People with chronic conditions and elderly frequently use different levels of health care. If those are not coordinated, patients are exposed to complications and adverse effects. To avoid this, the implementation of transitional care (TC) is proposed, which includes the coordination and follow-up of users through the different care settings. We aimed to analyze the concept of transitional care, its characteristics and impact on people with chronic conditions. A search of articles published between 2012 and 2019 in Google Scholar, MEDLINE, CINAHL and Cochrane Library databases was conducted looking for articles related to the concept of transitional care, characteristics, and impact on people with chronic conditions. Several models of TC have been formulated and the literature identifies common interventions, namely telephone follow-up, outpatient clinics and home visits for self-management support. Reports show that TC reduces re-hospitalizations, care costs, increases quality of life and user satisfaction with the health system.

PAHO/WHO proposes to implement the role of Advanced Practice Nurse (APN) in Latin America, to reduce gaps in coverage and access to health care. For this purpose, it is necessary to train nursing professionals with an expanded role, which allows them to collaborate in the diagnosis, treatment, and monitoring of people with specific diseases, under established protocols and clinical guidelines and within consolidated interdisciplinary health teams in a cost-effective way. One of the areas with the greatest coverage deficit in Latin America is adult oncology, with inequality in care opportunities for these patients. Part of the premature deaths attributable to this disease are due to the lack of access to timely diagnosis and treatment. As a contribution to the reduction of this gap, a training program of Advanced Nursing Practice was developed, addressing the most urgent needs in the field of oncology. The necessary competencies were defined to develop a professional-level master’s degree program, considering prevention, early detection, diagnosis, treatment, and monitoring of people with oncological diseases at different levels of care. A program of this kind is an opportunity to reduce the access gap and coverage of health care for people with cancer, improving their quality of life and their survival.

Abstract: Introduction: Becoming a first-time father is an important change in the life of men and families. Studies on the subject show that these kinds of changes have the power to put life into perspective. Being an involved father has a deep meaning for the child and the family. Objective: To explore the experience of becoming a first-time father during the child first year of the life. Subjects and Methods: A qualitative systematic review was conducted in 2014 in three stages, based on the Joanna Briggs Institute Method for Qualitative Systematic Reviews (QSR). The stages used in this QSR were: establishing the question, determining the type of studies to be included, defining the evaluation criteria, and synthesizing the data. Papers that assessed clinical prognoses were considered such as first-time parenting experience and child care during the first year of life. Only primary qualitative studies including ethnography, phenomenology, narrative analysis, and action research were con sidered. Results: Three meta-syntheses were obtained from the analysis: 1) fatherhood adjustment process, 2) paternal role development, and 3) being an active father. The path towards adoption and the fulfillment of the paternal role is mediated by different processes that are consolidated during the child first year of life. Conclusions: The results support the idea that fathers want to be active parti cipants in the care of their children, that public policies should consider both parents equal in terms of their parenting responsibilities, and that the protection of the family and the family environment is a priority as a health promotion intervention.

Resumen: Introducción: Ser padre por primera vez es un cambio importante en la vida del hombre y la familia. Los estudios en torno al tema demuestran que este tipo de cambios tienen la capacidad de poner la vida en perspectiva. Ser un padre participativo tiene un significado profundo para el niño/a y la familia. Objetivo: Explorar la experiencia de ser padre por primera vez durante el primer año de la vida del hijo/a. Sujetos y Método: Se realizó una revisión sistemática cualitativa en 2014 en 3 etapas, basado en el Joanna Briggs Institute Method para Revisiones Sistemáticas Cualitativas (QSR). Las etapas usadas en este QSR fueron: establecimiento de la pregunta, determinar el tipo de estudios a in cluir, definir los criterios de evaluación, y realizar la síntesis de los datos. Se consideraron manuscritos que evaluaran los pronósticos clínicos: experiencia de ser padre por primera vez y cuidados del niños durante el primer año de vida. Solo estudios cualitativos primarios incluyendo estudios de etnografía, fenomenología, análisis de narrativa e investigación de acciones fueron considerados. Resultados: Se obtuvieron tres meta-síntesis del análisis: 1) proceso de ajuste a la paternidad; 2) desarrollo del rol paterno y 3) ser un padre activo. El camino hacia la adopción y el cumplimiento del rol paterno está mediado por diversos procesos que durante el primer año de vida del niño/a se consolidan. Conclu siones: Los resultados apoyan la propuesta de que los padres desean ser protagonistas del cuidado de sus hijos/as, que las políticas públicas deben considerar a ambos padres como iguales en términos de sus responsabilidades de crianza, y que la protección de la familia y el entorno familiar es una priori dad como intervención de promoción de salud.

Background: A high level of social support (SS) is associated with better health outcomes in many conditions, such as chronic diseases. Aim : To describe the level of SS in patients with Hypertension and type II Diabetes at Primary Health Care level in Chile and its association with self-rated health, adherence to treatment and better glycemic and blood pressure control. Material and Methods : SS was measured using a social support inventory previously validated in Chile. Self-Rated Health was assessed with a single non-comparative general question; adherence to medication was assessed using the four-item Morisky medication adherence scale. Blood glucose and blood pressure control were also assessed. A logistic regression was performed to estimate Prevalence Odds Ratio (POR) and Robust Poisson method to estimate the Prevalence Ratio (PR). Results : Eighty three percent of the 647 participants evaluated high for SS. There was a significant correlation between SS and Self-rated health (POR 2.32; 95% confidence intervals (CI) 1.19-11.23; PR 1.18; 95% CI 1.07-1.31). No statistically significant association was observed with medication adherence, glycemic or blood pressure control. Conclusions: High levels of SS were found. The association between self-rated health suggests that SS interventions targeting vulnerable subgroups would be worthwhile.

ABSTRACT Alzheimer’s disease (AD) is one of the most common dementias and affects 8% of the population over 65 years and 30% of the population over 80 years, in countries with a high life expectancy. This disease is devastating because of the progressive deterioration of the person who presents it and the impact it has on the family, in which the responsibility of being the “primary caregiver” usually falls to one of its members. Objective: To know the experience of being a primary caregiver of a family member with AD and their care needs. Methodology: A phenomenological qualitative design was used. Results: 8 family caregivers of people with AD were interviewed. The caregivers’ experience was revealed in six interrelated comprehensive categories: Start of symptoms and search for a diagnosis; Impact of disease; Adaptation; Caregiver profile; Need to not lose the essence of the person and giving back hope. Conclusion: Comprehensive categories account for a process that carers live from the onset of symptoms to the adoption of their role as caregiver. This knowledge could provide information to generate innovative care programs to accompany caregivers and their families in the care process required by people with AD, in order to contribute to improve their quality of life, their family´s and to the person to his/her care.

RESUMEN La enfermedad de Alzheimer (EA) es una de las demencias más comunes y afecta al 8% de la población mayor de 65 años y al 30% de la población mayor de 80 años en los países con una alta expectativa de vida. Esta enfermedad es devastadora tanto por el deterioro progresivo de la persona que la presenta como por el impacto que produce en la familia, en la que habitualmente la responsabilidad de ser el “cuidador principal” recae sobre uno de sus integrantes. Objetivo: conocer la experiencia de ser cuidador principal de un familiar con EA y sus necesidades de cuidado. Metodología: se utilizó un diseño cualitativo fenomenológico. Resultados: se entrevistaron 8 cuidadores familiares de personas con EA. La vivencia de los cuidadores se develó en seis categorías comprensivas interrelacionadas entre sí: Inicio de los síntomas y búsqueda de un diagnóstico; Impacto de la enfermedad; Adaptación; Perfil del cuidador; Necesidad de no perder la esencia de la persona y Devolviendo la esperanza. Conclusión: Las categorías comprensivas dan cuenta de un proceso que viven los cuidadores desde el inicio de los síntomas hasta la adopción de su rol como cuidador. Este conocimiento podría aportar información para generar programas de atención innovadores que permitan acompañar a los cuidadores y su familia en el proceso de cuidados que requieren las personas con EA, para de esa manera contribuir a mejorar su calidad de vida, la de su familia y la del familiar a su cuidado.

Resumen Antecedentes: la prediabetes es una condición reversible y su tratamiento una oportunidad para modificar prácticas no saludables. Objetivo: evaluar la efectividad del Modelo Multi-componente de Telecuidado para apoyo a personas con prediabetes y obesidad en Chile. Método: ensayo clínico controlado en centros de atención primaria, Santiago, Chile. Se realizó un muestreo y asignación aleatoria en cada uno de los 5 centros de salud participantes. Participantes: 70 adultos con pre-diabetes, IMC: 25-34 y acceso a telefonía móvil. GI (n = 33), recibió modelo: consejerías telefónicas, envío de SMS, material educativo y equipos auto-monitoreo; y GC (n = 32) atención habitual atención habitual y equipos de auto-monitoreo. Medición pre y post intervención de los conocimientos sobre Prediabetes, alimentación no saludable, actividad física, peso, circunferencia de cintura, Glicemia, Triglicéridos y Colesterol Total. Resultados: en el GI, la intervención fue efectiva en mantener estable el nivel de conocimientos sobre pre-diabetes y disminuir nivel de triglicéridos. El modelo no superó a la atención habitual en disminución del peso, circunferencia de cintura, glicemia y colesterol total.

Abstract Background: Prediabetes is a reversible condition and its treatment a chance to change unhealthy practices. Objective: to evaluate the effectiveness of a multi-component tele-care model to support people with pre-diabetes and obesity in Chile. Method: a randomized clinical trial in primary care setting, Santiago, Chile. Participants: 70 adults with pre-diabetes: BMI between 25 and 34 and access to mobile phone. GI (n = 33) received telephone counseling, SMS, educational materials and self-monitoring equipment and GC (n = 32) usual care and self-monitoring equipment. Measures of knowledge of prediabetes, unhealthy diet, physical activity, weight, waist circumference, glucose, triglycerides and total cholesterol were made pre and post intervention. Results: in GI the intervention to maintain stable knowledge level about pre-diabetes, and decrease triglycerides level was effective. The model did not exceed usual care for decrease in weight, waist circumference, glucose and cholesterol.

The aging population increased the possibility of need to be care. Historically women have assumed this task adding it to those performed as paid workers. This dual role is a risk factor for the health of workers, quality of care delivery and job performance. Objectives: To evaluate the effect of intervention for workers who perform tasks of informal care on the perceived burden of care and social support program. Methods: A pre-post test study with 25 workers who wield dual role of informal caregivers. Conclusions: The intervention was effective to reduce the perceived burden of care and increase the perception of social support, which makes it highly recommended such interventions contributing to the health of workers and family caregiver.

El envejecimiento de la población aumenta la posibilidad de requerir cuidados, los cuales son proprocionados por las familias, especialmente por las mujeres. Para quienes tienen trabajo remunerado, significa cumplir un doble rol. Esto es un factor de riesgo para la salud del trabajador, la calidad del cuidado entregado y su rendimiento laboral Objetivos: evaluar el efecto de programa piloto de apoyo a trabajadores que ejercen tareas de cuidado informal, sobre su percepción de carga de cuidado y de apoyo social. Métodos: estudio pre-postest, con 25 funcionarios que ejercen el doble rol de trabajador-cuidador informal. Resultados: la intervención demostró ser efectiva al disminuir la percepción de carga de cuidado y aumentar la percepción de apoyo social. Conclusión: intervenciones implementadas dentro del ámbito laboral y con el apoyo de la institución aportan a la percepción de apoyo de los trabajadores y a su satisfacción con el programa.

Introduction Xerostomia is a common chronic health condition that affects a great number of elderly people. Palliative treatment, such as salivary substitutes should be used, but these products are not accessible in the Chilean market. Objectives To evaluate the efficacy of a new Chamomile and linseed based saliva substitute in the reduction of xerostomía-associated symptomatology in elderly people. Methodology Forty elderly subjects presenting with xerostomia of various origins were selected. Chamomile and linseed based saliva substitute and a carboxymethylcellulose based conventional artificial saliva were tested using a double-blind, randomized, cross-over clinical trial with an intervining wash out period. Results All (100%) of subjects had a sensation of dry mouth, and 58.8% mentioned a sensation of thick saliva, 52.9% needed to drink liquids to swallow, and with a sensation of swallowing difficulty. Burning tongue sensation was recorded in 23.5% of the patients. The most frequent pathologies in the sample were arterial hypertension and arthritis. Results of the clinical tests showed that Chamomile and linseed based saliva substitute significantly relieves the sensation of dry mouth and the sensation of thick saliva (Wilcoxon test P < .05). Conclusion New chamomile and linseed based saliva substitute was effective in relieving xerostomia symptoms in elderly people, and could improve the quality of life of population affected by this condition.

Introducción La xerostomía es una condición crónica que afecta a un alto porcentaje de adultos mayores, que deben ser tratados paliativamente mediante el uso de sustitutos salivales; sin embargo estos productos no se encuentran disponibles en el mercado nacional. Objetivos Evaluar la eficacia de un nuevo sustituto salival a base de manzanilla y semillas de linaza en la disminución de la sintomatología asociada a xerostomía en individuos adultos mayores. Metodología Se incluyeron 34 voluntarios adultos mayores con xerostomía de diverso origen. Un nuevo sustituto salival a base de manzanilla y semillas de linaza y un sustituto convencional a base de carboximetilcelulosa fueron testados en un ensayo clínico aleatorizado, cruzado, con período de blanqueamiento. Resultados El 100% de los sujetos presentó sensación de boca seca, el 58,8% sensación de saliva espesa, el 52,9% necesitaba beber líquidos para deglutir los alimentos y tenía sensación de dificultad para tragar. La sensación de ardor lingual se registró en el 23,5% de los individuos. Las enfermedades más frecuentes en la muestra analizada fueron la hipertensión arterial y la artritis. Los resultados del ensayo clínico indican que el sustituto salival a base de manzanilla y semillas de linaza disminuye significativamente la sensación de boca seca y la sensación de saliva espesa (test de Wilcoxon p < 0,05). Conclusión El nuevo sustituto salival a base de manzanilla y semillas de linaza es efectivo en el alivio de la sintomatología asociada a xerostomía en adultos mayores, por lo que puede contribuir a mejorar la calidad de vida de la población afectada por esta condición.

En el contexto demográfico actual de envejecimiento poblacional surge un nuevo rol: el funcionario-cuidador. La persona que trabaja y, además, cuida a un familiar con discapacidad, presenta problemas personales, laborales y menor compromiso con su autocuidado. Entre las intervenciones eficaces se encuentra el mejorar la percepción del apoyo social. Se presenta un programa interdisciplinario, iniciado en el año 2009, de apoyo a trabajadores-cuidadores familiares. Su propósito es promover la salud y prevenir factores de riesgo de enfermedad a través del fortalecimiento de sus habilidades de autocuidado y el desarrollo de políticas institucionales que faciliten el cumplimiento de ambos roles en forma eficiente y saludable. Como estrategias de promoción en salud se han utilizado: la educación para el autocuidado, el fortalecimiento de redes de apoyo familiar y social, la asesoría profesional y la comunidad de pares. En las últimas tres cohortes anuales han participado sesenta funcionarios, de los cuales el 83,4% son mujeres, con un promedio de edad de cincuenta años. El programa ha cumplido con éxito los objetivos propuestos, aumentando la percepción de apoyo social manifestado por los propios participantes.

A new role has emerged within the current demographic context of an aging population; namely, that of the worker-caregiver. The person who works and also cares for a disabled family member has personal and work-related problems and is less committed to their own self-care. Improving the perception of social support can be an effective intervention in this respect. The article describes an interdisciplinary program initiated in 2009 to support family workers-caregivers. Its purpose is to promote health and prevent disease risk factors by strengthening self-care skills and the development of institutional policies that facilitate efficient and healthy compliance with both roles. Some of the health promotion strategies that have been used include education for self-care, strengthening family and social support networks, professional counseling and a community of peers. Sixty workers took part in the last three annual cohorts: 83.4% were women, with an average age of fifty. The program has successfully met its proposed objectives by increasing the perception of social support expressed by the participants themselves.

No contexto demográfico atual de envelhecimento populacional, surge um novo papel: o funcionario-cuidador. A pessoa que trabalha e, além disso, cuida de um familiar com necessidades especiais apresenta problemas pessoais, laborais e menor compromisso com seu auto-cuidado. Entre as intervenções eficazes, encontra-se o melhorar a percepção do apoio social. Apresenta-se um programa interdisciplinar, iniciado em 2009, de apoio a trabalhadores-cuidadores familiares. Seu propósito é promover a saúde e prevenir fatores de risco de doenças por meio do fortalecimento de suas habilidades de autocuidado e o desenvolvimento de políticas institucionais que facilitem o cumprimento de ambos os papéis de forma eficiente e saudável. Como estratégias de promoção da saúde têm sido utilizados: a educação para o auto-cuidado, o fortalecimento de redes de apoio familiar e social, a assessoria profissional e a comunidade de pares. Nas últimas três coortes anuais, participaram 60 funcionários, dos quais 83,4% são mulheres, com uma média de idade de 50 anos. O programa tem cumprido com sucesso os objetivos propostos e, assim, tem aumentado a percepção de apoio social manifestado pelos próprios participantes.

mHealth is a practical, useful, and available tool for one-way or two-way communication between health professionals and patients. It is especially promising in countries such as Chile, with widespread and growing mobile telephone coverage that is very well accepted by the public. Our objective is to demonstrate the process for designing a mobile communication and monitoring model, aimed at providing communication between professionals in primary healthcare centers and their patients, to facilitate timely diagnosis and initiation of treatment for type 2 diabetes. This model's characteristics include use of mobile telephones as a communication tool, a one-way method (from health centers to patients), integration into in-person care delivered at health centers, use of different communication strategies (voice and written), and integrated functioning using open-source software. The system includes personalized communication, automated voice communication, and automated written communication using short message service (SMS). We describe the strategies and components of the system. The lessons learned include the contribution from successful implementation of COSMOS (consolidated online modulated operating systems), a technological innovation, to support the health care of people with suspected type 2 diabetes in primary healthcare centers. Working together with teams in the field is essential to this achievement.

La mSalud es una herramienta práctica, útil y disponible para la comunicación unidireccional o bidireccional entre profesionales de la salud y el paciente, cuyo uso es especialmente promisorio en países como Chile, con una amplia y creciente cobertura de telefonía móvil muy bien aceptada por la población. Nuestro objetivo es mostrar el proceso de diseño de un modelo de comunicación y seguimiento móvil, destinado a facilitar la comunicación entre profesionales de los centros atención primaria en salud y sus usuarios, para lograr el diagnóstico oportuno e inicio del tratamiento de la diabetes mellitus de tipo 2 (DM2). Este modelo se caracteriza por utilizar el teléfono móvil como herramienta de comunicación, ser un método unidireccional (desde los centros de salud hacia los usuarios), estar integrado con la atención presencial que se entrega en los centros de salud, utilizar diferentes estrategias de comunicación (vía voz y escrita), y funcionar integrado en un software diseñado en código abierto. El sistema incluyó la implementación de comunicación personalizada, comunicación automatizada de voz y comunicación automatizada escrita a través de servicio de mensaje corto de voz. Se describen estas estrategias y los componentes del sistema. Entre las lecciones aprendidas, se destaca el aporte de lograr implementar la innovación tecnológica COSMOS (sistemas operadores modulados consolidados en línea, por su sigla en inglés), para apoyar el proceso de cuidado de la salud de las personas con sospecha de DM2 en centros de atención primaria de salud. Para este logro, resulta imprescindible el trabajo conjunto con los equipos en terreno.

Introducción: el apoyo a la toma de decisiones en salud facilita el automanejo de personas con enfermedades crónicas (EC). Objetivo: validar la versión en español del DSAT-cdm: herramienta de análisis del apoyo en las decisiones para el manejo de EC, desarrollada por Stacey (2006). Materiales y métodos: estudio descriptivo que aplica un proceso sistemático que considera, entre otros: traducción-contratraducción, desarrollo de escenarios de simulación, entrenamiento de evaluadores, entrenamiento pacientes simulados y capacitación para participantes. Muestra: 15 profesionales y 2 jueces, obteniéndose 60 DSAT-cdm versión español aplicado (pre y pos capacitación). Resultados: el instrumento presentó confiabilidad aceptable en la aplicación entre-jueces y detectó la mejora en la calidad del apoyo a la toma de decisiones en los profesionales. Sin embargo, no se obtuvieron resultados que aportaran a la validez de criterio concurrente. Conclusiones: este estudio es la primera evaluación del DSAT-cdm en idioma español, el resultado principal indica que se detecta un cambio en el desempeño de profesionales para apoyar el proceso de toma de decisiones de sus pacientes y, a pesar estos hallazgos favorables, es necesario seguir evaluando el instrumento.

Introduction: Support for decision-making in health facilitates self-management by persons with chronic illness (CI). Objective: Validate the Spanish- language version of DSAT - cdm: an analytical tool developed by Stacey (2006) to support decision-making on CI management. Materials and Methods: This descriptive study applies a systematic process that considers a number of aspects, such as translation - back-translation, simulation scenario development, training evaluators, simulated patient training and training for participants. Sample: 15 professionals and two judges, obtaining 60 DSAT - cdm with the applied Spanish version (pre and post training). Results: The instrument showed acceptable reliability in application among judges and found improvement in the quality of decision-making support on the part of professionals. However, no results were obtained that contribute to concurrent criterion validity. Conclusions: This study is the first assessment of DSAT - cdm in Spanish. The main result indicates a change is detected in the performance of professionals to support the decision-making process of their patients. Yet, despite this favorable finding, further evaluation of the instrument is necessary.

Introdução: o apoio na tomada de decisões em saúde facilita o automanejo de pessoas com doenças crônicas (ec em espanhol). Objjetivo: validar a versão em espanhol do DSTA-cdm: ferramenta de análise do apoio nas decisões para o manejo de ec, desenvolvida por Stacey (2006). Materiais e métodos: estudo descritivo que aplica um processo sistemático que considera, entre outros: tradução-contratradução, desenvolvimento de cenários de simulação, treinamento de avaliadores, treinamento de pacientes simulados e capacitação para participantes. Amostra: 15 profissionais e 2 juízes, com obtenção de 60 dsat-cdm versão espanhol aplicado (pré e pós capacitação). Resultados: o instrumento apresentou confiabilidade aceitável na aplicação entre juízes e detectou a melhoria na qualidade do apoio na tomada de decisões nos profissionais. Contudo, não se obtiveram resultados que contribuíssem para a validade de critério concorrente. Conclusões: este estudo é a primeira avaliação do dsat-cdm em espanhol; o resultado principal indica que se detecta uma mudança no desempenho de profissionais para apoiar o processo de tomada de decisões de seus pacientes e, apesar dessas descobertas favoráveis, é necessário continuar avaliando o instrumento.

Background: Telephone based self-management support may improve the metabolic control of patients with type 2 (DM2) diabetes if it is coordinated with primary care centers, if telephone protocols and clinical guidelines are used and if it is provided by nurses trained in motivational interviewing. Aim: To assess the efficacy ofi a tele-care self-management support model (ATAS) on metabolic control of patients with DM2 attending primary care centers in a low income area in Santiago, Chile. Material and Methods: Two primary care centers were randomly assigned to continue with usual care (control group, CG) or to receive additionally 6 telecare self-management support interventions (IG) during a 15 month period. Glycosylated hemoglobin (HbA1c) was used to measure metabolic control of DM2; the “Summary of Diabetes Self-care Activities Measure” and the “Spanish Diabetes Self-efficacy” scale were used to measure self-management and self efficacy, respectively. Changes in the use of health services were also evaluated. Results: The IG maintained its HbA1c level (baseline and final levels of 8.3 ± 2.3 % and 8.5 ± 2.2% respectively) whereas it deteriorated in the CG (baseline and final levels of 7.4 ± 2.3 and 8.8 ± 2.3 % respectively, p < 0.001). The perception of self-efficacy in the IG improved while remaining unchanged in the CG (p < 0.001). Adherence to medication, physical activity and foot care did not change in either group. In the IG, compliance to clinic visits increased while emergency care visits decreased. Conclusions: The ATAS intervention, in low income primary care centers, significantly increased the probability of stabilizing the metabolic control of patients with DM2 and improved their use of health services.