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The Impact of an Interactive Guidance Intervention on Sustained Social Withdrawal in Preterm Infants in Chile: Randomized Controlled Trial
(2022)
Jorge Bustamante Loyola
;
Marcela Pérez Retamal
;
Andrés Mendiburo-Seguel
;
Antoine Claude Guedeney
;
Ricardo Salinas González
<jats:sec><jats:title>Background</jats:title><jats:p>Sustained social withdrawal is a key indicator of child emotional distress and a risk factor for psychological development. Preterm infants have a higher probability of developing sustained social withdrawal than infants born full-term during their first year.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To compare the effect of a behavioral guidance intervention to that of routine pediatric care on sustained social withdrawal behavior in preterm infants.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Multicenter randomized clinical trial.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>Ninety nine moderate and late preterm newborns and their parents were recruited and randomized into two groups, i.e., Intervention (<jats:italic>n</jats:italic> = 49) and Control (<jats:italic>n</jats:italic> = 50). Both groups attended medical check-ups at 2, 6 and 12 months and were assessed with the Alarm Distress Baby Scale. The intervention group received a standardized behavioral intervention if the neonatologist detected sustained social withdrawal. Also, parents filled out the Edinburgh Postnatal Depression Scale, the modified-Perinatal Posttraumatic Stress Disorder Questionnaire, and the Impact of Event Scale-revised.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>At baseline, the prevalence of withdrawal was 4.0% (95% CI: 0.03–14.2) for the control group and 22.4% (95% CI: 13.0–35.9) for the intervention group [OR = 0.22, <jats:italic>p</jats:italic> = 0.028 (95% CI =0.06–0.84)]. At 6 months, the prevalence was 10.0% (95% CI: 3.9–21.8) for the control group and 6.1% (95% CI: 2.1–16.5) for the intervention group [OR = 2.09, <jats:italic>p</jats:italic> = 0.318 (95% CI = 0.49–8.88)]. At 12 months, the prevalence was 22.0% (95% CI: 12.8–35.2) for the control group and 4.1% (95% CI: 1.1–13.7) for the intervention group [OR = 6.63, <jats:italic>p</jats:italic> = 0.018 (95% CI = 1.39–31.71)]. Logistic generalized estimating equation models were performed. The pooled crude OR (considering diagnosis at 6 and 12 months) was 3.54 [<jats:italic>p</jats:italic> = 0.022 (95% CI = 1.20–10.44); Cohen's d= 0.70]. In the case of pooled adjusted OR, the model considered diagnosis (0 = Withdrawal, 1 = Normal) as the dependent variable, time of evaluation (1= 6 months, 2 = 12 months) and group (0 = Control, 1 = Experimental) as factors. In this case, the pooled adjusted OR was 3.57 [<jats:italic>p</jats:italic> = 0.022 (95% CI = 1.20–10.65); Cohen's d = 0.70].</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Assessment and intervention of sustained social withdrawal in preterm infants via standardized instruments benefits families by reducing its prevalence, and possible associated negative outcomes.</jats:p></jats:sec><jats:sec><jats:title>Clinical Trial Registration</jats:title><jats:p>ClinicalTrials.gov; <jats:ext-link>https://clinicaltrials.gov/ct2/show/NCT03212547</jats:ext-link>, identifier: NCT03212547.</jats:p></jats:sec>
Scopus© Citations 1 1
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A comparative analysis of health status of international migrants and local population in Chile: a population-based, cross-sectional analysis from a social determinants of health perspective
(2022)
Isabel Rada
;
Marcela Oyarte
;
CABIESES VALDES, BALTICA BEATRIZ
<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>During recent decades intraregional migration has increased in Latin America. Chile became one of the main receiving countries and hosted diverse international migrant groups. Evidence have suggested a healthy migrant effect (HME) on health status, but it remains scarce, controversial and needs to be updated. This study performed a comprehensive analysis verifying the existence of HME and its association with social determinants of health (SDH).</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>We analyzed data from the Chilean National Socioeconomic Characterization Survey (CASEN, version 2017). Unadjusted prevalence of health status indicators such as negative self-perceived health, chronic morbidity, disability, and activity limitations were described in both international migrants and local population. Adjusted associations between these outcomes and sets of demographics, socioeconomic, access to healthcare, psychosocial and migration-related SDH were tested using multivariate logistic regression in each population. The HME for each health outcome was also tested using multivariate logistic regression and sequentially adjusting for each set of SDH (ref = Chilean).</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>International migrants had lower unadjusted prevalence of all health indicators compared to Chileans. That is, unadjusted analysis revealed an apparent HME in all health outcomes. Age, unemployment, and health care system affiliation were associated with health outcomes in both populations. Psychosocial determinants were both risk and protective for the analysed health outcomes. After adjustment for each set of SDH, the immigrant health advantage was only significant for chronic morbidity. Being migrant was associated with 39% lower odds of having chronic diseases compared to locals (OR: 0.61; 95% CI: 0.44–0.84; <jats:italic>P</jats:italic> = 0.0003). For all other outcomes, HME disappeared after adjusting by SDH, particularly unemployment, type of health system and psychosocial factors.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Testing the HME in Chile revealed an advantage for chronic morbidities that remained significant after adjustment for SDH. This analysis shed light on health disparities between international migrants and local population in the Latin American region, with special relevance of unemployment, type of health system and psychosocial SDH. It also informed about differential exposures faced during migration process that could dissolve the HME over time. Evidence from this analytical approach is useful for informing health planning and intersectoral solutions from a SDH perspective.</jats:p> </jats:sec>
2Scopus© Citations 12 3

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