y el consumo de cigarrillos en jóvenes. Este estudio evaluó un modelo de mediación de las creencias de control de peso asociadas al consumo de cigarrillos en la relación entre insatisfacción corporal y consumo de cigarrillos. Se realizó un estudio correlacional con 651 jóvenes chilenos de entre 12 y 23 años de edad. Se realizaron ANOVA y análisis de regresión lineal para evaluar las hipótesis propuestas. Se encontró una relación entre insatisfacción corporal y consumo de cigarrillos y diferencias significativas en dicha relación según sexo. Los resultados obtenidos confirman la relación entre insatisfacción corporal y consumo de cigarrillos en jóvenes chilenos, sin embargo, no se comprueba la mediación propuesta.

In several studies, researchers have found a link between body dissatisfaction, weight control beliefs associated with cigarette use and cigarette smoking among young people. This study examined a mediation model of weight control beliefs associated with cigarette use for the relationship between body dissatisfaction and cigarette smoking. A correlational study was conducted with 651 young chileans between 12 and 23 years of age. ANOVA and linear regression analyses were conducted to evaluate the proposed hypotheses. A relationship between body dissatisfaction and smoking and significant differences by sex for this relationship were found. These results confirm the relationship between body dissatisfaction and cigarette smoking among young Chileans, however, do not support the proposed mediation.

[Design and validation of an instrument to assess families at risk for health problems]. / Diseño y validación del instrumento SALUFAM: un instrumento de valoración de la salud familiar con alto valor predictivo clínico para la atención primaria chilena.

BACKGROUND: There is a paucity of screening instruments with a high clinical predictive value to identify families at risk and therefore, develop focused interventions in primary care. AIM: To develop an easy to apply screening instrument with a high clinical predictive value to identify families with a higher health vulnerability. MATERIAL AND METHODS: In the first stage of the study an instrument with a high content validity was designed through a review of existent instruments, qualitative interviews with families and expert opinions following a Delphi approach of three rounds. In the second stage, concurrent validity was tested through a comparative analysis between the pilot instrument and a family clinical interview conducted to 300 families randomly selected from a population registered at a primary care clinic in Santiago. The sampling was blocked based on the presence of diabetes, depression, child asthma, behavioral disorders, presence of an older person or the lack of previous conditions among family members. The third stage, was directed to test the clinical predictive validity of the instrument by comparing the baseline vulnerability obtained by the instrument and the change in clinical status and health related quality of life perceptions of the family members after nine months of follow-up. RESULTS: The final SALUFAM instrument included 13 items and had a high internal consistency (Cronbach's alpha: 0.821), high test re-test reproducibility (Pearson correlation: 0.84) and a high clinical predictive value for clinical deterioration (Odds ratio: 1.826; 95% confidence intervals: 1.101-3.029). CONCLUSIONS: SALUFAM instrument is applicable, replicable, has a high content validity, concurrent validity and clinical predictive value.