Integrated mapping of local mental health systems in Central Chile

Objective. To describe the availability of local mental health (MH) services in small MH catchment areas in Central Chile, using a bottom-up approach. Methods. MH services of 19 small MH catchment areas in five health districts of Central Chile that provide health care to more than 4 million inhabitants were assessed using DESDELTC (Description and Evaluation of Services and Directories in Europe for Long-Term Care), a tool for standardized description and classification of LTC health services, in a study conducted in 2012 (“DESDE-Chile”) designed to complement other studies conducted in 2004 and 2012 at the national and regional level using the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS). Key informants from national, regional, and local health authorities were contacted to compile a comprehensive list of MH services or facilities (health, social services, education, employment, and housing). The analysis of local care provision covered three criteria—service availability, placement capacity, and workforce capacity. Results. The study detected disparities in all three criteria (availability and placement and workforce capacity) across the five health districts, between urban and rural areas, and between neighboring urban areas. Analysis of service availability revealed differences in the weight of residential services versus day and outpatient care. The Talcahuano area could be considered a benchmark of MH care in Central Chile, based on its service provision patterns, and the criteria of the community care model. The list of MH services identified in this study differed from the one generated in the 2012 WHO-AIMS study. Conclusions. This survey of local MH service provision in small catchment areas using the DESDE-LTC tool provided MH service provision data that complemented information collected in other studies conducted at the national/regional level using the WHO-AIMS tool. The bottom-up approach applied in this study would also be useful for the assessment of equity and accessibility and local planning

Unmet needs in the management of schizophrenia

Studies on unmet needs during the last decades have played a significant role in the development and dissemination of evidence-based community practices for persistent schizophrenia and other severe mental disorders. This review has thoroughly considered several blocks of unmet needs, which are frequently related to schizophrenic disorders. Those related to health have been the first block to be considered, in which authors have examined the frequent complications and comorbidities found in schizophrenia, such as substance abuse and dual diagnosis. A second block has been devoted to psychosocial and economic needs, especially within the field of recovery of the persistently mentally ill. Within this block, the effects of the current economic difficulties shown in recent literature have been considered as well. Because no patient is static, a third block has reviewed evolving needs according to the clinical staging model. The fourth block has been dedicated to integrated evidence-based interventions to improve the quality of life of persons with schizophrenia. Consideration of community care for those reluctant to maintain contact with mental health services has constituted the fifth block. Finally, authors have aggregated their own reflections regarding future trends. The number of psychosocial unmet needs is extensive. Vast research efforts will be needed to find appropriate ways to meet them, particularly regarding so-called existential needs, but many needs could be met only by applying existing evidence-based interventions. Reinforcing research on the implementation strategies and capacity building of professionals working in community settings might address this problem. The final aim should be based on the collaborative model of care, which rests on the performance of a case manager responsible for monitoring patient progress, providing assertive follow-up, teaching self-help strategies, and facilitating communication among the patient, family doctor, mental health specialist, and other specialists

Clasificación y resolución de conflictos entre aspectos

En este trabajo se introduce la problemática de conflictos entre aspectos circunscripta al paradigma de programación orientada a aspectos. En base a una taxonomía para la resolución de conflictos se analizan brevemente algunas lenguajes orientados a aspectos. El análisis nos permite establecer algunos requisitos para diseñar e implementar herramientas mas abarcativas y seguras para el desarrollo de aplicaciones bajo este enfoque, en lo que respecta al manejo de conflictos entre aspectos.Eje: Programacion, LenguajesRed de Universidades con Carreras en Informática (RedUNCI

Clasificación y resolución de conflictos entre aspectos

En este trabajo se introduce la problemática de conflictos entre aspectos circunscripta al paradigma de programación orientada a aspectos. En base a una taxonomía para la resolución de conflictos se analizan brevemente algunas lenguajes orientados a aspectos. El análisis nos permite establecer algunos requisitos para diseñar e implementar herramientas mas abarcativas y seguras para el desarrollo de aplicaciones bajo este enfoque, en lo que respecta al manejo de conflictos entre aspectos.Eje: Programacion, LenguajesRed de Universidades con Carreras en Informática (RedUNCI

Life satisfaction, positive affect, depression and anxiety symptoms, and their relationship with sociodemographic, psychosocial, and clinical variables in a general elderly population sample from Chile

BackgroundThis study aims to describe the relationship between life satisfaction, positive affect, depression and anxiety symptoms with sociodemographic, psychosocial and clinical variables, and to identify the relative importance of these predictor groups.MethodsWe evaluated life satisfaction (SWLS), positive affect (PANAS), depressive (PHQ-9), and anxiety (GAI) symptoms and their association with sociodemographic, psychosocial and clinical variables in a multistage, random general population sample of fully functioning individuals aged 60–80 years from the Concepción province and Gran Santiago, Chile (n = 396). We performed weighted multiple regression analysis, considering the complex sample structure with age group, sex, and geographical area, complemented with general and conditional dominance analyses to estimate the relevance of the predictor groups.ResultsWe found significant associations with the geographical area, sex, age, education level, household members, having a partner, employment status, caregiver status, economic satisfaction, presence of chronic diseases, medication use, and alcohol use. Satisfaction with health was the most important predictor for positive affect (p < 0.001), depressive (p < 0.001), and anxiety (p < 0.001) symptoms, while alcohol use was the most significant predictor for life satisfaction (p < 0.001).ConclusionSimultaneously studying the positive and negative dimensions of wellbeing and mental health in older adults allows for a more comprehensive perspective on the challenges faced during this stage of life. This study accounts for previously unknown associations and contributes to the identification of common and specific predictors in both dimensions

Programa de Salud Mental en la Provil1cia de Río Negro (Argentina).

La provincia de Río Negro está situada en la región patagónica de la República Argentina, limitando al norte con la provincia de la Pampa; al oeste con la provincia de Neuquén y la República de Chile; al sur con la provincia de Chubut y al este con el océano Atlántico y la provincia de Buenos Aires. Tiene una superficie de 203.013 Km2 y una población de a 552.303 habitantes, en 1994. La capital de la provincia es la ciudad de Viedma y cuenta con una división política en 13 departamentos y una natural en cinco regiones: el Alto Valle, el Valle Medio, Atlántica o Valle Inferior, Cordillerana y Meseta Desértica. A excepción del conglomerado del Alto Valle, donde vive el 53% de la población, las 8 comunidades urbanas se encuentran separadas por distancias considerables. El 72% de la población río negrina es urbana, concentrada en los departamentos de General Roca, Adolfo Alsina, Bariloche y Avellaneda. La población rural (28%) se distribuye en los departamentos de Pilcaniyeu, Ñorquinco, El Cuy, Valcheta, 9 de Julio y 25 de Mayo

Programa de Salud Mental en la Provil1cia de Río Negro (Argentina).

La provincia de Río Negro está situada en la región patagónica de la República Argentina, limitando al norte con la provincia de la Pampa; al oeste con la provincia de Neuquén y la República de Chile; al sur con la provincia de Chubut y al este con el océano Atlántico y la provincia de Buenos Aires. Tiene una superficie de 203.013 Km2 y una población de a 552.303 habitantes, en 1994. La capital de la provincia es la ciudad de Viedma y cuenta con una división política en 13 departamentos y una natural en cinco regiones: el Alto Valle, el Valle Medio, Atlántica o Valle Inferior, Cordillerana y Meseta Desértica. A excepción del conglomerado del Alto Valle, donde vive el 53% de la población, las 8 comunidades urbanas se encuentran separadas por distancias considerables. El 72% de la población río negrina es urbana, concentrada en los departamentos de General Roca, Adolfo Alsina, Bariloche y Avellaneda. La población rural (28%) se distribuye en los departamentos de Pilcaniyeu, Ñorquinco, El Cuy, Valcheta, 9 de Julio y 25 de Mayo

Prediction of depression in European general practice attendees: the PREDICT study

Background Prevention of depression must address multiple risk factors. Estimating overall risk across a range of putative risk factors is fundamental to prevention of depression. However, we lack reliable and valid methods of risk estimation. This protocol paper introduces PREDICT, an international research study to address this risk estimation. Methods/design This is a prospective study in which consecutive general practice attendees in six European countries are recruited and followed up after six and 12 months. Prevalence of depression is assessed at baseline and each follow-up point. Consecutive attendees between April 2003 and September 2004 who were aged 18 to 75 were asked to take part. The possibility of a depressive episode was assessed using the Depression Section of the Composite International Diagnostic Interview. A selection of presumed risk factors was based on our previous work and a systematic review of the literature. It was necessary to evaluate the test-retest reliability of a number of risk factor questions that were developed specifically, or adapted, for the PREDICT study. In a separate reliability study conducted between January and November 2003, consecutive general practice attendees in the six participating European countries completed the risk factor items on two occasions, two weeks apart. The overall response rate at entry to the study was 69%. We exceeded our expected recruitment rate, achieving a total of 10,048 people in all. Reliability coefficients were generally good to excellent. Discussion Response rate to follow-up in all countries was uniformly high, which suggests that prediction will be based on almost a full cohort. The results of our reliability analysis are encouraging and suggest that data collected during the course of PREDICT will have a satisfactory level of stability. The development of a multi-factor risk score for depression will lay the foundation for future research on risk reduction in primary care. Our data will also provide the necessary evidence base on which to develop and evaluate interventions to reduce the prevalence of depression