Background:Given the limited understanding of individuals' positive gains, this study aimed to identify these gains that could be leveraged by policymakers to enhance future health and societal resilience. Methods:We used a global qualitative approach to survey adults over 18 from 30 countries across six World Health Organization (WHO) regions, who detailed up to three personal positive gains from COVID-19 pandemic via an open-ended question. Inductive thematic analysis was employed to identify main themes, and quantitative methods were used for demographic and regional comparisons based on the percentage of responses for each theme. Results:From 35 911 valid responses provided by 13 853 participants, six main themes (one negative theme), 39 subthemes, and 673 codes were identified. Five positive gain themes emerged, ordered by response frequency: 1) improved health awareness and practices; 2) strengthened social bonds and trust; 3) multi-dimensional personal growth; 4) resilience and preparedness building; 5) accelerated digital transformation. The percentage of responses under these themes consistently appeared in the same order across various demographic groups and economic development levels. However, there were variations in the predominant theme across WHO regions and countries, with either Theme 1, Theme 2, or Theme 3 having the highest percentage of responses. Although our study primarily focused on positive gains, unexpectedly, 12% of responses (4304) revealed 'negative gains', leading to an unforeseen theme: 'Distrust and emerging vulnerabilities.' While this deviates from our main topic, we retained it as it provides valuable insights. Notably, these 'negative gains' had a higher percentage of responses in areas like Burundi (94.1%), Rwanda (31.8%), Canada (26.9%), and in the African Region (37.7%) and low-income (43.9%) countries, as well as among non-binary individuals, those with lower education, and those facing employment challenges. Conclusions:Globally, the identified diverse positive gains guide the domains in which health policies and practices can transform these transient benefits into enduring improvements for a healthier, more resilient society. However, variations in thematic responses across demographics, countries, and regions highlights need for tailored health strategies.

Background We aimed to identify the central lifestyle, the most impactful among lifestyle factor clusters; the central health outcome, the most impactful among health outcome clusters; and the bridge lifestyle, the most strongly connected to health outcome clusters, across 29 countries to optimise resource allocation for local holistic health improvements. Methods From July 2020 to August 2021, we surveyed 16 461 adults across 29 countries who self-reported changes in 18 lifestyle factors and 13 health outcomes due to the pandemic. Three networks were generated by network analysis for each country: lifestyle, health outcome, and bridge networks. We identified the variables with the highest bridge expected influence as central or bridge variables. Network validation included nonparametric and case-dropping subset bootstrapping, and centrality difference tests confirmed that the central or bridge variables had significantly higher expected influence than other variables within the same network. Results Among 87 networks, 75 were validated with correlation-stability coefficients above 0.25. Nine central lifestyle types were identified in 28 countries: cooking at home (in 11 countries), food types in daily meals (in one country), less smoking tobacco (in two countries), less alcohol consumption (in two countries), less duration of sitting (in three countries), less consumption of snacks (in five countries), less sugary drinks (in five countries), having a meal at home (in two countries), taking alternative medicine or natural health products (in one country). Six central health outcomes were noted among 28 countries: social support received (in three countries), physical health (in one country), sleep quality (in four countries), quality of life (in seven countries), less mental burden (in three countries), less emotional distress (in 13 countries). Three bridge lifestyles were identified in 19 countries: food types in daily meals (in one country), cooking at home (in one country), overall amount of exercise (in 17 countries). The centrality difference test showed the central and bridge variables had significantly higher centrality indices than others in their networks (P< 0.05). Conclusions In 29 countries, cooking at home, less emotional distress, and overall amount of exercise emerged as common central lifestyle, health outcome, and bridge lifestyle factors, respectively. However, notable regional variations necessitate tailored interventions and resource allocations to effectively address unique local key variables and promote holistic health in each locale. The study's cross-sectional design and self-reported data may limit generalisability, emphasising the need for cautious interpretation and further longitudinal research.

Interpersonal trauma consists in any traumatic experience caused by other human beings. In Chile, although there are programs of intervention to support victims, these are mainly focused on reducing symptoms, neglecting other important aspects. The objective was to describe the perception of professionals from centers specialized in interpersonal trauma about the needs and motivations of adolescents when starting a reparative intervention. The participants were 85 professionals who work with adolescents exposed to interpersonal trauma. Through an online survey, they expressed their views on the needs of adolescents and their caregivers when initiating specialized interventions. Participants recognize the need to reduce symptoms but point out that there are more basic needs relevant to recovery. Among them, the need to be validated and believed, to be cared for and respected, as well as to receive social support stands out. They are also motivated to regain self-confidence and develop their personal resources to carry out normal activities during adolescence. These findings make it possible to make visible factors to be considered in the interventions.

Background: In Chile, there are long waiting lists for adolescents who are victims of interpersonal violence and require specialized care. A recent pilot study provides preliminary evidence in favour of minimally invasive group psychotherapies (focused on symptom stabilization) during the waiting period. However, more needs to be learned about their impact in the national context. Objective: To evaluate the acceptability and applicability of group interventions with adolescents on the waiting list in the Chilean context. Method: Using a open ended survey and a semi structured interview, the testimony of 85 people involved in the pilot experience of group interventions (patients, responsible adults, therapists, and staff at specialized centres) was obtained. The data were analysed qualitatively thematic analysis, Results. The participants have a favourable evaluation of these interventions; however, it is noted that their implementation in the Chilean context presents clinical and contextual challenges. These challenges include operational, technical, budgetary, and public policy-making aspects. Conclusions: Despite the preliminary evidence of the usefulness of the interventions, implementation problems must be resolved before their more widespread application in Chile.

Research on adverse childhood experiences and resilience (the process of overcoming trauma) has been dominated by studies originating in wealthy democracies of the global north. We call for a more global and ecological approach—not only for documenting the true global burden of childhood adversity, but also for advancing the science of resilience and understanding pathways to overcoming trauma. We identify several forms of trauma that need better consideration in prevalence estimates, including state, political, and institutional violence, crisis migration, climate change and related natural disasters, and global health crises such as the COVID-19 pandemic. We also need more nuanced analyses of culture and place and to recognize that the global south and global north are not monolithic concepts. We offer illustrative examples of how a more global, ecological approach can enhance our understanding of pathways to overcoming even high dosages of childhood adversity. One of the key insights of ACEs research, the dose-response relationship between trauma burden and outcomes, has been extended to research on resilience. Concepts that capture the total “dose” of positive assets and resources (people’s resilience portfolios) are showing how people might overcome even high doses of trauma. This work can become more global by including incorporating strengths and healing processes common in collectivist, versus individualistic, cultures. It can become more ecological by recognizing that physical environments—both natural and human-made built aspects—play key roles in resilience. Recognizing the intersectionality among these elements can take us to the next generation of trauma and resilience science.

In recent years, concern about the prevention of online sexual abuse has increased. Research has highlighted the role of parents or guardians as preventive agents, using measures of control, supervision, and emotional support with their children. However, more needs to be understood about the balance that parents should strike between su- pervision and emotional support. The main objective of this study was to find out if ado- lescents with parents who have different supervision-support profiles present differen- ces in factors linked to the prevention of OSA (knowledge about online sexual abuse, frequency of Internet use, self-efficacy, and well-being). The Participants were 82 high school students residing in Chile who responded to a series of self-report instruments. The cluster analysis recognized three groups of adolescents (with parents with high competence in the use of technology but with different levels of support and supervi- sion). Adolescents with competent, supportive, and supervising parents best unders- tand the risks of the Internet and have better self-efficacy and greater well-being.

Background Central and bridge nodes can drive significant overall improvements within their respective networks. We aimed to identify them in 16 prevalent chronic diseases during the coronavirus disease 2019 (COVID-19) pandemic to guide effective intervention strategies and appropriate resource allocation for most significant holistic lifestyle and health improvements. Methods We surveyed 16 512 adults from July 2020 to August 2021 in 30 territories. Participants self-reported their medical histories and the perceived impact of COVID-19 on 18 lifestyle factors and 13 health outcomes. For each disease subgroup, we generated lifestyle, health outcome, and bridge networks. Variables with the highest centrality indices in each were identified central or bridge. We validated these networks using nonparametric and case-dropping subset bootstrapping and confirmed central and bridge variables' significantly higher indices through a centrality difference test. Findings Among the 48 networks, 44 were validated (all correlation-stability coefficients >0.25). Six central lifestyle factors were identified: less consumption of snacks (for the chronic disease: anxiety), less sugary drinks (cancer, gastric ulcer, hypertension, insomnia, and pre-diabetes), less smoking tobacco (chronic obstructive pulmonary disease), frequency of exercise (depression and fatty liver disease), duration of exercise (irritable bowel syndrome), and overall amount of exercise (autoimmune disease, diabetes, eczema, heart attack, and high cholesterol). Two central health outcomes emerged: less emotional distress (chronic obstructive pulmonary disease, eczema, fatty liver disease, gastric ulcer, heart attack, high cholesterol, hypertension, insomnia, and pre-diabetes) and quality of life (anxiety, autoimmune disease, cancer, depression, diabetes, and irritable bowel syndrome). Four bridge lifestyles were identified: consumption of fruits and vegetables (diabetes, high cholesterol, hypertension, and insomnia), less duration of sitting (eczema, fatty liver disease, and heart attack), frequency of exercise (autoimmune disease, depression, and heart attack), and overall amount of exercise (anxiety, gastric ulcer, and insomnia). The centrality difference test showed the central and bridge variables had significantly higher centrality indices than others in their networks (P < 0.05). Conclusion To effectively manage chronic diseases during the COVID-19 pandemic, enhanced interventions and optimised resource allocation toward central lifestyle factors, health outcomes, and bridge lifestyles are paramount. The key variables shared across chronic diseases emphasise the importance of coordinated intervention strategies.

In recent years, an increasing trend in mental health research has been to collaborate with non-governmental organizations [NGOs] and their constituents. However, ethical difficulties can arise as a result of such partnerships. Understanding the ethics-related practices of NGOs engaged in mental health research is therefore critical. This study addressed these questions in a Malawian context. The goal of this study was to investigate NGO’s ethical practices in relation to mental health research by identifying characteristics that influence ethical practices and investigating staff conceptualization of ethics and mental health. Twenty individuals who work for different local NGOs took part in one-on-one interviews or a workshop about their engagement in diverse research initiatives. They pinpointed the areas that needed improvement, as well as the challenges and chances to create partnerships and increase research capability. The diversity in conceptualizing mental health was a key influence on research practices, with heterogeneity in definitions reflected in the use of cultural, spiritual, behavioural, or medical terms. Notably, there was also a greater emphasis on procedural ethics than ethics-in-practice. Collaboration dynamics and limited staffing capacity were cited as major ethical practice considerations. Each of these elements have an impact on NGOs’ ethical behaviour when conducting mental health research. Participants in the study saw engagement with notions of both ethics and mental health as lacking or rudimentary in their institutions and felt that they needed to be improved through capacity building and stronger research involvement.

Background In this study, we assessed the general population's fears towards various diseases and events, aiming to inform public health strategies that balance health-seeking behaviours. Methods We surveyed adults from 30 countries across all World Health Organization (WHO) regions between July 2020 and August 2021. Participants rated their fear of 11 factors on an 11-point Likert scale. We stratified the data by age and gender and examined variations across countries and regions through multidimensional preference analysis. Results Of the 16 512 adult participants, 62.7% (n = 10 351) were women. The most feared factor was the loss of family members, reported by 4232 participants (25.9%), followed by cancer (n = 2248, 13.7%) and stroke (n = 1416, 8.7%). The highest weighted fear scores were for loss of family members (mean ((x) over bar) = 7.46, standard deviation (SD) = 3.04), cancer (= 7.00, SD = 3.09), and stroke ((x) over bar = 6.61, SD = 3.24). The least feared factors included animals/ insects ((x) over bar = 3.72, SD = 2.96), loss of a mobile phone ((x) over bar = 4.27, SD = 2.98), and social isolation ((x) over bar = 4.83, SD = 3.13). Coronavirus disease 2019 (COVID-19) was the sixth most feared factor ((x) over bar = 6.23, SD = 2.92). Multidimensional preference analyses showed distinct fears of COVID-19 and job loss in Australia and Burundi. The other countries primarily feared loss of family members, cancer, stroke, and heart attacks; this ranking was consistent across WHO regions, economic levels, and COVID-19 severity levels. Conclusions Fear of family loss can improve public health messaging, highlighting the need for bereavement support and the prevention of early death-causing diseases. Addressing cancer fears is crucial to encouraging the use of preventive services. Fear of non-communicable diseases remains high during health emergencies. Top fears require more resources and countries with similar concerns should collaborate internationally for effective fear management.

Background:The interconnected nature of lifestyles and interim health outcomes implies the presence of the central lifestyle, central interim health outcome and bridge lifestyle, which are yet to be determined. Modifying these factors holds immense potential for substantial positive changes across all aspects of health and lifestyles. We aimed to identify these factors from a pool of 18 lifestyle factors and 13 interim health outcomes while investigating potential gender and occupation differences.Methods:An international cross-sectional study was conducted in 30 countries across six World Health Organization regions from July 2020 to August 2021, with 16 512 adults self-reporting changes in 18 lifestyle factors and 13 interim health outcomes since the pandemic.Results:Three networks were computed and tested. The central variables decided by the expected influence centrality were consumption of fruits and vegetables (centrality = 0.98) jointly with less sugary drinks (centrality = 0.93) in the lifestyles network; and quality of life (centrality = 1.00) co-dominant (centrality = 1.00) with less emotional distress in the interim health outcomes network. The overall amount of exercise had the highest bridge expected influence centrality in the bridge network (centrality = 0.51). No significant differences were found in the network global strength or the centrality of the aforementioned key variables within each network between males and females or health workers and non-health workers (all P-values >0.05 after Holm-Bonferroni correction).Conclusions:Consumption of fruits and vegetables, sugary drinks, quality of life, emotional distress, and the overall amount of exercise are key intervention components for improving overall lifestyle, overall health and overall health via lifestyle in the general population, respectively. Although modifications are needed for all aspects of lifestyle and interim health outcomes, a larger allocation of resources and more intensive interventions were recommended for these key variables to produce the most cost-effective improvements in lifestyles and health, regardless of gender or occupation.

The prevalence of online sexual abuse (OSA) is high worldwide.In Chile, law No. 20,526 seeks to punish sexual harassment, virtual child pornography and possession of child pornographic material.The evidence shows that preventative strategies, aiming to combat OSA, are ineffective, mainly due to their adultcentric logic.For this reason, this study aims to describe the preventive strategies that adolescents are familiar with and which ones they propose.Eighty-two adolescents answered a qualitative online survey.The thematic analysis shows that adolescents propose to prevent OSA by fostering dialogue within the family -balancing supervision with support-instead of imposing rigid norms.The adolescents further suggest incorporating the school community into this dialogue and that the strategies be continuous, in interactive and motivating formats, rather than rigid and scholarly.

Background The health area being greatest impacted by coronavirus disease 2019 (COVID-19) and residents’ perspective to better prepare for future pandemic remain unknown. We aimed to assess and make cross-country and cross-region comparisons of the global impacts of COVID-19 and preparation preferences of pandemic. Methods We recruited adults in 30 countries covering all World Health Organization (WHO) regions from July 2020 to August 2021. 5 Likert-point scales were used to measure their perceived change in 32 aspects due to COVID-19 (-2 = substantially reduced to 2 = substantially increased) and perceived importance of 13 preparations (1 = not important to 5 = extremely important). Samples were stratified by age and gender in the corresponding countries. Multidimensional preference analysis displays disparities between 30 countries, WHO regions, economic development levels, and COVID-19 severity levels. Results 16 512 adults participated, with 10 351 females. Among 32 aspects of impact, the most affected were having a meal at home (mean (m) = 0.84, standard error (SE) = 0.01), cooking at home (m = 0.78, SE = 0.01), social activities (m = -0.68, SE = 0.01), duration of screen time (m = 0.67, SE = 0.01), and duration of sitting (m = 0.59, SE = 0.01). Alcohol (m = -0.36, SE = 0.01) and tobacco (m = -0.38, SE = 0.01) consumption declined moderately. Among 13 preparations, respondents rated medicine delivery (m = 3.50, SE = 0.01), getting prescribed medicine in a hospital visit / follow-up in a community pharmacy (m = 3.37, SE = 0.01), and online shopping (m = 3.33, SE = 0.02) as the most important. The multidimensional preference analysis showed the European Region, Region of the Americas, Western Pacific Region and countries with a high-income level or medium to high COVID-19 severity were more adversely impacted on sitting and screen time duration and social activities, whereas other regions and countries experienced more cooking and eating at home. Countries with a high-income level or medium to high COVID-19 severity reported higher perceived mental burden and emotional distress. Except for low- and lower-middle-income countries, medicine delivery was always prioritised. Conclusions Global increasing sitting and screen time and limiting social activities deserve as much attention as mental health. Besides, the pandemic has ushered in a notable enhancement in lifestyle of home cooking and eating, while simultaneously reducing the consumption of tobacco and alcohol. A health care system and technological infrastructure that facilitate medicine delivery, medicine prescription, and online shopping are priorities for coping with future pandemics.

El propósito del estudio fue identificar los desafíos éticos que enfrentan los investigadores en Latinoamérica. Metodología: se planteó un estudio cualitativo en el que participaron 31 investigadores latinoamericanos, representantes de 6 países. En la primera fase, se realizó una encuesta en línea con pregunta abierta diligenciada por los 31 investigadores; en la segunda fase, una entrevista semiestructurada en donde participaron 23 de estos investigadores. Desarrollo: se identificaron 6 desafíos para la ética de la investigación: i) desde y hacia una Latinoamérica global, ii) hacia una cultura de investigación ética, iii) la ética dentro y fuera de la investigación, iv) relaciones humanas en investigación, v) presencia/ausencia de los comités de ética, vi) COVID-19, un nuevo escenario. Entre los aspectos más relevantes planteados por los participantes,se encuentran la generación de investigaciones sensibles a la variabilidad cultural que impactan positivamente las problemáticas locales, la necesidad de gestar alianzas sur-sur que definan políticas públicas en el tema, la reorientación de políticas latinoamericanas centradas en la región, el impulso a la formación en ética de la investigación desde inicios de la formación, la apertura de discusiones sobre el tema en la región para el desarrollo de directrices y una mayor conciencia en este tópico, la reflexión sobre el papel de los comités de ética como asesores y educadores, la flexibilidad en el consentimiento informado adaptable a las diversas condiciones y contextos, además de retos específicos derivados de la situación de pandemia por COVID-19.

La investigación intercultural plantea desafíos éticos complejos. Por ello, en el año 2019 se desarrolló un modelo de análisis de conflictos éticos en colaboración con más de 200 investigadores de más de 30 países. Este modelo parece pertinente para América Latina. El modelo propone que los desafíos éticos (y sus soluciones) dependen de cuatro factores presentes durante todo el proceso de investigación: el lugar donde se realiza la investigación, las personas involucradas, los principios éticos relevantes y los precedentes de investigaciones pasadas. En este artículo hacemos un análisis de la aplicabilidad de dicho modelo mediante dos análisis de casos referidos a la investigación con pueblos originarios en Chile y al trabajo con latinos migrantes en la frontera México-Estados Unidos.

Whilst individual psychotherapy is effective in treating the consequences of interpersonal violence, the demand for care usually exceeds the capacity of healthcare systems. Group interventions allow access for more children and adolescents, but evidence of their effectiveness is still scarce. Our objective was to investigate the opinions of Chilean professionals on what should be considered when designing group psychotherapeutic interventions for adolescent. Participants were 85 psychologists and social workers who work with adolescents exposed to violence. Participants completed an online survey about their opinions regarding the issues that should be addressed in group interventions. Thematic analysis uncovered broad support for this type of group intervention as part of a larger intervention process. Participants suggested that initial phases of the intervention should be carried out in a group format, address general aspects of trauma and intervention, and highlight personal resources and aspects of normal life. The individual trauma narratives should be addressed later, in individual therapy. Participants proposed a balance between psychoeducation and experiential activities. The results support group interventions to allow a better use of professional resources to face high demand for treatment, but it should be part of an intervention in phases, taking care not to retraumatize group participants.

BACKGROUND:Online sexual harassment in adolescence is associated with depressive symptoms. There is, however, a dearth of research investigating variability of symptom profiles in this population in relation to offender gender and age.OBJECTIVE:To identify the proportion of adolescents reporting online harassment by different types of offenders and compare their levels of depression.PARTICIPANTS AND SETTING:Participants were 18,872 Chilean students aged 12 to 17 years (3.063 of them online sexually harassed).METHODS:The study involved a secondary analysis of self-report data on online sexual harassment, poly-victimization, and depression collected as part of the National Poly-victimization Survey.RESULTS:In 37.6% of the cases the offender was male under 18, in 22.4% an adult male, in 14.5% a female under 18, and in 2.9% an adult female. In 22.5% of cases the offender could not be identified. An ANCOVA demonstrated levels of poly-victimization across the lifespan and frequency of online sexual harassment in the last year to predict depressive symptomatology. In females, higher levels of depressive symptoms were observed among those sexually harassed by either a female under 18, an offender whose age and gender the victim could not identify, or an adult male. In males, higher levels of depression were observed among those harassed by either an adult male, an offender whose age and gender the victim could not identify, or a male under 18.CONCLUSIONS:The current study highlights the importance of offender's age and gender in predicting depression levels in adolescent victims of online sexual harassment.

A municipal high school in Chile, located in the region of Libertador General Bernardo O'Higgins, has been experiencing difficulties with student learning in recent years, which can be seen in the results of classroom evaluations and standardized tests. In order to address this problem, an associative research project generated a diagnosis focused on students, teachers and curricular and evaluative instruments, which allowed changing the focus on student results to concentrate on teaching practices. From this, four learning communities were configured with all the teachers of the school, which generated intervention projects with didactically sequenced activities, whose implementation allowed the teachers to transform content-based teaching, moving towards the development of thinking skills; in addition, they could be aware that collaborative work enhances their own professional development and that of their peers. The support of the school's management team and the horizontal work with professors from the University of Santiago de Chile were key to the realization of the project. The main projection is in the continuity of the development of the learning communities for the following years and the establishment of the impact on the results of the students in the standardized tests.