Fanny Leyton

Adverse childhood experiences (ACEs) are associated with psychological difficulties across the life course, making their assessment important for developmental adversity research. This pilot compared a conventional 10-item questionnaire (ACE-10) with a modified 14-item version (ACE-14) in a school-based convenience sample of 93 parents and guardians in Ecuador. Participants completed both versions in Spanish about their own childhood; ACE-14 responses were mapped to 10 domains. Paired analyses examined agreement on individual adversity domains, total scores, and exposure categories using confidence intervals (CIs), McNemar tests, and Holm adjustment for multiple comparisons. Mean domain counts were similar (1.23 versus 1.25), but Bland–Altman limits for individual score differences were −2.00 to 2.04 domains. Any ACE was reported by 47 versus 56 participants (difference 9.7 percentage points; Holm-adjusted p = 0.099). Deprivation or impaired caregiving showed the clearest directional difference: 12 participants endorsed mapped ACE-14 only and one endorsed ACE-10 only (difference 11.8 percentage points, 95% CI [5.1, 20.3]; domain-adjusted p = 0.023; exact-test adjusted p = 0.034). Forty-five participants (48.4%) gave different answers for at least one domain. The study did not assess how often answers would change if the same questionnaire were completed twice. These findings show that similar average scores can conceal differences in individual exposure classification. Future studies should use cognitive interviews, randomized questionnaire order, and repeated administration of the same version to clarify how wording and question format contribute to these differences.

La formación en diversidad sexual y de género en Psiquiatría Pediátrica y de la Adolescencia en Chile sigue siendo limitada, lo que perpetúa barreras de discriminación y prejuicios en la atención de la población LGBT+. Objetivo: Analizar la autopercepción de los residentes sobre su formación en estas temáticas y su impacto en la práctica clínica. Material y Método: Estudio cualitativo exploratorio basado en entrevistas semiestructuradas online realizadas entre 2024 2025 a 16 residentes de primero a tercer año de diversas regiones. El reclutamiento se realizó con invitación abierta mediante la Asociación de Residentes de Psiquiatría Pediátrica y de la Adolescencia, sin criterios de exclusión. El análisis se desarrolló mediante teoría fundamentada (codificación abierta y axial) con ATLAS.ti y triangulación entre investigadores, alcanzando saturación teórica. Resultados: Emergieron tres categorías: concepciones de diversidad, formación médica y atención clínica. Coexisten posturas contrapuestas, desde enfoques biomédicos patologizantes hasta miradas críticas que conciben la identidad como un proceso. La pertenencia a la comunidad LGBT+ y el autoaprendizaje se asociaron a mayor sensibilidad clínica. De hecho, la autoformación surgió como estrategia compensatoria ante la insuficiencia de instancias formales, evidenciando tensiones entre la formación profesional, las creencias personales y las prácticas docentes. Conclusión: Los residentes perciben una formación deficiente en diversidad sexual y de género, lo que se refleja en dificultades para la práctica clínica. Estos hallazgos respaldan la necesidad de incorporar capacitación sistemática, formal e inclusiva en los programas de especialización en psiquiatría infanto-juvenil.

Clinical practice guidelines are a set of recommendations developed systematically and based on the best available evidence. Their purpose is to enable healthcare providers and patients to make the best decisions regarding healthcare interventions associated with a particular clinical condition, considering each patient's specific circumstances. One element that has gained importance recently is considering patient preferences when developing healthcare recommendations to increase adherence to therapeutic measures and patient satisfaction. One way to incorporate these preferences is by including patients or their representatives in developing these tools. Patient participation can take place through their inclusion as members of the development panel and/or at different stages of the guideline development process. This can be achieved through various methods like discussion groups, semi-structured interviews, or surveys. However, challenges still need to be addressed to optimally incorporate patients' perspectives, which, among other reasons, are related to socioeconomic barriers, educational gaps, and the persistence of a paternalistic view of healthcare. This article has been developed in the context of a methodological series on clinical epidemiology, biostatistics, and research methodology carried out by the departments of Research Methodology and Evidence-Based Medicine at the School of Medicine of the University of Valparaíso, Chile.

Strength‐based video‐feedback (SB‐VF) is an attached base and culturally sensitive video‐feedback intervention which promotes maternal well‐being and sensitivity through using mentalization technics. The goals of this study were to investigate the feasibility, acceptability, and preliminary effectiveness of internet‐delivered SB‐VF to mother with post‐partum depression during COVID‐19 pandemic. A pilot randomized, two arm controlled trial was conducted (trial registration NCT04748731) with depressive symptoms’ women (n = 172) from Chilean public primary health centers, 79 were randomized to either experimental group (on‐line SB‐VF plus treatment as usual [TAU], n = 41) or control group (TAU, n = 38). Primary outcomes were feasibility measured by eligibility rate, recruitment rate and intervention completion, and acceptability measured by in depth interviews to mothers and therapists. Secondary outcomes were change in depressive symptoms, maternal sensitivity and parental reflective function. The study demonstrated favorable feasibility and acceptability. Despite moderate recruitment rates, the completion rate was notably high in comparison to other online interventions. Participants reported positive experiences, though some faced challenges with internet access and privacy. Maternal sensitivity improved in the intervention group with a small to large effect size. The SB‐VF intervention is feasible and preliminarily effective in public health system, with potential for scaling up in similar contexts.

Qualitative research plays an essential role in health sciences, aiming to achieve a deep understanding of phenomena, experiences, perceptions, and behaviors in their natural contexts. In this article, we outline essential aspects to consider when conducting qualitative research, starting from formulating the research question to analyzing and reporting the obtained data. We present the main qualitative design methods and sampling techniques, emphasizing the importance of reaching data saturation and the data production methods. This article offers a roadmap for conducting qualitative research in health care, contributing to a more humanized and evidence-based clinical practice.

BACKGROUND The COVID-19 pandemic led to a prompt implementation of remote care, especially in mental health care. The evidence supporting this modality of care is still emerging, with few qualitative studies describing its implementation in Latin American countries. This study aims to understand the perspectives of therapists and patients regarding the use of telehealth in a child and adolescent mental health unit of a Chilean public service. METHODS This is a qualitative study. Two focus groups were defined with 14 professionals, and 16 in-depth interviews were conducted with users of an outpatient child and adolescent psychiatry unit. The data were analyzed using the grounded theory model. RESULTS In the group of therapists, four main categories emerged: background of mental telehealth, implementation, mental telehealth from the therapist's position, and projections. Three main categories emerged in the patient's group: implementation, evaluation of mental telehealth users, and projections. CONCLUSIONS There are elements in common between the opinions of patients and therapists. Something to note within the patient's group is that, despite accepting remote care and recognizing its positive aspects, aside from the pandemic context, they prefer face-to-face or mixed care.

Palabras clave: depresión; salud mental; atención primaria de salud

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.

Por otra parte, el riesgo de desarrollar sintomatología psíquica en estudiantes de medicina ha sido ampliamente descrito en la literatura, incluyendo cuadros afectivos, ansiosos, abuso de sustancias y suicidalidad¹⁰–¹². Factores como la presión y la carga académica, la competencia, la comparación entre pares y la exposición a situaciones de riesgo vital, entre otros, pueden perjudicar la estabilidad psicológica de las estudiantes, desencadenando formas maladaptativas de afrontar los conflictos¹².