Scaling up effective interventions, policies and programmes can improve breastfeeding (BF) outcomes. Furthermore, considerable interest exists in learning from relatively recent successful efforts ...that can inform further scaling up, with appropriate adaptations, across countries. The purpose of this four‐country case studies analysis was to examine why and how improvements in BF practices occurred across four contrasting countries; Burkina Faso, the Philippines, Mexico and the United States of America. Literature reviews and key informant interviews were conducted to document BF trends over time, in addition to why and how BF protection, promotion and support policies and programmes were implemented at a national level. A qualitative thematic analysis was conducted. The ‘Breastfeeding Gear Model’ and RE‐AIM (Reach; Effectiveness; Adoption; Implementation; and Maintenance) frameworks were used to understand and map the factors facilitating or hindering the scale up of the national programmes and corresponding improvements in BF practices. Each of the studied countries had different processes and timing to implement and scale up programmes to promote, protect and support breastfeeding. However, in all four countries, evidence‐based advocacy, multisectoral political will, financing, research and evaluation, and coordination were key to fostering an enabling environment for BF. Furthermore, in all countries, lack of adequate maternity protection and the aggressive marketing of the breast‐milk substitutes industry remains a strong source of negative feedback loops that are undermining investments in BF programmes. Country‐specific best practices included innovative legislative measures (Philippines), monitoring and evaluation systems (United States of America), engagement of civil society (Mexico) and behavior change communication BF promotion (Burkina Faso) initiatives. There is an urgent need to improve maternity protection and to strongly enforce the WHO Code of Marketing of Breast‐Milk Substitutes.
The purpose of these four‐country comparative case studies was to examine why and how improvements in breastfeeding (BF) practices occurred across four contrasting countries: Burkina Faso, the Philippines, Mexico and the United States of America. Advocacy, political will, evaluation, multisectoral coordination, monitoring and funding are key to the successful scaling up and impact of national BF programmes. There is an urgent need to improve maternity protection and regulation of the marketing of breast‐milk substitutes.
Key messages
The effective scale up of national breastfeeding (BF) policies and programs has been identified as a global health priority.
There is a need to systematically conduct and compare case studies to understand drivers for the successful dissemination and scale up of national breastfeeding policies and programmes.
Implementation science frameworks were key to systematically identify key drivers for the scale up of BF protection, promotion, and support policies and programmes in Burkina Faso, Mexico, the Philippines and the United States.
Advocacy, multisectoral political will, financing, monitoring and evaluation, and coordination were key for enabling the BF environments.
In all countries, there was a strong need to improve maternity protection and to tighten regulation and enforcement of the WHO Code of Marketing of Breast‐Milk Substitutes.
An ethos of violence based on political ideologies aiming to delegitimize an adversary is a psychosocial barrier to solving lasting conflicts, such as in Colombia. Beyond the signing of a peace ...agreement, the cessation of political violence implies modifying the complex symbolic dynamics constructed by various opposing actors to legitimize acts of direct violence. This research evaluates whether a new rhetoric that encourages the development of a peace culture has replaced the ideological rhetoric of various social actors involved in dialog and negotiations to end the armed conflict between the Colombian government and the Revolutionary Armed Forces of Colombia - People's Army (FARC-EP). To this end, a textual analysis of the ideological rhetoric disseminated through Twitter® by several actors in Colombian society was conducted to identify the expressions used (semantic analysis) to legitimize or delegitimize those involved in the conflict in the last negotiation year (2016). The outcome indicates that the agenda of topics revolves around peace, and although the ideological differences between the negotiation table (i.e., the government and FARC-EP) and the opposition party are evident in the published messages, all the actors are striving to develop a rhetoric of tolerance and coexistence.
La reexperimentación emocional (re) permite dar sentido a hechos traumáticos o estresantes mediante un proceso dirigido por instrucciones verbales o escritas, y por ello puede generar beneficios en ...el bienestar psicológico y la salud física autoinformada. El objetivo del presente estudio fue evaluar la comprensión de tres tipos de instrucciones experimentales (re tradicional, re con claves de aceptación y compromiso, y re psicosocial) y una instrucción para el grupo control (re trivial), mediante técnicas de validación cognitiva (pruebas centradas en el significado y verbalización de pensamiento) en personas expuestas a hechos de violencia política en Colombia. Para ello, se desarrolló un estudio de tipo cualitativo con corte instrumental, en el que se entrevistó a 42 colombianos víctimas de violencia política, en su mayoría mujeres, elegidos con un muestro por conveniencia. Las entrevistas fueron transcritas y codificadas mediante un análisis categorial mixto que tomó como referente procedimientos del Movimiento de Aspectos Cognitivos de la Metodología de Encuestas. Como resultado, los participantes comprendieron de manera diferencial las instrucciones dadas en cada protocolo, enfocándose en aspectos como el contexto sociopolítico en el caso del protocolo psicosocial, y en respuestas asociadas a la aceptación en el protocolo con claves de aceptación y compromiso. Se identificaron dificultades en la comprensión de algunas secciones de los protocolos, las cuales fueron ajustadas. Finalmente, se enfatiza la importancia de implementar técnicas de validación cognitiva para verificar la comprensión de instrucciones, protocolos o instrumentos, dado que el desempeño de los participantes y la calidad de las medidas de las intervenciones pueden verse afectados por la comprensión e interpretación de las instrucciones propuestas.
Se evaluó psicométricamente la Lista de Verificación de la conducta infantil de Achenbach y Edelbrock en un grupo de 100 preescolares entre 4.0 y 5.5 años de un colegio público de Suba en Bogotá, ...mediante la aplicación de los formatos de padres y maestros, previa traducción, adaptación lingüística y pilotaje. El coeficiente Alfa de Cronbach para la escala global fue de 0,94 para padres y para maestros 0,95. El análisis de factores por componentes principales saturó la varianza en el 87%, aunque no correspondió con los factores propuestos por el modelo original. Este instrumento proporciona información diagnóstica sobre la estructura comportamental de los niños desde una visión multiaxial e identificaperfiles de las dimensiones internalizantes y externalizantes de la conducta
Los efectos beneficiosos sobre la salud de la reexperimentación emocional mediante la utilización de la escritura expresiva de vivencias traumáticas están bien establecidos. La efectividad de la ...utilización de la reexperimentación parece verse afectada por ciertas condiciones. Entre las variables personales que han mostrado tener influencia sobre la recuperación de tales vivencias se ha destacado el optimismo y la alexitimia. El objetivo del presente trabajo fue evaluar los efectos de una intervención basada en la reexperimentación emocional sobre la salud mental. Se aplicó un diseño experimental intergrupo pre y posttratamiento. La muestra estuvo compuesta por un total de 60 participantes, de los que 40 llevaron a cabo un procedimiento de reexperimentación emocional mediante tres sesiones de escritura expresiva. El resto formaron el grupo control y escribieron sobre situaciones triviales. Todos fueron evaluados antes y después de la reexperimentación emocional en afecto positivo y negativo, ansiedad, depresión, pensamientos intrusivos y evitación cognitiva. Además, se controló el nivel de optimismo y la alexitimia. Los resultados mostraron la eficacia de la escritura expresiva sobre el afecto positivo y negativo y el nivel de depresión. Entre las covariables, únicamente el optimismo produjo un efecto significativo sobre las variables más emocionales. Se discuten las condiciones contextuales y personales que pueden favorecer el uso clínico de la reexperimentación emocional.
The Achenbach and Edelbrock Child Behavior Checklist was assessed psychometrically in a group of 100 preschool students between 4,0 and 5,5 years old who attend a public school at Bogota city. It was ...done by applying formats to parents and teachers. These formats were previously translated, linguistically adapted and piloted. The Cronbach’s Alpha for the total scale was 0,94 -0,94 for parents and 0,95 for teachers-. The analysis of factors by main components saturated the variance in 87%, although it did not correspond to the factors proposed by the original model. This measure gives diagnostic information about the children’s behavioral structure from a multiaxial perspective. Moreover, it identifies profiles of the internalizing and externalizing dimensions of behavior.
Aim
To determine the effectiveness of a case management model for approaching multi‐pathological people in a health promoting entity of the contributory healthcare scheme in Bogotá, Colombia between ...2018 ‐
.
Design
Mixed methods research.
Method
The study contemplates two components: a quantitative component using a quasi‐experimental analytical design before and after longitudinal intervention to determine the effectiveness of the case management model and a qualitative descriptive design to understand the experience of the participants about the model.
The Administrative Department of Science, Technology and Innovation of Colombia (Colciencias) funded this project by means of call 777—November 2017, under the financing agreement No. 848—December 2017.
Discussion
Addressing problems deriving from the structure of the Colombian healthcare system is crucial for implementing case management models. Furthermore, the effectiveness of such models may be affected by power relations and market failures, but the proved potential of a model may represent a generalized benefit for the Colombian health system.
Impact
In Colombia, considering complications and management of chronic non‐communicable diseases as isolated cases is considered as the highest cost events in healthcare provision, since an average of 12.8 million pesos is invested in each patient. This has led to rethink the management in these patients by means of a comprehensive model that guarantees the effectiveness of healthcare delivery, in the framework of a healthcare system heavily affected by payment capacity, where the market has a strong predominance, such as the case of Colombia.
Trial registration number: RPCEC00000293
目的
为确定2018‐2019年期间在哥伦比亚波哥大的贡献型医疗保健计划的健康改善实体中,病例管理模式对临近患有多种疾病的患者的有效性。
设计
用混合方法进行研究。
方法
本研究考虑了两个方面:定量方面,在纵向干预前后使用准实验性分析设计来确定案例管理模式的有效性;另一方面,运用定性描述性设计来理解参与者对该模式的体验。哥伦比亚科技和创新行政部(Colciencias)根据2017年12月的第848号融资协议,在2017年11月通过电话呼叫777资助了该项目。
讨论
解决哥伦比亚医疗系统结构产生的问题对于实施病例管理模式而言至关重要。此外,虽然这种模式的有效性可能会受到权力关系和市场失灵的影响,但是其已证明的潜力可以代表哥伦比亚卫生系统的一种普遍利益。
影响
在哥伦比亚,将慢性非传染性疾病的并发症和管理看做孤立病例被是医疗保健条例中的最高成本事件,因为每个患者平均会被投资1280万比索。因此,需要重新考虑的是,在支付能力影响力巨大并且市场具有强大优势医疗体系框架内,通过一个保证医疗服务有效性的全面模式来管理这些患者,例如哥伦比亚的案例。
试验注册号
RPCEC00000293
Aims
The aim was to determine the impact of a case management model on indicators of health service utilization, polypharmacy, quality of life and dependency of patients with multimorbidity, and ...family caregiver overload in a group of patients insured with two insurance companies in the city of Bogotá (Colombia).
Design
This was a mixed methods study, which integrated a quantitative and qualitative component.
Methods
The study was conducted between July 2019 and March 2020. A quantitative component is based on a pre‐experimental study with a single group and pre‐ and post‐test measurements. Patients with multimorbidity with a medium or high level of complexity were included in the study. A sample of 317 patients and their caregivers was estimated. Following the completion of the intervention, a descriptive study that explored the perspective of nurses, patients and caregivers was developed to better understand the process and results from their own words and experience. A total of 17 dyads of patients and caregivers were interviewed, as well as six nurse managers. The integration strategy was developed based on a comparison made from the perspective of multiple stakeholders.
Results
The model's impact on quality of life, particularly in terms of social functioning and mental health, has been documented. Caregiver overload was reduced and an improvement in the adoption of the role was observed, aspects that converge with the experience of the dyads and the caregivers in the support and backing provided by the model.
Conclusion
The intervention was structured in five modules: case detection, complexity screening, comprehensive assessment with various instruments, individualized care and follow‐up plan, and plan assessment. The nurse manager role is confirmed as that of a professional with the leadership capacity to articulate disciplines and actors, whilst also dealing with the day‐to‐day needs of people with complex health conditions.
Impact
A comprehensive and integrated approach to patients with multiple diseases in a health insurance context marked by access barriers and fragmentation of health services. The study provides quantitative and qualitative evidence of the benefits of the case management model in Colombia for patients with multiple diseases and their family caregivers, particularly in terms of the psychosocial dimensions of health‐related quality of life and dependence assessment. A significant impact on the caregiver role, as well as an improvement in perception and trust in the health system, was observed as a result of the overcoming of administrative barriers achieved by the nurse case manager. The findings are considered to be extremely useful for decision‐makers and insurers in developing a case management model focused on comprehensive and individualized care plans, as well as for individuals with multiple diseases and their caregivers.
Introduction: People with multimorbidity and their caregivers are beginning to be recognized as emerging subjects of health systems. In Colombia there is no differentiated approach to care for this ...population, as well as its health-disease process. Objective: To understand the experience of people with multimorbidity and their caregivers after receiving a case management intervention. Methods and materials: It is a qualitative study in which 33 participants among people with multimorbidity and their caregivers who received intervention with case managers were interviewed, a comparative analysis and use to tools analytics grounded theory. Results: There are 3 dimensions that are, the actors where nursing becomes relevant as a reliable source of care; the Care Meeting, as a space created within case management to maintain trust and; Results in the health system, where the need to integrate this type of outbreak into the Colombian Health Model is confirmed. Discussion: Complementary qualitative evidence data from the central study with a greater impact on the quality of care through the therapeutic relationship at home. Conclusion: The dyad requires home support for self-management of the disease based on trust, empathy, empowerment and administrative management carried out by case managers.
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