Experiences from the field: Chilean healthcare providers' perspectives on partner notification for syphilis - a qualitative case study / Experiencias en el campo: perspectivas de los proveedores de salud chilenos sobre la notificación de parejas para sífilis ­ un estudio de caso cualitativo

Introduction: Partner Notification (NP) has long been considered an essential strategy for the control of sexually transmitted infections (STIs). Although the delivery of clinical services for STIs has improved in Chile, syphilis in the general population is one of the most commonly reported STIs. Objective: To understand PN current practices and challenges, we explored health care providers' (HCPs) perspectives about PN for syphilis in public health services in Chile. Methods: Semi-structured interviews were conducted with HCPs in 14 primary health care centres and 6 sexual health units located at two regional Health Services as well as with key informants from different backgrounds. Interviews were transcribed verbatim and coded using QSR International's NVivo 11 PRO Software, for cross-case thematic analysis, which followed an inductive approach. Selected quotes were translated from Spanish to English. Consensus on codes and themes was reached by the multi-disciplinary research team. Results: A total of 58 interviews were conducted. Forty-eight HCPs were interviewed across both Health Services; most with midwives with more than 10 years of work experience; and ten were key informants. Participants acknowledged PN as a syphilis control strategy with patient referral being the most common approach. Participants commented that index cases do not provide information about their partners easily and the delivery of PN is further impacted by gender and the socio-cultural context of Chile. PN was perceived by HCPs as an exhausting and difficult process. Conclusion: This is the first study to identify the perceptions of Chilean HCPs about PN for syphilis. PN is a valuable strategy for syphilis control in Chile; however, our findings suggest that HCPs consider this strategy a challenge both for them and for the Chilean population. Improving current practices and increasing awareness about PN would strengthen the work that has been done by HCPs for syphilis control and enhance the long-term impact of existing policies.

la Notificación de Pareja (NP) se ha considerado durante mucho tiempo una estrategia esencial para el control de las infecciones de transmisión sexual (ITS). Aunque la prestación de servicios clínicos para las ITS ha mejorado en Chile, la sífilis en la población general es una de las ITS más comúnmente reportadas. Objetivo: Para comprender las prácticas y los desafíos actuales de la NP, exploramos las perspectivas de los proveedores de salud (PS) sobre la NP para la sífilis en los servicios de salud pública en Chile. Métodos: Se realizaron entrevistas semiestructuradas con PS en 14 centros de atención primaria de salud y 6 unidades de salud sexual ubicadas en dos servicios de salud regionales, así como con informantes clave (IC) de diferentes orígenes. Las entrevistas se transcribieron textualmente y se codificaron utilizando el software NVivo 11 PRO de QSR International, para el análisis temático de casos cruzados, que siguió un enfoque inductivo. Las citas seleccionadas fueron traducidas del español al inglés. El equipo de investigación multidisciplinario llegó a un consenso sobre códigos y temas. Resultados: Se realizaron un total de 58 entrevistas. Se entrevistaron 48 PS en ambos Servicios de Salud; la mayoría con matrones con más de 10 años de experiencia laboral; y diez eran IC. Los participantes reconocieron la NP como una estrategia de control de la sífilis, siendo la derivación de pacientes el enfoque más común. Los participantes comentaron que los casos índice no proporcionan información sobre sus parejas fácilmente y que la entrega de NP se ve afectada aún más por el género y el contexto sociocultural de Chile. La NP fue percibida por los PS como un proceso agotador y difícil. Conclusión: Este es el primer estudio que identifica las percepciones de los PS chilenos sobre la NP para la sífilis. La NP es una estrategia valiosa para el control de la sífilis en Chile; sin embargo, nuestros hallazgos sugieren que los PS consideran esta estrategia como un desafío tanto para ellos como para la población chilena. Mejorar las prácticas actuales y aumentar la conciencia sobre la NP fortalecería el trabajo realizado por los profesionales de la salud para el control de la sífilis y mejoraría el impacto a largo plazo de las políticas existentes

High rates of chlamydia found among 12- to 16-year-olds attending a rural sexual health clinic: implications for practice.

UNLABELLED: Background Chlamydia is the most commonly diagnosed bacterial sexually transmissible infection (STI) and is asymptomatic in ~80% of women. If untreated, potential consequences include pelvic inflammatory disease, ectopic pregnancy and infertility. METHODS: In 2014, a retrospective audit was undertaken at a rural service to determine what proportion of patients were aged 12-16 years, infected with chlamydia and their reasons for attending the clinic. RESULTS: There were 111 patients aged 12-16 years attending during 2011-2014; 104 (95%) were female. One hundred and ninety-four chlamydia tests were conducted, with the proportion of patients having at least one test annually being 100% in 2011, 81% in 2012, 72% in 2013 and 78% in 2014. There was no difference in the proportion tested by age during the study (P=0.59). Forty-six tests were positive for chlamydia (23.7%; 95%CI: 17.8%, 30.9%) with proportions decreasing with increasing age from 46.7% (95%CI: 16.4%, 79.5%) in 12- or 13-year-olds to 15.5% (95%CI: 9.4%, 24.2%) in 16-year-olds (P=0.02). The reasons for attending when a chlamydia test was ordered included: (i) fear of pregnancy (18.3%, 34/185); (ii) symptoms (16.7%, 31/185); (iii) STI test/treatment (32.4%, 60/185); and (iv) contraception (32.4%, 60/185). Only 29.7% (33/111) would have been tested if symptoms or requesting a test were impetus. CONCLUSION: Sexually active 12- to 16-year-olds should be tested for chlamydia, and establishing their sexual history is crucial. Amending the current Australian guidelines to annual testing of any sexually active person under the age of 30 years should be considered.

Pathways to late-life problematic gambling in seniors: a grounded theory approach.

PURPOSE OF THE STUDY: To develop a grounded theory on how older adults, who may not have previously experienced gambling issues, come to develop gambling problems in later life. DESIGN AND METHODS: Through semistructured in-depth interviews with 31 adults aged 56-85, routes that led the current sample of older adults to develop late-life gambling problems were identified and mapped into coherent pathways using a constructivist grounded theory methodology. RESULTS: Three main pathways to late-life problematic gambling were identified, all linked with a common theme of isolation: a grief pathway associated with unresolved losses; a habit pathway associated with habituation to gambling; and a dormant pathway marked by preexisting behavioral excess or impulsivity. Overall, unresolved losses and/or mismanagement of life's stresses were found to be the most significant predictors of late-life problematic gambling. IMPLICATIONS: As late-life problem gambling appears to predominantly signify late-life emotional distress and an attempt to deal with this distress using gambling as an escape, it is crucial for problem gambling prevention programs to raise awareness about the processes of loss and grief and provide ideas about constructive loss management. In addition, community-level recreational and social opportunities to combat isolation are identified.

Pathways to problem gambling in seniors.

Little is known about problem gambling in older adults, particularly when gambling problems only commence late in life. Knowledge of pathways to later life problem gambling can assist prompt and effective interventions for vulnerable older adults. This study builds on a generic Pathways Model. It proposes routes to problem gambling for individuals aged 55 years and above, with a particular focus on late-life, rather than lifetime problem gambling. Gambling-related risk and protective factors/correlates were extracted from the literature based on the extent to which the studies were senior-specific. Common themes were then identified and classified into 3 main clusters: 1 concerning individual vulnerability factors, a 2nd concerning social and environmental factors, and a 3rd concerning factors affecting behavioural regulation.