• Overview of newborn hearing screening activities in Latin America Original Research Articles

    Garcia, Barbara Gerner de; Gaffney, Claudia; Chacon, Susan; Gaffney, Marcus

    Abstract in Spanish:

    OBJETIVO: Evaluar la situación de los servicios de detección e intervención tempranas de problemas auditivos en América Latina. MÉTODOS: Entre junio y noviembre del 2007, la universidad Gallaudet, en colaboración con el Comité de Diversidad del Programa de Detección Auditiva e Intervención Tempranas de los Centros para el Control y la Prevención de Enfermedades de los Estados Unidos, distribuyó un cuestionario en 11 países latinoamericanos. El cuestionario incluía preguntas acerca de los procedimientos de examen sistemático de la capacidad auditiva en recién nacidos, la disponibilidad de servicios de intervención para menores de un año hipoacúsicos y los retos para detectarlos. Además, se efectuó una revisión bibliográfica para ayudar a determinar el estado de las iniciativas de examen sistemático de la audición en recién nacidos en América Latina. RESULTADOS: Respondieron a la encuesta seis países (Chile, Costa Rica, Guatemala, México, Panamá y Uruguay) y un territorio de los Estados Unidos (Puerto Rico). Las respuestas indicaron que los esfuerzos para detectar a los menores de un año hipoacúsicos varían dentro de cada país y de un país a otro en América Latina. En algunos países se han realizado actividades a nivel nacional; en otros, en un único hospital o zona del país. Los factores que con frecuencia obstaculizan la puesta en práctica de los programas de examen sistemático de la audición en recién nacidos incluyen la falta de financiamiento, de equipos de tamizaje y diagnóstico, de concientización del público y de personal capacitado para atender a menores de un año y niños pequeños. CONCLUSIONES: A pesar de que existen varios obstáculos, se han ejecutado programas de examen sistemático de la audición en recién nacidos en al menos algunos establecimientos de salud y zonas de América Latina. Se necesitan esfuerzos mayores para ampliar estas actividades en América Latina.

    Abstract in English:

    OBJECTIVE: Ascertain the status of early hearing detection and intervention services in Latin America. METHODS: Between June and November 2007, Gallaudet University, in collaboration with the U.S. Centers for Disease Control and Prevention Early Hearing Detection and Intervention Diversity Committee, disseminated a survey to 11 Latin American countries. It included questions about newborn hearing screening (NHS) procedures, the availability of intervention services for infants with hearing loss, and challenges in identifying infants with hearing loss. In addition, a literature review was conducted to help identify the status of NHS efforts in Latin America. RESULTS: Six countries (Chile, Costa Rica, Guatemala, Mexico, Panama, and Uruguay) and one U.S. territory (Puerto Rico) responded to the survey. Responses indicated that efforts to identify infants with hearing loss vary within and across countries in Latin America. In some countries, activities have been implemented at a national level; in others, activities have been implemented at a single hospital or region within a country. Common barriers to implementation of NHS programs include a lack of funding, screening and diagnostic equipment, public awareness, and personnel qualified to work with infants and young children. CONCLUSIONS: In spite of several barriers, NHS programs have been implemented in at least some facilities and regions in Latin America. Additional efforts are needed to expand NHS activities in Latin America.
  • Cost-effectiveness of chest x-rays in infants with clinically suspected viral bronchiolitis in Colombia Artículos de Investigación Original

    Rodríguez Martínez, Carlos E.; Sossa Briceño, Mónica P.

    Abstract in Spanish:

    OBJETIVO: Estimar el costo-efectividad de no realizar radiografía de tórax a ningún lactante con sospecha clínica de bronquiolitis viral versus realizarla en todos estos pacientes de manera rutinaria, que es la práctica más utilizada hoy en Colombia. MÉTODOS: Se realizó un estudio de costo-efectividad en el que se compararon las estrategias consistentes en tomar radiografía a todos y no tomar radiografía de tórax a ningún lactante con sospecha clínica de bronquiolitis viral. El desenlace principal fue la proporción de diagnósticos correctos. El horizonte temporal fue la evolución de la bronquiolitis. La perspectiva fue la del tercer pagador y los costos se obtuvieron de las tarifas vigentes en una clínica en la ciudad de Bogotá. Se realizaron análisis de sensibilidad determinísticos y probabilísticos. RESULTADOS: La estrategia de no realizar radiografía de tórax a ningún paciente fue dominante en relación con realizarla en todos los casos de manera rutinaria, con un costo promedio de US$ 111,0 y una tasa de diagnósticos correctos de 0,8020, comparados con los valores correspondientes de US$ 129,0 y 0,7873 para la estrategia de tomar radiografía rutinaria a todos estos pacientes. La variable más influyente fue el costo hospitalario de la neumonía. En el análisis de sensibilidad probabilístico, la estrategia de no radiografiar a ningún lactante fue dominante en 61,1% de las simulaciones. CONCLUSIONES: Los resultados sugieren que no realizar radiografía de tórax de rutina a lactantes con sospecha clínica de bronquiolitis viral es una estrategia costo-efectiva respecto a la práctica común de realizarla en todos estos casos, dado que arroja una mayor proporción de diagnósticos correctos a un menor costo promedio por paciente. No obstante, harán falta nuevos estudios con muestras más representativas de todos los establecimientos de salud e incluir la estrategia de tomar radiografía de tórax únicamente a pacientes que tengan predictores de anormalidades radiológicas.

    Abstract in English:

    OBJECTIVE: Estimate the cost-effectiveness of not taking chest x-rays of any infant with clinically suspected viral bronchiolitis versus routinely taking them of all such patients, the most common practice today in Colombia. METHODS: A cost-effectiveness study was conducted, comparing strategies of taking chest x-rays of all infants with clinically suspected viral bronchiolitis and not x-raying any of these infants. The principal outcome was the proportion of correct diagnoses. The time horizon was the clinical course of the bronchiolitis. The perspective was that of the third-party payer, and the costs were obtained from the rates in effect in a clinic in Bogotá. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: The strategy of not taking a chest x-ray of any patient prevailed over that of routinely taking one in all cases, with an average cost of US$ 111.00 and a correct diagnosis rate of 0.8020, versus the respective values of US$ 129.00 and 0.7873 for the strategy of routinely x-raying all of these patients. The most influential variable was pneumonia-related hospital costs. In the probabilistic sensitivity analysis, the strategy of not x-raying any infant prevailed in 61.1% of the simulations. CONCLUSIONS: The results suggest that not taking routine chest x-rays of infants with clinically suspected viral bronchiolitis is a cost-effective strategy compared with the common practice of taking them in all cases, since the former yields a greater proportion of correct diagnoses at a lower average cost per patient. Nevertheless, new studies will be needed that have more representative samples from all of the health facilities and include the strategy of taking chest x-rays only of patients with predictors of radiologic abnormalities.
  • Frequency of Pap smear testing in young women with an obstetric history in Teresina, Piauí, Brazil

    Barroso, Michelina F.; Gomes, Keila R. O.; Andrade, Jesusmar Ximenes

    Abstract in Portuguese:

    OBJETIVO: Analisar a frequência da colpocitologia oncótica em jovens com pelo menos uma gravidez completa em Teresina, capital do Estado do Piauí, Brasil. MÉTODOS: Estudo transversal realizado de maio a dezembro de 2008. Foram coletados dados de 464 jovens, selecionadas por amostragem acidental, que finalizaram uma gravidez no primeiro quadrimestre de 2006 em seis maternidades da Cidade de Teresina. Investigou-se a frequência da coleta de colpocitologia oncótica. A frequência inadequada foi definida como coleta em intervalos maiores do que 1 ano. RESULTADOS: A média de idade das participantes foi de 20 anos. A frequência da colpocitologia foi semestral em 180 jovens (39,0%) e anual em 160 (34,5%). Quinze jovens (3,2%) nunca haviam feito a colpocitologia. A regressão logística simples mostrou que o não uso de contraceptivo na primeira relação sexual e não poder optar por atendimento ginecológico por homem ou mulher aumentou o risco em 48,0% (P = 0,049) e 49,0% (P = 0,044), respectivamente, para frequência inadequada de coleta do exame. A regressão logística múltipla mostrou que ter tido mais de uma gravidez elevou em 71,4% a chance de inadequação da frequência de coleta em comparação com ter somente uma gestação (P = 0,011). CONCLUSÕES: O fato de muitas jovens realizarem o exame de colpocitologia oncótica em intervalos menores do que 1 ano não melhora o rastreamento do câncer de colo uterino e pode onerar o serviço público de saúde. A multiparidade foi fator de risco para a frequência inadequada de coleta do exame, devendo esse aspecto ser considerado na assistência à saúde ginecológica de jovens.

    Abstract in English:

    OBJECTIVE: To analyze the frequency of Pap smear testing in young women with at least one pregnancy in Teresina, capital of the state of Piauí, Brazil. METHODS: A cross-sectional study was undertaken from May to December 2008. A convenience sample of 464 young women was selected, and data were collected using a pre-tested questionnaire. Women giving birth in the first four months of 2006, in six hospitals in Teresina, were included. Inadequate Pap smear frequency was defined as an interval of more than 1 year between tests. RESULTS: Mean age was 20 years. The frequency of Pap smear testing was every 6 months in 180 women (39.0%) and yearly in 160 (34.5%). Fifteen women (3.2%) had never had a Pap smear test. Simple logistic regression showed an increase of 48.0% in the risk of inadequate Pap smear frequency (P = 0.049) in women who did not use any contraceptive method at their first sexual intercourse, and 49.0% (P = 0.044) in those who were not able to choose between a male or female gynecologist when seeking health care services. On multivariate logistic regression, having more than one pregnancy increased the risk of inadequate Pap smear frequency by 71.4% in comparison to having only one pregnancy (P = 0.011). CONCLUSIONS: The fact that many young women had Pap smear testing at intervals shorter than 1 year does not improve cervical cancer screening and may burden the health care system. Multiparity was a risk factor for inadequate Pap smear frequency, an aspect that must be taken into account when providing gynecological care to young women.
  • Deinstitutionalization and attitudes toward mental illness in Jamaica: a qualitative study Original Research Articles

    Hickling, Frederick W.; Robertson-Hickling, Hilary; Paisley, Vanessa

    Abstract in Spanish:

    OBJETIVO. Evaluar si el externamiento psiquiátrico y la integración de los servicios comunitarios de salud mental con los servicios de atención primaria de salud han reducido el estigma respecto de las enfermedades mentales en Jamaica. MÉTODOS. Estudio cualitativo de 20 grupos de opinión con un total de 159 participantes agrupados según sus características sociodemográficas. Se analizaron los resultados con el software ATLAS.ti. RESULTADOS: Los relatos de los participantes revelaron que, cuando los servicios comunitarios de salud mental se integraron con el sistema de atención primaria de salud de Jamaica, el estigma había pasado de negativo a positivo y de la evitación y el temor a un comportamiento violento durante el período de externamiento a sentimientos de compasión y amabilidad. Las principales causas de estigma identificadas fueron el modelo de atención del hospital mental Bellevue y vivir en las calles. CONCLUSIONES: Las actitudes hacia los enfermos mentales han mejorado y el estigma ha disminuido desde que aumentó la relación de la comunidad con los pacientes. Esta reducción del estigma parece deberse al proceso riguroso de externamiento psiquiátrico y al desarrollo de un servicio comunitario de salud mental sólido en Jamaica.

    Abstract in English:

    OBJECTIVE: To consider whether or not deinstitutionalization and the integration of community mental health care with primary health care services have reduced stigma toward mental illness in Jamaica. METHODS: A qualitative study of 20 focus groups, with a total of 159 participants grouped by shared sociodemographic traits. Results were analyzed using ATLAS.ti software. RESULTS: Participant narratives showed that stigma had transitioned from negative to positive, from avoidance and fear of violent behavior during the period of deinstitutionalization to feelings of compassion and kindness as community mental health services were integrated with Jamaica's primary health care system. The Bellevue Mental Hospital and homelessness were identified as major causes of stigma. CONCLUSIONS: Attitudes toward the mentally ill have improved and stigma has decreased since the increase of community involvement with the mentally ill. This reduction in stigma seems to be a result of the rigorous deinstitutionalization process and the development of a robust community mental health service in Jamaica.
  • Feasibility of community-based health insurance in rural tropical Ecuador Original Research Articles

    Eckhardt, Martin; Forsberg, Birger Carl; Wolf, Dorothee; Crespo-Burgos, Antonio

    Abstract in Spanish:

    OBJETIVO: El objetivo principal de este estudio fue evaluar la voluntad de los habitantes de El Páramo, una zona rural en el Ecuador, de participar en un seguro de salud comunitario y determinar los factores que influían en dicha voluntad. Otro objetivo fue identificar la comprensión y las actitudes de la población hacia el modelo presentado. MÉTODOS: Se llevó a cabo una encuesta transversal usando un cuestionario estructurado. De unos 829 hogares, 210 se escogieron aleatoriamente mediante un muestreo por conglomerados en dos etapas. Se analizaron las actitudes hacia un esquema de seguro de enfermedad, se recopiló información sobre los factores que posiblemente influían en la voluntad de participar y se correlacionaron con esta última. Para comprender la posible capacidad de pago de un entrevistado, se evaluó el gasto en atención de la salud en el último episodio de enfermedad. Se definió "factibilidad" como la existencia de voluntad de participar en el esquema de seguro de enfermedad en al menos 50% de los jefes de hogar. RESULTADOS: La voluntad de participar en un modelo de seguro de enfermedad por un costo de US$ 30 por año fue de 69,3%. El 92,2% de los entrevistados declararon que, en el caso de adherirse al programa, concurrirían al establecimiento de salud local más a menudo. El nivel educativo presentó una correlación negativa con la voluntad de participar, pero otras variables no mostraron ninguna asociación significativa con ella. El estudio reveló una actitud positiva hacia el esquema del seguro de enfermedad. Se documentaron gastos de atención de salud importantes en el último episodio de enfermedad. CONCLUSIONES: La puesta en marcha de un seguro de enfermedad en la zona de estudio es factible. Sin embargo, es probable que la participación real sea inferior a la voluntad de participar declarada. Aun así, un esquema de seguro de enfermedad podría representar una opción financiera interesante en las zonas rurales donde los servicios son escasos y difíciles de mantener.

    Abstract in English:

    OBJECTIVE: The main objective of this study was to assess people's willingness to join a community-based health insurance (CHI) model in El Páramo, a rural area in Ecuador, and to determine factors influencing this willingness. A second objective was to identify people's understanding and attitudes toward the presented CHI model. METHODS: A cross-sectional survey was carried out using a structured questionnaire. Of an estimated 829 households, 210 were randomly selected by two-stage cluster sampling. Attitudes toward the scheme were assessed. Information on factors possibly influencing willingness to join was collected and related to the willingness to join. To gain an insight into a respondent's possible ability to pay, health care expenditure on the last illness episode was assessed. Feasibility was defined as at least 50% of household heads willing to join the scheme. RESULTS: Willingness to join the CHI model for US$30 per year was 69.3%. With affiliation, 92.2% of interviewees stated that they would visit the local health facility more often. Willingness to join was found to be negatively associated with education. Other variables showed no significant association with willingness to join. The study showed a positive attitude toward the CHI scheme. Substantial health care expenditures on the last illness episode were documented. CONCLUSIONS: The investigation concludes that CHI in the study region is feasible. However, enrollments are likely to be lower than the stated willingness to join. Still, a CHI scheme should present an interesting financing alternative in rural areas where services are scarce and difficult to sustain.
  • Health consultations provided by the public Unified Health System to Brazilians living on the Brazil-Paraguay border

    Cazola, Luiza Helena de Oliveira; Pícoli, Renata Palópoli; Tamaki, Edson Mamoru; Pontes, Elenir R. J. C.; Ajalla, Maria Elizabeth

    Abstract in Portuguese:

    OBJETIVO: Identificar e analisar as características dos atendimentos realizados no Sistema Único de Saúde (SUS) a brasileiros residentes no exterior em Ponta Porã, Coronel Sapucaia, Paranhos e Sete Quedas, municípios fronteiriços de Mato Grosso do Sul com o Paraguai. MÉTODOS: Os dados foram colhidos durante 30 dias através de um formulário para cada atendimento efetuado. Foram estudados todos os serviços de saúde do SUS disponíveis nos quatro municípios (14 unidades básicas de saúde da família, quatro unidades básicas de saúde, cinco hospitais e quatro laboratórios). Também foram realizadas entrevistas semiestruturadas com informantes-chave (secretários de saúde, gerentes das unidades de saúde e representantes do conselho municipal de saúde). RESULTADOS: Constatou-se que a maior demanda de atendimentos a brasileiros não residentes no País foi nos serviços de atenção básica: 11,9% nas unidades básicas de saúde da família de Coronel Sapucaia, 1,1% nas de Sete Quedas, 3,5% em Paranhos e 3,5% em Ponta Porã. Nas unidades básicas de saúde, o percentual foi de 21,1, 43,8, 14,7 e 2,3%, respectivamente. As entrevistas confirmaram a percepção de que existe um número importante de brasileiros que moram no exterior recebendo atenção pelo SUS nessas cidades. CONCLUSÕES: Uma proporção considerável de brasileiros não residentes no País busca atendimento pelo SUS nos municípios brasileiros. Entretanto, essa demanda não é considerada no planejamento dos serviços e pode causar impacto na qualidade da atenção prestada.

    Abstract in English:

    OBJECTIVE: To identify and analyze the characteristics of consultations provided by the Unified Health System (SUS) to Brazilians living abroad in the cities of Ponta Porã, Coronel Sapucaia, Paranhos, and Sete Quedas, located on the border of the state of Mato Grosso do Sul and Paraguay. METHODS. Data were collected during a 30-day period using a form filled out for each consultation provided. All the SUS facilities in the four cities were studied (14 primary family health care units, four primary health care units, five hospitals and four laboratories). Semi-structured interviews were also performed with key informants (city health secretaries, health care unit managers, and city health council representatives). RESULTS: The highest demand from Brazilians living abroad was related to primary health care services: 11.9% of the primary family health care consultations in Coronel Sapucaia, 1.1% in Sete Quedas, 3.5% in Paranhos, and 3.5% in Ponta Porã. In primary health care units, the percent of consultations to non-resident Brazilian citizens was 21.1%, 43.8%, 14.7%, and 2.3%, respectively. The interviews supported the perception that a major number of Brazilians living abroad seek health care in public services of Brazilian border cities. CONCLUSIONS: Despite the considerable number of Brazilians living abroad who seek health care provided by SUS in Brazil, this demand is not taken into consideration in the planning of services and may have an impact on the quality of the health care provided.
  • A road traffic injury surveillance system using combined data sources in Peru Special Reports

    Medina, Yliana Rojas; Espitia-Hardeman, Victoria; Dellinger, Ann M.; Loayza, Manuel; Leiva, Rene; Cisneros, Gloria

    Abstract in Spanish:

    Con el liderazgo del Ministerio de Salud, en el 2007 se estableció un sistema hospitalario nacional de vigilancia de traumatismos no mortales por accidentes de tránsito en unidades centinela de todo el Perú. Los datos de vigilancia se extraen de tres fuentes diferentes (registros hospitalarios, informes policiales e informes del seguro del vehículo) e incluyen los traumatismos no mortales por accidentes de tránsito atendidos inicialmente en las salas de urgencia. Se usa un único formulario de recopilación de datos para registrar la información sobre los heridos, las características del hecho relacionadas con el conductor o los conductores de los vehículos y del vehículo o los vehículos involucrados. Los datos se analizan periódicamente y se comunican a todos los participantes del sistema de vigilancia. Los resultados indicaron que los hombres adultos jóvenes (de 15 a 29 años) fueron los más afectados por traumatismos no mortales por accidentes de tránsito y con mayor frecuencia eran los conductores de los vehículos que participaron en la colisión. Los ocupantes de vehículos de cuatro ruedas representaron la mitad de los casos en la mayoría de las zonas del país y los peatones lesionados en el hecho representaron prácticamente la otra mitad. El sistema establecido en el Perú podría servir de modelo del uso de múltiples fuentes de datos para la vigilancia a nivel nacional de traumatismos no mortales por accidentes de tránsito. Según los resultados de este estudio, los retos de un sistema de este tipo consisten en mantener y aumentar la participación de las unidades de vigilancia de todo el país y determinar las intervenciones de prevención adecuadas en el nivel local según los datos obtenidos.

    Abstract in English:

    A national hospital-based nonfatal road traffic injury surveillance system was established at sentinel units across Peru in 2007 under the leadership of the Ministry of Health. Surveillance data are drawn from three different sources (hospital records, police reports, and vehicle insurance reports) and include nonfatal road traffic injuries initially attended at emergency rooms. A single data collection form is used to record information about the injured, event characteristics related to the driver of the vehicle(s), and the vehicle(s). Data are analyzed periodically and disseminated to all surveillance system participants. Results indicated young adult males (15-29 years old) were most affected by nonfatal road traffic injuries and were most often the drivers of the vehicles involved in the collision. Four-wheeled vehicle occupants comprised one-half of cases in most regions of the country, and pedestrians injured in the event accounted for almost another half. The system established in Peru could serve as a model for the use of multiple data sources in national nonfatal road traffic injury surveillance. Based on this study, the challenges of this type of system include sustaining and increasing participation among sentinel units nationwide and identifying appropriate prevention interventions at the local level based on the resulting data.
  • Knowledge and attitudes about intrauterine devices among women's health care providers in El Salvador Brief Communications

    Hohmann, Heather Lyn; Cremer, Miriam L.; Gonzalez, Enrique; Maza, Mauricio

    Abstract in Spanish:

    A fin de evaluar el conocimiento, las actitudes y las prácticas clínicas de los prestadores de atención de salud salvadoreños en torno al dispositivo intrauterino (DIU), se solicitó a un grupo de prestadores del Ministerio de Salud que respondiera un cuestionario anónimo autoadministrado. Se recibieron 135 respuestas. La mayoría manifestó que el DIU es un método anticonceptivo seguro (94,7%) y eficaz (97,0%). Solo 46,6% de los participantes habían recibido algún tipo de capacitación acerca de la colocación del DIU y 32,0% habían colocado más de 10 dispositivos. La mayoría de los prestadores (54,2%) consideraron que el DIU está asociado a una incidencia de infecciones más alta que la descrita en la bibliografía. La escasa frecuencia con que los prestadores salvadoreños colocan el DIU probablemente sea atribuible, en cierta medida, a la falta de capacitación formal y de conocimiento acerca de los índices de infección persistente asociados a los DIU. Los prestadores de servicios de salud encuestados refirieron estar dispuestos a instruirse más acerca del DIU y a transmitir la información a sus pacientes.

    Abstract in English:

    In order to gain an understanding of Salvadoran health care providers' clinical knowledge, attitudes, and practice toward the intrauterine device (IUD), Ministry of Health providers completed a self-administered, anonymous survey. Surveys were completed by 135 participants. The majority (94.7% and 97.0%) agreed the IUD is a safe and effective form of contraception. Only 46.6% of participants had ever received training in IUD placement, and 32.0% of them had ever inserted more than 10 IUDs. The majority of providers (54.2%) believed that the IUD was associated with a higher rate of infection than is described in the literature. Lack of formal training and knowledge about persistent infection rates associated with IUDs may contribute to low IUD placement by Salvadoran providers. Health care providers surveyed are open to learning more about the IUD and sharing the information with their patients.
  • Evaluation of the first training on clinical research methodology in Chile Temas de Actualidad

    Espinoza, Manuel; Cabieses, Báltica; Pedreros, César; Zitko, Pedro

    Abstract in Spanish:

    Este trabajo describe la evaluación del primer "Entrenamiento en Metodología de Investigación Clínica en Chile (EMIC-Chile) tras 12 meses de haber finalizado. Se aplicó una encuesta online para alumnos y el método Delphi para el equipo docente. Entre los estudiantes, la mayoría informó que el programa apoyó su desarrollo profesional y que transmitieron los conocimientos en su lugar de trabajo. El 41% presentó un proyecto a fondos concursables de investigación una vez finalizado el curso. Entre los profesores, las áreas de mayor interés fueron la estrategia comunicacional, la metodología educativa, las características del equipo docente y las posibles estrategias de permanencia de EMIC-Chile a futuro. Esta experincia podría servir a futuras iniciativas de formación en investigación para profesionales de la salud. Se reconocen como desafíos la incorporación de profesiones no médicas en la investigación clínica, complejidades asociadas a la metodología semi-presencial y permanencia duradera de iniciativas de esta envergadura a nivel nacional y regional.

    Abstract in English:

    This paper describes the evaluation of the first training on clinical research methodology in Chile (EMIC-Chile) 12 months after its completion. An online survey was conducted for students and the Delphi method was used for the teaching team. Among the students, the majority reported that the program had contributed to their professional development and that they had shared some of the knowledge acquired with colleagues in their workplace. Forty-one percent submitted a project to obtain research funding through a competitive grants process once they had completed the course. Among the teachers, the areas of greatest interest were the communication strategy, teaching methods, the characteristics of the teaching team, and potential strategies for making the EMIC-Chile permanent in the future. This experience could contribute to future research training initiatives for health professionals. Recognized challenges are the involvement of nonmedical professions in clinical research, the complexities associated with the distance learning methodology, and the continued presence of initiatives of this importance at the national and regional level.
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Organización Panamericana de la Salud Washington - Washington - United States
E-mail: contacto_rpsp@paho.org