Mixed-Methods Evaluation of the Initial Implementation of Advanced Home Visits in Chile

Home visiting programs are evidence-based interventions that have a myriad outcomes for mothers and newborns. Chile offers these services as part of the Chile Crece Contigo, a nationwide program. However, implementing home visiting programs in community settings is difficult. In this study, we report clinic, provider, and participant engagement with the implementation of advanced home visits (ViDAs) in Chilean primary care clinics. ViDAs include a high number of visits, external supervision, and the use of technology. In this study, qualitative and quantitative data were collected to assess the initial implementation of the home visiting strategy. Qualitative data consisted of individual interviews and focus groups with directors of city health departments, clinic managers, and providers conducting home visits. Quantitative data included clinic, provider, and participant recruitment. City health departments were approached to authorize the participation of primary care clinics in the ViDAs program. Then, clinic directors were invited to approve the implementation of the home visiting program at their health centers. In total, 16 clinics, 42 practitioners, and 185 participants were recruited. A large amount of resources was needed to recruit clinics, providers, and participants. The intervention had low acceptability, low adoption, and a high implementation cost. Initial program implementation experienced several challenges. Identified facilitators and barriers both highlighted the need for community engagement at all levels for the successful implementation of an innovation in Chilean primary care clinics. In addition, this article provides recommendations for practitioners and researchers regarding the conduct of research in community-based settings.

Microstructural brain and multivoxel spectroscopy in very low birth weight infants related to insulin-like growth factor concentration and early growth

BACKGROUND

Very low birth weight (VLBW) children have higher risk of neurologic disabilities and growth factors are essential for brain maturation.

AIM

To assess whether there are differences in neurologic findings, psychometric parameters and microstructural brain morphology in 1-year-old VLBW infants versus term healthy controls and whether these differences are related to hormonal/growth changes.

METHODS

Prospective anthropometry, prefeed venous blood sample [insulin, insulin-like growth factor-I (IGF-I), insulin-like growth factor-II (IGF-II), leptin, glucose], neurologic and imaging assessment, at age 1 year in 34 VLBW infants (12 SGA; 10 M) and 10 healthy term controls (5 M).

RESULTS

IGF-I concentrations at 1 month of corrected age were 20% lower in SGA versus appropriate for gestational age VLBW (p < 0.02). Gray and white matter volume and fractional anisotropy in 15/27 regions were decreased (p < 0.001). Abnormal spectroscopy was observed in 4 zones in VLBW versus term controls (p < 0.001). Some of these changes were associated with different periods of first-year growth and IGF-I/IGF-II, leptin and HOMA-IR.

CONCLUSIONS

VLBW infants show differences in brain volumes and microstructural brain morphology as compared to term controls, changes related to circulating growth factor and anthropometry changes in the first year. This apparent reorganization of the developing brain offers a unique opportunity to investigate the relationship between changes in cortical anatomy, cognitive and social impairments and periods of early growth.

Necesidades en Padres Varones con Parejas Adolescentes

Esta investigación tiene como objetivo, describir las necesidades que presentan jóvenes que van a ser padres o lo han sido recientemente, siendo la madre de sus hijos adolescente. El propósito es favorecer la realización de un programa educativo de apoyo a padres jóvenes.Los jóvenes entrevistados sienten una fuerte necesidad de reunirse con otros queestán en su misma situación, ya que quieren aprender, compartir experiencias, desahogarse y demostrar interés en su pareja e hijo. Sin embargo, existen pocas instancias de este tipo, observándose una dificultad para acercarse a ellos con el objetivo de que se reúnan y traten temas de su interés. Por esto, se plantea la necesidad de  diseñar nuevas estrategias de acercamiento, adecuándose más a sus necesidades.

Necesidades en Padres Varones con Parejas Adolescentes

Esta investigación tiene como objetivo, describir las necesidades que presentan jóvenes que van a ser padres o lo han sido recientemente, siendo la madre de sus hijos adolescente. El propósito es favorecer la realización de un programa educativo de apoyo a padres jóvenes.Los jóvenes entrevistados sienten una fuerte necesidad de reunirse con otros queestán en su misma situación, ya que quieren aprender, compartir experiencias, desahogarse y demostrar interés en su pareja e hijo. Sin embargo, existen pocas instancias observándose una dificultad para acercarse a ellos con el objetivode que se reúnan y traten temas de su interés. Por esto, se plantea la necesidad de diseñar nuevas estrategias de acercamiento, adecuándose más a sus necesidades.

[Chronic exposure to environmental lead in Chilean infants. II: Effects on the psychomotor development]

BACKGROUND

Lactating children are specially susceptible to lead toxicity due to their underdeveloped nervous system, lower body mass, higher intestinal absorption and lower elimination rates.

AIM

To determine the effects of lead exposure, comparing Chilean lactating children residing in rural areas with low lead exposure, and in urban areas with high lead exposure.

MATERIAL AND METHODS

Newborns from public maternity hospitals of the rural locality of San Felipe and from Metropolitan Santiago, were recruited for the study. On admission to the study, umbilical cord and maternal blood samples were obtained and an inquiry about perinatal, sociohereditary and lead exposure history was done. Children were followed every 6 months until 24 months of age, measuring blood parameters and neurobehavioral development using Bayley scales.

RESULTS

Three hundred twelve children from Santiago and 113 from San Felipe were studied. Maternal and children blood lead levels were higher in Santiago, but lower than those reported in other international studies. At 24 months of age, 4.5% of children from Santiago and 0.7% of children from San Felipe had levels over 10 micrograms/dl. No differences in neurobehavioral development were observed between children of both cities. At 24 months, scores of MDI scales were 91 in Santiago and 97 in San Felipe. The figures for PDI scale were 93 in Santiago and 93 in San Felipe. Main risk factors for a retarded neurobehavioral development were socieconomic level with a mean Odds ratio of 3.5 (0.99-12.4), made sex with an Odds ratio of 2.3 (1.09-5.07) and stimulation at home with an Odds ratio of 0.7 (0.53-0.82).

CONCLUSIONS

In this cohort of children, no effect of lead levels on neurobehavioral development was found.

[Chronic exposure to environmental lead in Chilean infants]

BACKGROUND

In Chile, there are several sources of environmental lead exposure. However, the few studies about lead levels in Chilean infants, do not allow to establish the prevalence of high lead levels in this population.

AIM

To measure blood lead levels in nursing infants, living in rural and urban areas, from birth until two years of age.

SUBJECTS AND METHODS

Newborns from public maternity hospitals in Santiago and a rural area were selected for the study. An umbilical cord blood sample was obtained at birth and venous blood samples thereafter, every 6 months until the age of 24 months. Lead levels were measured by atomic absorption spectrophotometry. Atmospheric lead was measured simultaneously every week in Santiago and the rural area.

RESULTS

Three hundred twelve children from Santiago and 113 from the rural area completed the 24 months follow-up. The mean lead exposure for infants living in Santiago and in the rural area was 1.23 +/- 0.66 and 0.19 +/- 0.15 micrograms/m3 respectively (p < 0.001). Mean blood levels were always higher in infants from Santiago, compared to those from the rural area. At 24 months, 4.5% of children from Santiago and 0.7% of children from the rural area had blood lead levels over 10 micrograms/dl. Significant risk factors for high lead levels were recent painting of the house where the infant lives, eating soil, biting banisters and familiar labor exposure to lead.

CONCLUSIONS

Infants living in an urban area and exposed to increased atmospheric lead levels have higher blood lead levels than infants living in a rural area.