[Healthy lifestyles in times of pandemic]

SARS-CoV-2 pandemic generated a profound impact on people's health, emphasizing the relevance of healthy lifestyles. Recommendations on how to maintain adequate physical activity, diet, sleep and social connection have been issued. However, it is worth expanding our look to other possible elements related to lifestyles such as the relationship with technology, nature, pets and music. These areas should be included in the assessment and intervention from this perspective. To achieve changes, the values, beliefs, intentions, motivations, risk/benefit balances, capacity for self-regulation, previous history of changes and the person's sense of competence in relation to the possible changes that are being suggested, should be assessed. Individualized and contextualized suggestions that increase the intention of change should be made, avoiding confrontation and generalizations. Although there are still areas of uncertainty in this approach, particularly in relation to dosage and mechanisms of action, its development should be encouraged, given its great potential in terms of cost-effectiveness.

[Thanks for everything: a review on gratitude from neurobiology to clinic]

The World Health Organization (WHO) defines health not only as the absence of disease but as a state of complete physical, mental and social well-being. Gratitude is one of the concepts most commonly associated with well-being from the empirical point of view. Despite of this, we seldom use the concept, possibly due to the lack of dissemination of its scientific bases and possible clinical applications. At an anatomical level, it is related consistently with the medial prefrontal cortex and at molecular level, with the neuropeptide oxytocin. It has been associated with better physical and mental health parameters, both in healthy and sick populations. It is usually measured using scales, being the most used worldwide the Gratitude Questionnaire-6 item (GQ-6). There are exercises that can enhance gratitude and its benefits, such as the gratitude letter and the gratitude journal. Given the current state of knowledge about gratitude, and considering its potential benefits, low risks, ability to complement other treatments, the simple and cost-effectiveness of gratitude interventions, a continuing research on this topic and its practical implementation is warranted.

Healthcare team training programs aimed at improving depression management in primary care: A systematic review

BACKGROUND

Although evidence from Latin America and the Caribbean suggests that depression can be effectively treated in primary care settings, depression management remains unevenly performed. This systematic review evaluates all the international evidence on healthcare team training programs aimed at improving the outcomes of patients with depression.

METHODS

Three databases were searched for articles in English or Spanish indexed up to November 20, 2014. Studies were included if they fulfilled the following conditions: clinical trials, meta-analyses, or systematic reviews; and if they evaluated a training or educational program intended to improve the management of depression by primary healthcare teams, and assessed change in depressive symptoms, diagnosis or response rates, referral rates, patients' satisfaction and/or quality of life, and the effectiveness of treatments.

RESULTS

Nine studies were included in this systematic review. Five trials tested the effectiveness of multi-component interventions (training included), and the remaining studies evaluated the effectiveness of specific training programs for depression management. All the studies that implemented multi-component interventions were efficacious, and half of the training trials were shown to be effective.

LIMITATIONS

Contribution of training programs alone to the effectiveness of multi-component interventions is yet to be established. The lack of specificity regarding health providers' characteristics might be a confounding factor.

CONCLUSIONS

The review conducted suggests that stand-alone training programs are less effective than multi-component interventions. In applying the evidence gathered from developed countries to Latin America and the Caribbean, these training programs must consider and address local conditions of mental health systems, and therefore multi-component interventions may be warranted.

Chile: Acceptability of a Training Program for Depression Management in Primary Care

Background: In Chile, there are inconsistencies in the management of depression in primary care settings, and the National Depression Program, currently in effect, was implemented without a standardized training program. The objective of this study is to evaluate the acceptability of a training program on the management of depression for primary care health teams.

Methods: The study was a randomized controlled trial, and two primary centers from the Metropolitan Region of Santiago were randomly selected to carry out the intervention training program. Pre-post surveys were applied, to evaluate expectations and satisfaction with the intervention, respectively. Descriptive and content analysis was carried out.

Result: The sample consisted of 41 health professionals, 56.1% of who reported that their expectations for the intervention were met. All of the training activities were evaluated with scores higher than 6.4 (on a 1–7 scale). The trainers, the methodology, and the learning environment were considered strengths and facilitators of the program, while the limited duration of the training, the logistical problems faced during part of the program, and the lack of educational material were viewed as weaknesses.

Conclusion: The intervention was well accepted by primary health care teams. However, the clinical impact in patients still has to be evaluated.