Leishmania spp—mammalian host interaction in the onset of infection and after the clinical cure of the lesions. We will also examine the information already available concerning the parasite strategy to evade immune response mainly at the beginning of the infection, as well as during the parasite persistence. This knowledge can improve the conditions of treatment, follow-up and cure control of patients, minimizing the potential damages this protozoosis can cause to infected individuals.For a long time Leishmaniasis had been considered as a neglected tropical disease. Recently, it has become a priority in public health all over the world for different aspects such as geographic spread, number of population living at risk of infection as well as the potential lethality and/or the development of disfiguring lesions in the, respectively, visceral and tegumentary forms of the disease. As a result, several groups have been bending over this issue and many valuable data have been published. Nevertheless, parasite-host interactions are still not fully known and, consequently, we do not entirely understand the infection dynamics and parasite persistence. This knowledge may point targets for modulation or blockage, being very useful in the development of measures to interfere in the course of infection/ disease and to minimize the risks and morbidity. In the present review we will discuss some aspects of the  Leishmania that affect humans and other animals. They are transmitted by insects popularly known as sand flies  and can cause different clinical presentations, from cutaneous, and/or mucosal lesions (tegumentary leishmaniasis) up to visceral infection with tropism by the lymphohematopoietic system . Due to its potential for lethality, mainly in visceral forms, as well as its dispersion in several continents with large population groups under infection risk, it is considered by WHO as one of the priority attention diseases  and induced up-regulation of the cellular signaling factors involved in pathogenesis (ERK1/2) as well as down regulated the signaling elements (p38 MAPK) involved in the Th1 response  in mice macrophages was demonstrated in vitro and in vivo  on the immune response of peripheral blood mononuclear cells of patients affected by visceral leishmaniasis were observed , favoring L. infantum infection in C57BL6 mice  can promote macrophage survival via LRV1 recognition through TLR-3. The authors showed in an in vitro model the possibility of LRV1 interference leading therefore to an increased infection in macrophages  the host-parasite equilibrium can be broken leading to the development of severe disease. In this context, the authors showed in a mouse model of leishmaniasis resistance that after a secondary challenge parasites are able to colonize and persist as much as the parasites from the primary infection. However, disease is weak when compared with the primary clinic onset. According to the authors, these results indicated that this strategy would facilitate the generation of parasite diversity during the life cycle maintenance. The same authors  to cytokine macrophage migration inhibitory factor (MIF) and a wild type (mif+/+) as control. The results showed that mice infected with mif−/− parasites had three times less parasites, a decrease in antigen presenting cells activation, as well as in T cell priming and CD4 effector cells, leading to diminished inflammation signs. On the other hand, the infection promoted differences in the expression of exhaustion markers when compared with the infection produced by the mif+/+Leishmania major. Taken the results together, the authors pointed out the influence of MIF produced by L. major to facilitate parasite persistence. In this aspect, Soulat and Bogdan , and the evasion mechanisms enrolled in persistence can indicate new steps for the design of new drugs and vaccines in order to control leishmaniasis.In summary, results published until now point out an important influence of FC-S and FM conceived the manuscript and wrote, reviewed, and approved the manuscript. FC-S conceived the figure. FM conceived the table.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


It is an exciting time to be caring for patients with cancer. Great strides are being made in the treatment landscape, with new therapies approved seemingly every month. Patients have more opportunities to receive novel and innovative treatments with improved outcomes. These therapies require advanced practitioners in oncology to update and add to their current knowledge base regarding treatments for our patients, one of the important reasons to attend JADPRO Live at APSHO and stay informed!The US Food and Drug Administration (FDA) approved a new therapy for children and young adults with B-cell acute lymphoblastic leukemia (ALL) on August 30, 2017. Chimeric antigen receptor (CAR) T-cell therapy is an important part of immunotherapy, which is emerging to become an essential part of cancer therapy. The treatment tisagenlecleucel (Kymriah) is the first-ever FDA-approved CAR T-cell therapy that genetically alters a patient’s own cells to battle the cancer itself and has the potential to change cancer therapy for the future . ApprovaThe treatment involves altering the cells of each patient by removing the individual’s T cells, freezing them, and shipping the cells to a manufacturing center. The manufacturer then genetically engineers the cells, multiplies them, and ships them back to the medical center for infusion of this "living" drug into the affected patient. The treatment carries a variety of significant side effects and the potential for cytokine release syndrome, including hypotension, pulmonary edema, fever, and other life-threatening complications. Treating hospitals and clinics must be specially certified to administer the therapy per the FDA approval . And, asIt is important to mention that this innovative therapy is very expensive. The individual cost of the treatment is $475,000. The pharmaceutical company acknowledges that if a patient does not respond to treatment, there will be no charge to the individual, and that there are financial assistance programs to help defer the cost of therapy . AdditioIn a recently published study, oncologist and patient discussions regarding the cost of care in breast cancer did produce positive changes in the reduction of cost . Some ofThe American Society of Clinical Oncology (ASCO) is committed to a discussion and framework on the rising costs of cancer care. Its value framework assesses the value of new cancer therapies, comparing clinical benefit, side effects, and potential for improvement in patient symptoms or quality of life with the cost of therapy . The AmeOncology advanced practitioners are directly involved in patient care and the ordering and administering of cancer therapies. The newly approved CAR T-cell therapy for pediatric patients with B-cell ALL is critically important and represents a pivotal change in our approach to these patients as well as potentially others. However, the costs of cancer care are rising, and advanced practitioners should be at the forefront of discussions regarding these costs. Whether you are sitting on your hospital’s Pharmacy and Therapeutics committee or filling out forms for financial assistance for your patient, stay involved in the discussion. The costs of cancer care are significant and can affect your patients’ quality of life as well as their pocketbooks .


Background: Organizational culture plays a key role regarding organizational outcomes and determining strategies, goals, and modes of operating which is associated with higher rates of worker morale, turnover and lower adverse events related to patient quality of care issues. Aim: to describe the impact of the relocation of nurses from hospitals and other contexts to primary care from the perspective of primary care nurses. Methods: A qualitative, focused ethnographic study. Site: Cantabro Health Service, Cantabria, Spain. Purposeful sampling methods were used to include nurses who were working in primary care during the study, and who had previous experience of at least one year in primary care. Observation  and in-depth interviews (17) were used to collect data. A thematic analysis was applied. Results: Four themes emerged from the data: (a) staff policies applied, (b) beliefs regarding the newly incorporated nursing staff, (c) reasons for relocation to primary care, and (d) concern for the future. Conclusions: In primary care, the relocation of non-qualified nursing professionals who are at the end of their career may have a negative impact on the organizational culture. It is necessary to research the most appropriate measures for guaranteeing a satisfactory work environment based on nurses who are qualified in primary health care settings. At present, societies must face an evolving dynamic health reality, which forces governments to organize, plan and adapt their health resources to meet new challenges . These nAdditionally, the model of health management and organization influences the distribution of its resources , and therefore, this influences the healthcare received ,3,4. On Culture is defined as a pattern of shared basic assumptions that are learnt by a group via solving their problems of external adaptation and internal integration, which has worked well enough to be considered valid and, therefore, to be taught to new members as the correct way to perceive, think, and feel in relation to those problems ,8. In adThese organizational cultures appear in health care and nursing professionals ,10,11, aA challenge that these organizational cultures must face is incorporating new members that do not share, accept or know the culture ,5, provoLastly, the incorporation of nurses into P, who lack specialized training and have PC work expectations that are based on myths and preconceptions , and replacing veteran nurses in primary care , may hamNo studies to date have investigated the effects of the health organization (human resources) and their interventions on the organizational culture of nursing. In addition, to our knowledge, no qualitative study exists exploring the perspective of primary care nurses regarding the application of norms that condition the incorporation of new nurses in primary care. The following questions guided this study: What are the shared roles and values of PC nurses? What is their experience regarding new nurses that relocate to PC from hospitals? The aims of this study were (a) to describe the impact that the application of the Spanish law on the management of human resources in primary care (BOE Ley 9/2010) ,20 has oThis study was conducted following the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines  . All the researchers had experience in qualitative designs. All the researchers held PhDs in health sciences, were University professors, and were not involved in clinical activity. Three members of the research team worked as nurses in PC , although they had no previous relationship with the participants. The positioning of the researchers was established regarding the theoretical framework, their beliefs, prior experience and personal motivations for participating in the research  See Tab.This study was conducted at the ‘Astillero’ Health Clinic (HC), belonging to the Servicio Cantabro de Salud . In Spain, the HC represents the basic physical and administration unit via which PC is performed in Spain . The funThe description of the shared culture of primary care nurses regarding an event (new human resources policy management) is important to describe how this cultural group works and lives via their “emic” perspective . In Spain, based on the current regulations ,20, workThe inclusion criteria consisted of the following: (a) nurses with a university degree in Nursing, (b) whose workplace was PC at the time of the study, (c) with at least one year of experience in PC, (d) able to communicate, and (e), who had signed the informed consent. All participants had to meet the previously defined inclusion criteria. All the professionals who were invited to participate joined the study, with no refusals.Purposive sampling strategies are well suited to ethnographic studies ,22. PurpThe researchers made initial contact with the patients via the gatekeeper who was the nurse in charge of the health center . The funData were acquired from 1 July 2013 until 30 October 2013. Data collection consisted of a first phase based on unstructured interviews, with open questions such as: how was the incorporation of the new nurses? Do the newly incorporated nurses share the values, beliefs, principles and knowledge of care in primary care? After this phase, areas of interest were identified to determine which items required further examination; therefore, a second phase was necessary based on semi-structured interviews and non-participant observation.The semi-structured interviews were conducted using an open-ended questions guide based on the unstructured interviews performed in phase one. The question guide it shows in the All the interviews and observations were accompanied by researcher notes. During the interview, the researcher made notes, including a description of the environment, patients’ non-verbal responses to questions, the use of metaphors in patients’ narratives, and other relevant points that emerged in the interview .In total, 55 days of observations (385 hours) were performed, over three months (seven weeks), divided into 55 sessions and with a mean duration of seven hours, focused on the following research areas and interaction moments: (a) welcome/reception session of newly incorporated nurses, (b) nurse training sessions, (c) interdisciplinary team meetings at the HC, (d) meetings of the HC nursing group, (e) sessions of the HC quality commission, (f) clinical sessions involving the interdisciplinary group, and (g) sessions for HC activity coordination and planning.In total, 17 in-depth interviews took place: five non-structured, and 12 semi-structured interviews , and 17 researcher notes were performed.Participant recruitment finished when there was repetition in the information obtained from the interviews . This waFirst, a complete and literal transcription was drafted for each interview, and observation and researcher field notes were drafted. The texts were then collated for qualitative analysis , after wThe COREQ guidelines  were folThe study was approved by the Cantabria Health Service, based on current legislation and performed in accordance with the Declaration of Helsinki . InformeIn total, 12 women and two men, with a mean age of 47.4 years (SD ± 8.41), participated in this study. The mean work experience in primary care was 12.50 years (SD ± 5.14). Of the nurses who worked in the HC, five came from other primary care HCs (35.71%), five came from hospitals (37.71%), and four came from elsewhere (28.57%).The themes representing the participants’ perspective were extracted from the non-participant observations, in-depth interviews, and researcher notes. Four themes emerged from the material analyzed: (a) staff policies applied, (b) beliefs regarding the newly incorporated nursing staff, (c) reasons for relocation to primary care, and (d) concern for the future.The themes presented below were aimed at depicting a holistic cultural portrait, in which researchers described a working set of rules as to how the nurses’ culture-sharing group functions, in the case of the incorporation of new nurses . We inclTheme 1.Staff policies applied.The nurses narrated that while they understood the need for constant change and evolution in the HC, they felt that the changes underway were contradictory because the new nurses were nurses with an extensive career path, however, based in a hospital context, having no previous contact with primary healthcare.Nurses narrated how these new nurses come from a hospital culture geared towards illness, where technology is of prime importance and where health promotion and illness prevention is not the priority.“this has been disastrous” (E03), show that they perceived that this strategy was altogether wrong.Affirmations made by some nurses such as, Regarding the HC nursing teams, the nurses described how the policies for assigning new staff on behalf of the management had not been directed at reinforcing or maintaining a balance between the staffing of nurses and the care and interventions performed in the community.Primary care nurses assigned the responsibility of this poor staffing strategy to the managers who call for the provision of vacancies, without considering the nurses or the real needs and without considering the repercussion this had on care provision within the HC teams. This leads to conflicts between members of the team and the newly hired nurses.Theme 2.Beliefs regarding the newly incorporated nursing staff.the old glories of Valdecilla believe that they have come to the elephants’ graveyard.Primary care nurses shared a series of myths and beliefs concerning the new nurses who were relocated from the hospital. These myths and beliefs support a distorted vision of hospital nurses, characterized by comments such as, The nurses based these beliefs on the fact that nurses coming from the hospital had a “fixed”, “civil servant”-like relationship and this condition is related with staff who have low motivations and whose expectations equal poor work involvement.These beliefs are justified by the perception of the complexity of the nursing role in primary care, based on the essence of their work and their professional autonomy.On the other hand, they referred to the fact that the vision and conception of work and the objectives of hospital nursing and primary care nursing are totally different. These different views are the ones that lead to conflicts.Theme 3.Reason for relocation to primary careThe nurses included in this study who were relocated into primary care from hospitals narrated that despite having a long professional career as nurses in the hospital, this type of relocation was solitary, met with little support and in an abrupt manner. These nurses experienced conflicting emotions after all the years they had worked at the hospital.The motivation for the relocation from the hospital to PC was moslty due to professional disenchantment with hospital work and the search for better work conditions, although they lacked knowledge regarding PC.Theme 4.Concern for the future.With the arrival of the newly relocated staff, in addition to the problems affecting the cohesion of the teams, the presence of considerable work instability amongst primary care nurses  led to a major turnover, affecting the ability for nurses to become involved and to establish relationships of trust with patients.Nurses described that all the individual and collective work performed in order to build an individualized care model that is oriented towards people and the community was ignored by the managers and was contradictory with the main benefit that primary care provokes, which is the continuity of healthcare.Our results show how policies for the incorporation of new staff affected the organizational culture of nurses in PC. The presence of beliefs regarding the new nurses who came from the hospital and their motivations, were met with great concern for the future work of PC nurses.The strategy for the provision and relocation of staff used in the Cantabrian Health Service (BOE Ley 9/2010) ,20 meansThe findings of authors  show thaNonetheless, in addition to the previously commented factors, another author  revealedIn our environment, there are no staff policies adapted to the professional in all phases of professional life. This forces older professionals from the hospital context to choose PC as the last destination two or three years before retirement. This generates alterations in the work of the interdisciplinary team due to the high turnover and the non-specialization of the professionals. Moreover, this negatively affects their work satisfaction and level of stress , the turThis staff policy is becoming removed from the main aim of PC, which is to provide care to the community , which, The incorporation of new non-qualified professionals is negatively affecting the organizational culture of PC, and this obviously has a direct repercussion on the care of patients.The most effective mode of care based on interprofessional teams is met with barriers such as the absence of support and scarce relationships with the rest of the team . For all these reasons, the wealth of literature over the last decade on the importance of PC implies the need for managers to establish policies for the provision of staff which are coherent with the professional requirements in this sector. Developing policies for the provision and relocation of staff based on the level of qualification and experience on PC, creating in hospital care/specialized positions and schedules adapted to the last years of the professional career and promoting PC specialization can be some of the formulas that contribute to reversing the current situation.Nonetheless, robust and longitudinal research is necessary to determine which aspects are necessary to guarantee that employment in this context is satisfactory and to ensure that it is dominated by nurses who are qualified in this area .A limitation of this study is that the results cannot be generalized due to the qualitative nature of the data. Furthermore, the authors consider that the main strength of this study is that the application of human resource policies may influence the organizational culture of nurses in the complex primary care context.The organizational model in healthcare must evolve towards strategies that adapt to the changing needs of the professionals throughout their professional career. The provision of unqualified staff in PC who are at the end of their career may negatively affect the organizational culture.The elaboration of staffing policies must be coherent with the professional needs of PC, favoring the incorporation of nurses who are qualified in the area and not for reasons related to the work load or the shift.In the future, it is necessary to perform research to determine which aspects are necessary in order to guarantee a satisfactory work environment with nurses who are qualified in this sector.


Difficulties with delaying gratification, coping with frustration, and regulating emotions are significant predictors of aggression and behavioural and interpersonal problems early in life and mental health disorders during childhood, adolescence, and adulthood. Mental health problems generate a high burden of disease in society in general, and there is a significant treatment gap, especially among economically vulnerable populations. Prevention strategies appear to be the more recommendable options, mainly if these interventions can be implemented early in life and at low cost. Few preventive interventions aiming to increase resilience in the face of adversity have been rigorously evaluated among Chilean preschoolers. Substantial international evidence indicates that strengthening basic psychological skills, such as emotion regulation and social problem-solving, can reduce the incidence of mental pathology and improve various academic indicators. The curriculum of the Interpersonal Cognitive Problem-Solving Programme, also known as I Can Problem Solve (ICPS), is focussed on the development of the cognitive process and children’s social problem-solving skills. ICPS is effective at increasing prosocial behaviours and reducing aggressive behaviour among preschoolers. ICPS provides children with the skills to think about how to solve problems using sequenced games, discussion, and group-interaction techniques focussed on listening to, and observing, others, promoting empathy and alternative and consequential thinking. The aims of this study are (1) to develop a culturally appropriate version of the ICPS programme and (2) to evaluate the acceptability and feasibility of the adapted version of ICPS among vulnerable schools in Santiago, Chile, conducting a pilot randomised controlled trial with three arms: (1) the ICPS programme delivered by an internal early teacher, (2) the ICPS programme delivered by an external early teacher, and (3) a control group.This is a pilot, three-armed randomised controlled trial of the adapted version of ICPS with an enrolment target of 80 preschoolers attending four schools per arm. Children in both intervention groups will receive the ICPS programme: 59 sessions of 20 min each delivered three times a week by trained internal or external early teachers over 5–6 months. Internal teachers are part of the school staff, and external teachers are facilitators hired by the research team to go to schools and deliver the intervention during a normal school day, working together with the early teacher present in the classroom. The intervention consists of games using pictures, puppets, and simple role-playing techniques to facilitate the learning process. Cognitive regulation, emotion recognition, social-problem-solving skills, and psychological functioning will be measured at baseline and after the intervention.No previous studies in Spanish-speaking Latin American countries have been conducted to explore the acceptability and feasibility of ICPS to provide information to evaluate the effectiveness of this intervention on a larger scale.NCT03383172. Registered on 26 December 2017.ClinicalTrials.gov, ID: The online version of this article (10.1186/s13063-019-3245-3) contains supplementary material, which is available to authorized users. Mental health disorders are among the leading causes of the Global Burden of Disease , 2, and In Chile, mental health among children and families is an urgent public health problem. Several epidemiological studies have shown that a significant percentage of the adult population has psychiatric disorders. For example, one recent study reported that 31.5% of the population aged 15 years and older has some type of psychiatric pathology in their life and that 22.2% suffered from a psychiatric disorder during the last year . The mosVarious studies have shown that children from socio-economically vulnerable families have a higher risk of behavioural difficulties given their exposure to a greater number of risk factors . Among tScientific evidence has recently indicated that the stimulation of cognitive and non-cognitive skills in the first years of life promotes general development and has a beneficial long-term impact on health , 14 and On the one hand, cognitive skills refer mainly to executive functions, such as attention, working memory, inhibitory control, and cognitive flexibility , that arSocial and emotional learning skills, as mentioned above, can be categorised into three main groups: cognitive regulation, emotional processes, and social and interpersonal skills. There are alternative ways to categorise them, such as the model presented by the Collaborative for Academic, Social, and Emotional Learning (CASEL) group , but theCognitive regulation is one of the basic skills required to direct behaviour towards the attainment of a specific goal. It is closely related to the concept of executive function and is used for prioritising and sequencing behaviours , inhibiting one behaviour in favour of a behaviour more appropriate to the context , considering relevant information , resisting distractions, changing tasks, using information to make decisions, and creating abstract rules to handle new situations . There iEmotional processes are a group of skills that help children to recognise, express, and regulate their emotions . These sSocial and interpersonal skills help children to adequately interpret the behaviours of others, manage social situations effectively, and interact with peers and adults. These skills are built on the aforementioned emotional processes. Children must first be able to recognise, express, and regulate their emotions before building effective social relationships. These skills help children and young people to collaborate effectively on their schoolwork (and later in the workplace) and to solve social problems. The main skills in this category are , 34 undeThere is sufficient evidence that shows the benefits of interventions aiming to promote social and emotional skills. A recent meta-analysis reviewed 82 universal school-based interventions involving 97,406 students from kindergarten to high school with a follow-up period of 6 months to 18 years . SEL intThere are interventions that have proven effective in reducing mental disorders and promoting social-emotional competence  such as I Can Problem Solve (ICPS) was recently selected as one of the top 25 programmes to implement in schools and promote social-emotional skills in a careful review conducted by Jones et al. (2017) . SimilarThe curriculum of the Interpersonal Cognitive Problem-Solving Programme, also known as I Can Problem Solve (ICPS), is focussed on the development of the cognitive process and children’s social problem-solving skills. That is, it is a programme that explicitly promotes cognitive regulation , solving social problems , and the promotion and learning of emotional processes . A recent analysis of the included activities  that assp < 0.001), the WHNG  = 23.80, p < 0.001), and the behaviour adjustment measures . The results also show that these effects are sustained over time after 1 year. When comparing the results between well-adjusted, impulsive, or inhibited children, improvements in problem-solving skills were evident in all three groups. Finally, when studying the effectiveness in relation to training time, 2 years (TT) vs 1 (TC and CT) or none (CC), those who received 2 years of training had better results than those who were trained for 1 year, and all of the groups that received training had better results than those that did not (CC).Two randomised controlled trials tested the effectiveness of ICPS. In the first study , a groupn = 96), ICPS for 1 year , and a control group (n = 24) without ICPS. The majority of the participants were of Hispanic origin, and more than 90% of the children received free lunches (which is a poverty indicator used in the United States). The student evaluations were based on: (1) the Preschool Social Behaviour Scale (PSBS), which evaluates relational and direct aggressive behaviours in addition to prosocial behaviour, has 16 items, and is answered by teachers; and (2) the Hahnemann Behaviour Rating Scale (HBRS), an instrument that evaluates student behaviour in relation to aggressiveness, impulsiveness, passivity, and prosocial behaviour, and allows for the creation of sub-scales of aggression/impulsivity , passivity , and prosocial behaviour . It consists of 11 items and is answered by teachers. Students who received 2 years of ICPS had the best results in terms of increasing prosocial behaviours and reducing aggressive behaviour. For the HBRS, on the sub-scale of prosocial behaviour, a 12% greater effect was shown for the ICPS group (both groups that received ICPS). But when those who received ICPS for 1 year were excluded from the analysis, comparing only those who received 2 years of ICPS with those who received none, this effect increased by 19% in favour of the intervention group. Similarly, for the PSBS, the sub-scales of open and relational aggression showed 3 and 4% improvement in favour of the intervention, respectively. But when those who received ICPS for 1 year were excluded from the analysis, the effect was 6 and 9%, respectively, in favour of the intervention group.In a second study , particiTo adapt the ICPS programme through a process of translation, editing, and cultural adjustmentTo evaluate the acceptability of this programme, and the instruments it uses, by students, parents, teachers, and authorities at Chilean educational institutionsTo evaluate the feasibility of implementing this programme and the instruments it uses by studying (1) the participant recruitment process to report on the feasibility of a randomised controlled trial by large-scale clusters, (2) the time and effort required to answer the programme’s evaluation scales, and (3) the measurement of the response rate, loss levels during follow-up, and general information lost in the studyTo compare the acceptability, feasibility and fidelity of the implementation of this programme between internal and external facilitatorsTo identify and compare changes in social-emotional competence as well as the presence of emotional and behavioural problems among preschoolers in the intervention group schools and the control group schoolsThe general objective of this study is to evaluate the acceptability and feasibility of the adaptation of the I Can Problem Solve (ICPS) programme for preschoolers in a national context at educational institutions with high socio-economic vulnerability, and to compare the implementation process and fidelity of the programme delivered by school staff early teachers  and by external early teachers . The specific objectives are:H1: The recruitment and adaptation of the interventions, evaluations, and procedures in this study will be feasible and acceptable in the national context at educational institutions with high socio-economic vulnerability, which will allow progress to be made towards the subsequent proposal of a randomised controlled trial using large-scale clustersH2: The acceptability, feasibility, and fidelity of the implementation of this programme will be better in the intervention groups led by the external facilitatorH3: Preschoolers in the intervention group will have a greater degree of social-emotional competence compared to preschoolers in the control groupH4: Preschoolers in the intervention group will have fewer emotional and behavioural symptoms compared to preschoolers in the control groupThe following hypotheses are presented in this study: the hypothesis related to the feasibility and acceptance of this intervention programme (H1) and those related to the expected effects of the intervention (H2 and H3):Municipal and private subsidised educational institutions of the province of Santiago will be invited to participate. Within the province of Santiago, schools from four municipalities  will be contacted and invited to participate. Refusal reasons will be noted.This is a pilot study and, therefore, primarily exploratory. It will provide data on the acceptability and feasibility of an ICPS programme adapted to the Chilean context and culture. This study also has a quantitative component that will be a single-blind, three-armed randomised controlled trial. Two groups of schools will receive the intervention: (1) in one group, the intervention will be delivered by trained external facilitators, that is, early teachers hired by the research project to go to the schools and deliver the intervention to the students and, at the same time, allow the participation of the early schoolteacher in the ICPS activities; and (2) in the other group, the intervention will be delivered by trained internal preschool educators. Both intervention groups will receive the adapted ICPS programme, while the educational institutions in the control group will continue with their normal activities.This design will enable the comparison of several aspects of the implementation; for example: how frequently the ICPS programme can be delivered each week over the entire academic year, the fidelity of implementation, and the difficulties faced by external and internal facilitators in order to determine which option may be more practical and feasible for a larger randomised controlled trial  and subsidised (charter) schools of the province of Santiago. Informed consent forms  will be sent to the parents/guardians explaining the objectives of the research and giving them the option to enter and exit the study whenever they wish. The parents or guardians must provide their written consent in order to participate in the study. For those who agree to participate in the pilot intervention and are selected for the intervention groups, their child will receive the adapted ICPS intervention during their time at school during the aforementioned periods. In addition, all students, regardless of the group they are assigned to, will be evaluated using various instruments both before and after the intervention. This will be a direct evaluation by an evaluator member of the research team and through a report by their preschool educator. The parents and teachers will also be asked to evaluate certain behaviours and emotions of their children both before and after the intervention.Municipal or subsidised educational institutionsMixed educational institutionsEducational institutions with preschool education and one class per levelÍndice de Vulnerabilidad Escolar-Sistema Nacional de Asignacion con Equidad) ≥ 75%Educational institutions with a high vulnerability index as assessed by a School Vulnerability Index-National System of Equality Allocation (IVE-SINAE) , and all these images were included in keynotes presentations for the children to present to the whole class, in addition to the images on paper. Additionally, we have increased the number of activities where children could interact with the facilitator and with other children, especially using puppetsMany cultural aspects have been considered in the adaptation of the programme:The entire process was supervised directly by the research team of Dr. Myrna Shure, author of the programme. Regular meetings were held (every 2 weeks) throughout the initial adaptation process and during the pilot programmeA manualised intervention will be conducted using I Can Problem Solve by Dr. Myrna Shure. ICPS content includes vocabulary and concepts about emotions and emotion recognition, the development of social problem-solving skills, practising alternative solutions, consequences, and sequential thought (solutions-consequences) using interactive techniques , and guided discussion strategies used to solve problems. These activities are organised in 59 sessions of 20 min each delivered three times a week by trained early teachers over 5–6 months. The ICPS programme will be adapted from the English version, through the translation, editing, and adaptation of all of the components of the ICPS preschool programme. These activities will be carried out during the first 6 months of the study. Team members have an advanced command of English and have experience in the cultural adaptation of other programmes with similar characteristics. The following procedure was followed:The intervention is designed for two different groups, students and preschool educators/assistants.how to think, not what to think.Students will participate in the ICPS programme that has been adapted to the Chilean culture. This programme is a universal intervention designed to promote interpersonal cognitive processes and problem-solving skills in children from preschool through sixth grade. This project will adapt the preschool programme, which has a total of 59 sessions. Each session lasts approximately 20 min. The trained facilitator follows a simple manual that guides their work with the students on ICPS vocabulary and concepts and the development of problem-solving skills such as practising alternative solutions, consequences, and the sequential thought (solutions-consequences). Interactive techniques and guided discussion strategies are used to solve problems. The interactive techniques include games, role-playing, and the use of stories, illustrations, and puppets. These may also be used in other curricular activities for children, whether they are working on math, reading, or science. Children learn The educators/assistants from the selected schools and the facilitators who are part of the research team for the intervention will be trained in the programme during a 2-day session (8 h per day). This will be provided by coaches previously trained by Stephanie Roy, official coach of the ICPS programme. In addition, supervision will be conducted with a member of the research team twice a month in order to solve issues involving the programme’s content and implementation.The educational institutions assigned to the control group will continue to carry out their normal academic and prevention activities. Although one initial exclusion criterion was that the educational institutions not be implementing a manualised programme for the development of social-emotional skills at the time they agree to participate in this study, these schools will be able to continue with their normal activities. The normal academic and prevention activities follow the curriculum designed by the Chilean Ministry of Education, which is common to all state and subsidised schools in Chile. This curriculum for pre-kindergarten includes basic literacy and language learning  and prevention activities, such as healthy nutrition and hygiene habits, and social and emotional teaching . However, the social and emotional teaching is less structured, and it does not follow a clear and manualised programme such as ICPS.All of the participating students, teachers, and parents will be evaluated during the same period of time after inclusion in the study. For the schools in the three arms of the study, the following times will apply for the quantitative evaluations: pre-intervention (beginning of the school year) and post-intervention (end of the school year) for all of the classes participating in the study.Qualitative evaluations of the intervention will be performed through interviews, surveys, or group meetings (focus groups) in the middle and at the end of the programme’s implementation. During these same activities, the different measurements used in the pre-intervention and post-intervention periods will be used for evaluation.A brief instrument will be designed to collect data from children and parents regarding demographic variables (such as age and gender).The acceptability will be evaluated by establishing how this intervention programme is received by students, parents, teachers, and authorities of educational institutions and to what extent this intervention responds to the needs of this target population.Specifically, acceptability will be evaluated using a questionnaire that will be answered after each session by the facilitator. It will include questions regarding the fidelity of the implementation , and the participation of the children and the class climate during the sessions . Participation and class climate will be rated using a scale from 1 = low to 5 = high. All of the sessions will be filmed in their entirety to assess the fidelity of each intervention and children participation by an independent observer, using similar to the above questions. Having the same questions answered by facilitators and video observers will help to recognise the degree of a facilitator’s self-awareness of her performance, important skill to facilitate change and improvement over time and with the help of supervision. More than 50% of the recorded sessions, randomly selected, will be observed and analysed by trained evaluators using a pre-designed form where they will register and answered the following questions: (1) Were the activities performed as they were stated in the manual?; (2) Did the facilitators use and follow the scripts of the activities?; (3) Did the facilitators motivate students for participation according to the manual?; (4) Did the facilitators use the ICPS vocabulary during the sessions?; and (5) Did the facilitators pronounce the ICPS words with the emphasis and stress suggested by the manual? All the above questions will be rated using a scale from 1 = never to 5 = always. The recorded sessions will also be used to assess the process of building the relationship between the facilitator and the students: (1) Did the facilitator treat and show respect to the students; (2) Did the facilitator give space and time for the participation of all students ; and (3) Did the facilitators consider and view children as an active agents of their own learning? All the above questions will also be rated using a scale from 1 = never to 5 = always.The facilitators will have a supervision meeting with a member of the research team twice a month where they will answer a brief questionnaire regarding the acceptability of the intervention (e.g. ‘Was this session’s activity interesting/relevant?’ ‘Did you like the session?’ ‘What did you like the most?’ ‘What did you like the least?’), and opinions about potential changes to be included for the future . The answers to these questionnaires will be used continuously to improve the sessions if needed.There will also be a brief assisted survey for the students, a self-reported survey for the teachers who are not implementing the programme, and a self-reported survey for the parents asking about the acceptability of the programme.The feasibility and viability will be evaluated by measuring the achievement of the study’s objectives and by making a detailed assessment of whether it is possible to develop an effective study on a larger scale. The recruitment and the intervention process will also be evaluated. For this purpose, data will be collected on the number of schools that are eligible, those that are contacted, and those that agree to participate. Data will also be collected on the number of students, parents, and teachers contacted and those who consent and agree to participate. Data will also be collected on the number of sessions attended , the time needed to complete the questionnaires and student assessment tests, and the loss of participants during follow-up.Data will also be collected on the recruitment process for the facilitators and their participation in the training.The Minnesota Executive Function Scale (MEFS) , 48. ThiThe Assessment of Children’s Emotions Scale (ACES) . The ACEThe Challenging Situations Task (CST) . This inThe Strengths and Difficulties Questionnaire (SDQ)  is widelIn all cases, we will register the time and resources consumed for children and parents’ assessments in order to gain information for planning the future, larger randomised controlled trial.After the examiners have completed the assessments of children, and parents and teachers have sent back the questionnaires, the data will be entered by trained research assistants into a secure platform, without identifying information (each participant will be assigned an ID number). The original copies of the answer sheets and questionnaires will be filed and stored, under lock and key, in the Principal Investigator’s (PI’s) office, along with the list linking the participants’ names and ID numbers. Only two research assistants, in charge of data entry, and the statistician will have access to the database. All the recordings will be stored, under lock and key, in the PI’s office.All the data will be collected by trained research assistants and stored and organised by the project coordinator. All of the forms will be typed and then securely stored in a warehouse. All of the data will be handled confidentially and only the PI at the University de los Andes and the PI of the San Carlos de Maipo Foundation will have access.For the interviews, two researchers will independently code the information and identify the relevant topics. Any difference in the analyses by these two researchers will be discussed and resolved. If it is not possible to reach an agreement, a third researcher will participate in the discussions to reach a solution.For the analysis of the video recordings, two adherence evaluators will independently code the data and the prevailing topics in these will be identified from the evaluated videos. Any difference in the analyses by these two researchers will be discussed and resolved. If it is not possible to reach an agreement, a third researcher will participate in the discussions to reach a solution.The results of the satisfaction surveys will be used to improve the content and implementation of the interventions.The presentation of the results of this pilot study will be guided by the Consolidated Standards of Reporting Trials (CONSORT) for randomised controlled trials. Intention to treat will be used as the basis for the analysis of all of the participants in both groups. Initially, the sample will be described and the variables will be presented for the different follow-up events. To evaluate the changes produced by the intervention, analyses will be performed with regression models—simple for the continuous dependent variables and logistic for the dichotomous dependent variables. ‘Group’ will be used as the main independent variable. It will be controlled by the pre-intervention evaluations and the analyses will be adjusted by clustering given the hierarchical nature of the participants (students in a school). Exploratory analyses will be performed to evaluate the effect of different variables on the intervention results. Finally, sensitivity analyses will be performed to explore the effect of the data lost in the results. All analyses will be performed using complete data.The study will comply with local Research Governance requirements.This study is the first to assess the acceptability and feasibility of the I Can Problem Solve programme in a Spanish-speaking country in Latin America. The result of this pilot study should provide valuable information to plan and conduct a larger study in the future to test the effectiveness of the programme to reduce behavioural problems and psychological distress among preschoolers.Promoting social and emotional learning skills may produce immediate benefits for the children and their families, reducing behavioural problems, but we also expect long-term effects improving academic performance, mental health, the school climate, and a reduction of risk behaviours.There are some potential risks. It may be difficult to recruit schools to conduct the pilot, especially if we consider that we are introducing a new programme to be implemented along with the usual curriculum, and we may face some resistance. Additionally, the study design may be less appealing to schools because they may prefer implementing already scientifically effective interventions. However, given the fact that there are no available interventions similar to the one proposed herein, participation is anticipated. To minimise this risk, we will prepare the recruitment carefully and inform the schools in a timely manner utilising the substantial networks of the members of the Chilean team.Another potential difficulty may be keeping the facilitators motivated to deliver the intervention over the entire academic year. We have planned regular meetings where it will be possible to assess the adherence to the intervention and the workload.The recruitment began in October 2017 with the permission of the local educational authorities.Additional file 1:Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 Checklist: recommended items to address in a clinical trial protocol and related documents. (DOCX 61 kb)


The Winton Formation is increasingly recognised as an important source of information about the Cretaceous of Australia, and, more broadly, the palaeobiogeographic history of eastern Gondwana. With more precise dating and stratigraphic controls starting to provide temporal context to the geological and palaeontological understanding of this formation, it is timely to reassess the palaeoenvironment in which it was deposited. This new understanding helps to further differentiate the upper, most-studied portion of the formation (Cenomanian–Turonian) from the lower portions (Albian–Cenomanian), allowing a coherent picture of the ecosystem to emerge. Temperatures during the deposition of the Upper Cretaceous portion of the Winton Formation were warm, with high, seasonal rainfall, but not as extreme as the modern monsoon. The landscape was heterogeneous, a freshwater alluvial plain bestrode by low energy, meandering rivers, minor lakes and mires. Infrequent, scouring flood events were part of a multi-year cycle of drier and wetter years. The heavily vegetated flood plains supported abundant large herbivores. This was the final infilling of the great Eromanga Basin. The Winton Formation of central-western Queensland provides a detailed insight into the continental biota of eastern Gondwana during the middle part of the Cretaceous Period, with deposition spanning from the upper Albian to the upper Cenomanian–lower Turonian  portion of the Winton Formation, in which the bulk of the described fossil sites occur. A more refined model of the changing palaeoenvironmental conditions that existed during the time the Winton Formation was deposited will be of use not only for future research on the Winton Formation specifically but also for Cretaceous researchers more broadly. The refined models can also be used as a base from which future finds may be used to clarify, resolve or change our understanding of this increasingly important suite of ‘mid’ Cretaceous terrestrial localities, with the added advantage of considerably simplifying comparisons with other Cretaceous Gondwanan fossil assemblages.Multiple electronic searches were conducted from study conception to February 2018, with no language or period restrictions, in online databases including the ISI/Web of Science, Scopus and Google Scholar. Initial search terms included ‘Winton Formation’, as well as combinations of ‘Cretaceous’, ‘Queensland’, and ‘Australia’. The search included materials in peer-reviewed journal articles, geological reports, conference proceedings and academic books. Non-peer-reviewed sources such as unpublished theses, conference abstract volumes and popular articles were not included. We also searched the reference section of these publications, which aided discovery of older sources, particularly where the age and name of units has been reassigned since publication. Materials were included that were considered to inform the authors on the palaeoenvironment. Articles related to the Winton Formation, but on derived topics , were only included if they also contributed to the broader palaeoenvironmental reconstruction.The Winton Formation covers a large geographic area of western Queensland, northeast South Australia and northwest New South Wales  and has On the basis of detrital zircon chronology, stratigraphy, sedimentology, and architectural analysis, the Winton Formation is now informally divided into Upper and Lower Cretaceous parts . Fossil-It is clear from surface sediment localities in the greater Winton region that the Upper Cretaceous portion of the Winton Formation was derived from terrestrial and freshwater depositional environments . This isNeoceratodus forsteri Krefft, 1870, a living example from the family Neoceratodontidae to which the Cretaceous lungfish found in the Winton Formation belong, live in low-flow to still waters and require a low-flow regime in spring for egg laying on shallow-water plants . Compare this with the Upper Cretaceous portion of the Winton Formation, which is estimated to have received 630 ± 206 mm during the three wettest months and 268 ± 137 mm during the three driest months  similar to modern podocarps, including those that grow on low nutrient soils  de Laub., Prumnopitys taxifolia (Sol. ex D.Don) de Laub., and Podocarpus totara G.Benn. ex D.Don . By comparison, A potential cause of the low diversity is sampling intensity. Taphonomy also must be accounted for, which may bias preservation of parts of a palaeo-landscape over others, and can result in a low apparent diversity of the death assemblage. The Turonian Raritan Formation , for exaProtophyllocladoxylon owensii  portion of the Winton Formation ; Fig. 5 Wintonotitan wattsi is contra this pattern. In their study of sauropod environmental preferences As well as the climatic  and hydrological (see Hydrology) needs of the animals for which we have modern analogues, the environmental preferences of some of the groups that have no modern analogue  are also informative. Some nodosaurid ankylosaurs seem to have a broad range of ecological tolerances  and examThere does not seem to be a clear pattern of distribution of megaraptoran theropods, but that they are almost always found in association with other dinosaurs , from poQM L311 comprises the most well-preserved flora of the Upper Cretaceous portion of the Winton Formation, and although investigation of this flora has been pursued e.g., , undescrThe insect record is also very poor for the Winton Formation, likely due to the rapid destruction of specimens by weathering once exposed . The samUpper portions of the Winton Formation are the most likely to have been exposed to the extensive Cenozoic weathering that hampers understanding of the palaeoecology of this unit and surface exposures of the Winton Formation are very limited. Much of the detailed stratigraphic work to date, identifying Upper and Lower Cretaceous portions of the unit, has been conducted on data core logs or surface concretions. Many of the fossil-bearing localities, particularly those around Winton, do not have site-specific sedimentological and stratigraphic data associated with them, so broad scale stratigraphic correlations that include these sites are tentative and limited to a few key sites . This problem is exacerbated by extensive vertical faulting throughout the area. Continued investigation of the stratigraphy, sedimentology, and geomorphology of the region, along with the application of absolute dating methods to fossil-bearing localities within the Winton exposures, are key steps to guide future prospecting and to inform interpretation of the palaeoecology and palaeoenvironement of this important Australian Cretaceous formation.2 as high as 1000 ppm (When all of the current evidence—sedimentological, taphonomic, floristic, vertebrate, and invertebrate—is combined, a coherent yet complex image of the climate and environment of the Upper Cretaceous portion of the Winton Formation is apparent. The temperatures were warm, mesothermal, and probably similar to those of the sub-tropics today despite the palaeolatitude of ∼50° S. This was in keeping with globally high temperatures that supported forest in the southern polar regions during the Cretaceous  at atmos1000 ppm . Precipi1000 ppm . This reThe landscape that is preserved at the many sites where the Upper Cretaceous portion of the Winton Formation is exposed may be broadly continuous both temporally and stratigraphically, but in terms of their floral communities, they are heterogeneous. In some parts of the palaeolandscape, low diversity appears to be linked to a disturbance regime that may have comprised primarily flooding events. These flooding events were likely infrequent and possibly scouring in places when they occurred, leading to the establishment of long-lived podocarp stands that excluded other plants early in their establishment on the barren sediment. Other parts of the landscape were either less affected by flood events, or were affected at different times, such that their floral community was comprised of a different combination and abundance. These communities appear to have been more diverse, although not as diverse as would be expected of a forest climax community, and not as high or as diverse as at the other Late Cretaceous mid-latitude fossil floras to which it has been compared.Comparing the range of communities recorded within the Upper Cretaceous portion of the Winton Formation to the other well-studied Australian Cretaceous plant localities, the older Albian Otway Basin flora, the Winton communities and their sediments are not as distinct as the six biofacies recorded in the Otway Basin . WhereasThe disturbance events suggested to have shaped this palaeoenvironment may be linked to the influence of a ‘Pacific Decadal Oscillation’-like cycle affecting Queensland during the Late Cretaceous. This may have influenced both precipitation and temperature covariantly, as in modern climate systems. It is likely that precipitation varied between years, possibly on an oscillation of relative drought years and years of higher precipitation similar to the Pacific Decadal Oscillation. Thus, during the earliest part of the Late Cretaceous, when the rocks that now form the Upper Cretaceous portion of the Winton Formation were deposited, this part of eastern Gondwana was a dynamic and heterogeneous environment.


On an absolute basis, Argentina is the country with the largest affected population with Chagas Disease (ChD). This constitutes a significant public health issue. As a consequence of Argentina’s migratory patterns, there has been a significant increase of affected population in urban centers. An innovative project for early diagnosis and timely treatment of ChD was designed for Municipal Primary Care Facilities of La Plata City, a non- endemic area, in line with a proposal from the Pan-American Health Organization. The project was a public –private intervention. The objectives of this study were to demonstrate the feasibility of the primary healthcare level for early diagnosis and timely treatment of ChD; to design and implement a tailor made program and to innovate in a public-private association.The healthcare barriers for early diagnosis and timely treatment for the population with ChD of La Plata were analyzed. The four dimensions described by Peters et al.  were used. The baseline was measured during a previous pilot project and the same items were evaluated at the end of 2017. The model from Damschroder et al.  was used during the implementation process.With all the information gathered during this investigation, a “patient-centered” model was designed. During the program, 17,894 people were serologically tested for ChD, 1,394 were positive and 1,035 were treated. Additionally, 3,750 children from 46 public schools were evaluated for risk factors of ChD.This project showed the feasibility of the primary healthcare level for early diagnosis and timely treatment of ChD. Tailor made programs and public-private associations should be considered for vulnerable populations in emerging economies in order to enhance efforts and obtain better results. This program may be replicated in other countries of Latin America were Chagas is a main public health issue and, with the corresponding adaptations, for other neglected diseases as well.The online version of this article (10.1186/s12889-019-7248-5) contains supplementary material, which is available to authorized users. On an absolute basis, Argentina is the country with the largest affected population with Chagas Disease (ChD) . This coNeither vector surveillance and control policies, nor developmental programs have been successful enough in achieving their respective goals in Argentina. Public health policies have been highly erratic in nature, therefore vector surveillance and control strategies were not always consistently implemented to be effective. A study by experts in the field claims that “between 1962 and 1990, 100% coverage was achieved with insecticides, while only 20% of the epidemiological surveillance activities were consistently conducted. The National Chagas Program started with 2000 technicians in 1964, but subsequently dropped to roughly 600 technicians in 1990. The annual household treatment rate dropped from 216,000 in 1978 to just 37,000 in 1985, before recovering to nearly 200,000 in 1993” [ChD has historically been associated with rural populations. However, as a consequence of migratory patterns in place in Argentina since the 1940s , there has been a significant increase of affected population in urban centers. On the other hand, Argentina also received a large migration from bordering endemic countries such as Bolivia and Paraguay. Currently, the city of Buenos Aires (with no vector) is the city with the largest infected population .For decades, ChD has been associated with rural areas and this is one of the reasons why early diagnosis was not usually performed in big city hospitals. , 12. PooThe Argentine healthcare system is complex, overlapped, and highly fragmented . ArgentiFrom 1940 onwards and driven in the 80’s by the Alma Ata Declaration, primary care units grew throughout the country. By 2002, nearly 10,000 such centers were distributed across the 24 Argentinean provinces. Although having a diverse structure in terms of technical and human resources, they constituted an important healthcare provider for patients affected with chronic diseases or minor and frequent acute illnesses.During 2010, the Pan American Health Organization (PAHO) requested (CD50/16 y CD50.R17) that its constituent nations provide medical access to the ChD affected population through Primary Healthcare Centers. Concurrently, Mundo Sano Foundation (MS), a non-governmental organization focused on the prevention of Neglected Tropical Diseases (NTD), began promoting early diagnosis and timely treatment through Municipal Primary Care Facilities (MPCF) in La Plata City, capital of the Province of Buenos Aires, a non-endemic area. One of the main goals of the project was to reduce or eliminate the healthcare barriers for diagnosis and treatment of ChD and to demonstrate the feasibility of primary care as an adequate level for this purpose. A pilot project was implemented in 2010 [This article describes the analysis of the healthcare barriers for early diagnosis and timely treatment of ChD in the MPCFs of La Plata. It also explores the implementation process of the city wide roll out to 46 MPCFs after the pilot project ended. Both aspects permitted the consolidation of a public policy providing ChD diagnosis and treatment to thousands of people with high quality medical care.The importance of this study lies in being the first tailor made program for the primary healthcare level implemented by a public-private association in order to favor the access to medical care for people with Chagas Disease.A Framework Convention between MS and the Municipality of La Plata (MLP) was signed during 2010. Initially, a pilot project was designed and implemented in three MPCFs and three rural schools during 2011–2013 . The thrThe pilot project’s results Table  encouragFor the implementation process, the CFIR model from Damschroder LJ et al.  was usedBased on the analysis performed above, a patient centered model was designed for diagnosis and treatment with the premise “the healthcare needs to move, but not the patient”. The municipality made two vehicles available for this purpose, and two technicians for obtaining blood samples. MS trained and paid for two electrocardiograph technicians. For better planning, MS purchased two ECGs with telemedicine and PDF format studies that could be sent by e-mail to local networks. Additionally, MS hired a cardiologist to evaluate and report all the ECGs carried out across the 46 MPCFs. ECG results were printed and carried to each MPCF so patients could receive them in a timely fashion.Patients were evaluated on a weekly basis during the first month of treatment and on a bi-weekly basis during the second month of treatment. The purpose of the high frequency with which patients were evaluated during the first 2 months of treatment was to ensure that the medication was administered correctly and to minimize the occurrence of adverse reactions. Social workers conducted home visits to patients who failed to attend check-ups in order to confirm that treatment was being adequately carried out. Those excluded from the antitrypanosomal drugs treatment were either pregnant, over 50 years old or had other sever pathologies .MS recruited physicians working for the La Plata Municipality by paying them an extra incentive for performing extraordinary tasks such as oversight of the new organizational model and supervision of the diagnosis and therapeutic process. All the human resources working in the MPCFs were permanent and hired by La Plata Municipality. Finally, the design included a MS senior physician to assist health teams, if necessary and to solve any problem or doubt. A 24-h communication line was available for the entire network of MPCFs.As in the pilot study, schoolchildren were also included and the municipality rolled out the program to all the public schools of La Plata. Therefore, all children were given the ChD survey and those that presented risk factors were tested for infection in the MPCFs. Those that tested positive were treated. Ultimately, a subset of patients that were also serological evaluated consisted of those children with risk factors, women who attended primary healthcare centers to conduct routine checkups for ongoing pregnancies, relative from patients who had previously tested positive for ChD, and patients who suffered from diverse clinical problems while presenting epidemiological risks .The population from the pilot project had a high prevalence of ChD. This is probably because they were migrants from high endemic areas. All patients were treated since they fulfilled requirements of the National ChD guidelines and there were no drop-outs.During the extended project 2014–2015) the number of people tested and treated increased. In 2016, and coinciding with elections and the local authority’s rotation, treatment rates fell but then increased during 2017  in order to assure the sustainability of the project once MS was no longer involved. For structural problems out of the scope of the program, reports were generated and recommendations were made to local authorities.With all the information gathered during this investigation, a “patient-centered” model was designed. All the services needed for basic diagnosis and treatment were done in the MPCFs. As a result of the implementation of the extended program, 17,894 patients were serological evaluated for ChD diagnosis, 1,394 were positive and were 1,035 treated with antitrypanosomal drugs. The specific survey to detect risk factors for ChD was performed in 3,750 children from 46 public schools, a total of 280 children were tested at the MPCFs.The financing source of the MPCFs was mainly from the municipal budget . MS bought two electrocardiograms with telemedicine and paid extra salaries to four local physicians to coordinate specific actions: gather information about the number of people diagnosed and treated as well as basic data through the monitoring process. Initially, a cardiologist was hired by MS to read and analyze the electrocardiograms.In Argentina, there are very few experiences in public – private associations and in implementation analysis. Given the lack of a referential framework, an extensive evaluation of implementation matrices was done Table .Table 3IThrough this assessment, an important finding was an initial perception of all the members interviewed that some changes in the way of providing health services were needed. Nonetheless, all agreed that those changes were extremely difficult to achieve and there was no competitive peer pressure to enforce them. Another important finding was the lack of important barriers for the implementation and development of the project.People with low income typically have diminished access to health care providers. When health care is needed and it is not available, people’s health worsens contributing to a further reduction in income and higher health related out-of-pocket payments, both of which negatively impact poverty . This isAs mentioned above, Argentina has free of charge public health governmental suppliers distributed all across the country with uneven levels of capacity, complexity and quality. While access to healthcare in Argentina is free of charge in public facilities, quality and availability of equipment as well as qualified human resources may represent challenges to PHGMs . This coA so called “patient centered model” resulted in a practical, low cost and easy way to minimize or reduce the healthcare barriers found during the survey. Nearly all the patients that were serologically evaluated knew about the disease and most had a family member or acquaintance with ChD. This level of awareness displayed by the patient pool improved the ability to execute the program and the willingness of the people to be evaluated. Many of these potential patients had already made medical consultations regarding ChD, most of which had gone unanswered by the medical staff. The program achieved a high rate of adhesion to the treatment, with very few drop-outs. The high retention rate is attributable to the fact that patients were evaluated with a high frequency strategy and there were social workers in charge of home visits if necessary.In 2014, MS’ venture with the La Plata City was the only project focused on granting ChD patients access to ambulatory care facilities with high quality standards: providing safe, effective, timely, efficient and equitable treatment, with a unique people-centered model.The main conclusions that derive from the analysis of access barriers for this project are that there are two critical aspects to focus on during implementation:1) strengthening resources of the primary healthcare centers, and 2) creating a patient centered clinical management. Although in Argentina patients typically switch from one provider to another in order to complete the entire diagnostic and therapeutic process, providers that are usually distant from each other, this traditional pattern was considered highly inconvenient for this project. The pilot project evidenced that continuing with a model of rotation of health centers for diagnosis and treatment could entail that, at least, 30% of patients would never have an ECG, which is fundamental for ChD diagnosis and treatment. Previous to implementation of the program, many ECGs were not performed because since there were no electrocardiographs available at the MPCFs, patients needed to go to the PHGMs to have an ECG done. This implicated extra days of absence from the workplace and therefor many patients did not get an ECG.In terms of the implementation aspects, trust building became a key issue. A senior physician from MS was fully dedicated to the project and available on the phone for medical queries from MPCFs staff 24 h during business days. Although help was not often needed, high level of availability offered by MS’s staff was well received by MPCFs staff and helped to consolidate confidence between both entities.As a response to limited and inflexible municipal budgets, MS decided to donate two electrocardiographs to La Plata Municipality and to invest in human resource training. MS considered these two actions as key to succeed in the implementation startup. All the financial investments made by MS along the implementation, mostly in human resources, were small and could be easily absorbed by municipal budgets, if necessary, to assure the project sustainability. MS identified a series of structural problems during the data analysis period, but the necessary actions to solve these problems were initially defined as out of scope. For example, lack of investment in infrastructure, problems in the hiring of human resources, etc., that did not interfere in the implementation of the project.Before the final project was designed, the main difficulties were associated to the limited existence of evidence supporting the desired outcomes of the project which did not give the stakeholders a clear vision of implementation advantages. There was an additional challenge: key stakeholders perceived the intervention source as externally developed and health teams perceived that the municipality was a difficult organization to be changed. Low salaries and lack of incentives plus bad infrastructure in the MPCFs were also key issues.When the pilot project began, the advantages of this new intervention became visible and the first results of the pilot project encourage both authorities and health teams, to scale the project.After the implementation phase was launched, positive results were self-evident and sufficient to guarantee the initiative’s sustainability. By the end of 2014, the project became a Municipal Program in line with others like vaccination campaigns.In 2015, 2 years after the implementation, MS was ready to leave the project in the hands of the municipality. However, in light of upcoming presidential elections and potential change in the local authority, MS decided to remain actively involved in the project. The rotation of local authorities was seen as a challenge to implementation continuity, both from a political willingness perspective as well as availability of resources and proper understanding of the program scope.Although during the first year of rotation of local authorities the number of treated patients fell, the program was not interrupted and during the second year, the program showed an increase in treatment rates.By the end of 2017, after the new administration took office and the program continuity was guaranteed, MS began to decline its participation in the project. Although MS’s participation is not necessary to assure the program continuity, local authorities invited MS to keep participating in the ChD program. Nowadays, MS’s activity is to supervise the general management of the program: new patients enrolled in the program, number of diagnostic procedure, number of treatments performed and act as an external consultant for complex clinical cases.Retrospectively, the ChD program of La Plata was very successful since 17,894 people were tested, 1,394 were diagnosed and medically evaluated, 1,035 were treated for ChD and 3,750 children from public schools were evaluated for risk factors. Pillars of success were the deep knowledge of access barriers, a comprehensive approach considering strengths and weaknesses of the local healthcare system, and being able to design a reasonably tailored made project. Trust building among stakeholders and the implementing task force was another key success factor. Finally, the limitations of this study are the absence of specific studies to explore user’s attitudes and expectations, such as satisfaction with the health service, and how the program was in line with the prevailing cultural norms of the community.This is the first study that shows the feasibility of the primary care level to give high quality early diagnosis and timely treatment to a population with ChD in Argentina. Although further studies should be done to gather more evidence, the results from this study can encourage policy makers to give medical assistance to people in early stages of ChD without other severe illnesses in the first health care level. This can help to reduce the burden of this disease and to reduce congenital transmission.Tailor made programs and public-private associations should be considered for vulnerable populations in emerging economies in order to enhance efforts and obtain better results. Public-private associations may constitute a challenge in low and middle –income countries due to the limited experience in health care systems with this type of associations, the lack of regulations and a complex government structure. Although these types of associations may have been applied in healthcare settings before, references on these experiences are not easily available in the literature. This program may be replicated in other countries of Latin America were Chagas is a main public health issue and, with the corresponding adaptations, for other neglected diseases as well. Some necessary conditions for successful implementation lie in the comprehensive analysis of access barriers and the implementation context. The results of this comprehensive analysis would be crucial for the development of a suitable project based on the local needs and the acceptability from the health teams and local authorities involved.Additional file 1:Short survey used for children attending public schools. (PDF 192 kb)