RESUMEN
Information on the effects of government nutrition programmes provided to socially vulnerable children to improve their nutritional status is scarce. We analysed the effectiveness of a nutritional programme, including food supplementation with infant formula, on the evolution of the weight and height of socially vulnerable children from Manaus in the Brazilian Amazon. This study included 7752 children aged 12-24 months admitted to the programme between 2017 and 2020. Weight and height measurements at admission and every three months thereafter were extracted from the programme database. Weight-for-age, weight-for-height, body mass index-for-age (BMI/A), and height-for-age z-scores were analysed using a multilevel linear regression model, which showed a statistically significant decrease in nutritional deficits toward nutritional recovery at follow-up. The programme's effectiveness was evaluated in 1617 children using a paired analysis comparing data from between 12 and 15 months of age at admission and follow-up after 6-9 months. Children admitted with wasting presented an increase in the BMI/A z-score, whereas children admitted with a risk of being overweight and obese had a statistically significant decrease in the BMI/A z-score. Children admitted with stunted growth also showed increased height-for-age z-scores. The nutrition programme was effective for children experiencing wasting and reducing excess weight.
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Fórmulas Infantiles , Estado Nutricional , Niño , Lactante , Humanos , Brasil , Índice de Masa Corporal , Caquexia , Suplementos DietéticosRESUMEN
AIMS: To describe an implementation programme for an evidence-based practice (EBP) model in a new Chilean hospital and to analyse the programme evaluation results. BACKGROUND: Evidence-based practice is key to professional nursing for improving health care safety and quality. METHODS: First, a literature review was performed to develop an institutional EBP model. Second, internal and external analyses contributed to assessing facilitators for and barriers to implementation. Third, a multi-stage implementation plan was conducted. Fourth, process and outcome indicators were evaluated. RESULTS: The model considered the basic elements of EBP and outlined different decision-making levels in clinical practice. Several facilitators for implementation were identified. Each implementation stage included activities addressing EBP knowledge, attitude and skills. Outcome indicators showed significant improvement regarding knowledge (p = .038). Providers with formal EBP training, compared with providers without training, showed a significant difference of 8.6% (0.6 points) in the average CPBE-19 score in knowledge, attitude and application in the last evaluation (p < .01). CONCLUSION: Having an EBP programme with ongoing implementation strategies improves knowledge over time, and formal training enhances positive results. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers can build an institutional research culture to improve the quality of care using an EBP programme that fits organisational needs.
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Actitud del Personal de Salud , Práctica Clínica Basada en la Evidencia , Chile , Enfermería Basada en la Evidencia , Conocimientos, Actitudes y Práctica en Salud , Hospitales , Encuestas y CuestionariosRESUMEN
BACKGROUND: Despite great progress made in methods to prevent mother-to-child transmission of HIV (MTCT), delivery and uptake of these measures remains a challenge in many countries. Although the Brazilian Ministry of Health aimed to eliminate MTCT by 2015, infection still occured in 15-24% of infants born to HIV-infected mothers. We sought to identify remaining factors that constrain MTCT elimination. METHODS: We conducted a retrospective, matched case-control study by reviewing hospital charts of infants born to HIV-infected mothers between 1997 and 2014 at three MTCT reference hospitals in the Rio de Janeiro metropolitan area. Cases were defined as HIV-exposed children with two positive HIV tests before 18 months of age; controls were defined as HIV-exposed children with two negative HIV tests before 18 months of age. We performed bivariate and MTCT cascade analyses to identify risk factors for MTCT and gaps in prevention services. RESULTS: We included 435 infants and their mothers (145 cases, 290 controls). Bivariate analyses of MTCT preventative care (PMTCT) indicated that cases were less likely to complete all individual measures in the antenatal, delivery, and postnatal period (p < 0.05). Assessing completion of the PMTCT cascade, the sequential steps of PMTCT interventions, we found inadequate retention in care among both cases and controls, and cases were significantly less likely than controls to continue receiving care throughout the cascade (p < 0.05). Motives for incompletion of PMTCT measures included infrastructural issues, such as HIV test results not being returned, but were most often due to lack of care-seeking. Over the course of the study period, PMTCT completion improved, although it remained below the 95% target for antenatal care, HIV testing, and antenatal ART set by the WHO. Adding concern, evaluation of co-infections indicated that case infants were also more likely to have congenital syphilis (OR: 4.29; 95% CI: 1.66 to 11.11). CONCLUSIONS: While PMTCT coverage has improved over the years, completion of services remains insufficient. Along with interventions to promote care-seeking behaviour, increased infrastructural support for PMTCT services is needed to meet the HIV MTCT elimination goal in Brazil as well as address rising national rates of congenital syphilis.
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Infecciones por VIH/transmisión , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Complicaciones Infecciosas del Embarazo , Servicios Preventivos de Salud/organización & administración , Brasil/epidemiología , Estudios de Casos y Controles , Femenino , Infecciones por VIH/epidemiología , Humanos , Lactante , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Embarazo , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: Chile Crece Contigo (ChCC) is defined as a comprehensive, intersectoral, and multicomponent policy that aims to help all children reach their full potential for development, regardless of their socio-economic status. METHODS: This case study was developed on the basis of grey literature review and key informants' interviews. RESULTS: ChCC behaves as a complex adaptive system that combines universal and targeted benefits for the more vulnerable starting since gestation and until the children are 4 years old. Three key ministries are involved in ChCC management: health, education, and social development. Studies show adequate programme implementation and positive effects of ChCC on child development. In addition, it was found that the more families use ChCC benefits and the longer the subsystem has been operating in the commune, the greater the positive effects. CONCLUSIONS: Strong political support based on principles of equity and child rights combined with strong evidence and funding commitment from government has been central to emergence, scaling up, and sustainability of ChCC. Further sustainability of ChCC will rely on firmly establishing a well-trained and compensated cadre of early child development professionals and paraprofessionals as well as an improved management and evaluation decentralized system.
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Prestación Integrada de Atención de Salud/organización & administración , Educación en Salud/organización & administración , Implementación de Plan de Salud , Política de Salud , Desarrollo Infantil , Crianza del Niño , Protección a la Infancia , Preescolar , Chile , Implementación de Plan de Salud/organización & administración , Humanos , Lactante , Recién Nacido , Entrevistas como Asunto , Desarrollo de Programa , Evaluación de Programas y Proyectos de SaludRESUMEN
BACKGROUND: There is still limited knowledge regarding the translation of early child development (ECD) knowledge into effective policies and large-scale programmes. A variety of frameworks that outline the key steps in scaling up exist, but we argue that taking a complex adaptive systems (CAS) approach assists in understanding the complex, dynamic processes that result in programmes being taken to scale. OBJECTIVES: The objective of this study is to examine the process of scaling up four major country-level ECD programmes through the application of a CAS framework. METHODS: Nine key informants with a deep knowledge of how each ECD programme was established and brought to scale were interviewed via Skype or phone by using open-ended interviews. The interviews were tape recorded and then transcribed verbatim for subsequent coding by using CAS domains. The coding and integration of the results to identify unique and common CAS scaling up features across the case studies involved an iterative process of reaching consensus. RESULTS: The scaling up of all four programmes behaved as a CAS including as follows: (i) positive feedback loops (five themes) and negative feedback loops (two themes); (ii) scale-free networks (two themes); (iii) phase transitions (four themes); (iv) path dependence (two themes); and (v) emergent behaviour (six themes). Five additional themes were identified for sustainability, which was repeatedly mentioned as an important consideration when deciding how to scale up programmes. CONCLUSIONS: CAS analysis is likely to improve our understanding of how effective ECD programmes become scaled up. Prospective CAS implementation research is needed to continue advancing the knowledge in the field.
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Servicios de Salud del Niño , Atención a la Salud/organización & administración , Implementación de Plan de Salud/organización & administración , Política de Salud , Niño , Desarrollo Infantil , Servicios de Salud del Niño/organización & administración , Servicios de Salud del Niño/normas , Preescolar , Chile , Atención a la Salud/normas , Práctica Clínica Basada en la Evidencia , Investigación sobre Servicios de Salud , Humanos , India , Objetivos Organizacionales , Desarrollo de Programa , Estudios Prospectivos , Investigación Cualitativa , SudáfricaRESUMEN
OBJECTIVE: To assess the cost-effectiveness of a nurse facilitated, cognitive behavioural self-management programme for patients with heart failure compared with usual care including the un-facilitated access to the same manual, from the perspective of the NHS. DESIGN: Data were obtained from a pragmatic, multi-centre, randomized controlled 'open' trial conducted in seven centres in the UK between 2006 and 2008. Effectiveness was estimated as Quality-Adjusted Life Years. Resource use was measured prospectively on all patients using information provided by patients in postal questionnaires, case-note review, electronic record review and interviews with patients. Unit costs were obtained from the literature and applied to the relevant resource use to estimate total costs. Multiple imputation was used to handle missing data. RESULTS: There were no substantial differences in the utility scores between treatment groups in all follow-up assessments, in the use of medication or outpatient visits and both groups report a similar frequency of contact with health care professionals. After controlling for baseline utility and using imputed dataset, treatment was associated with a reduction in QALY of 0.004 and a additional cost of £69.49. The probability that the intervention is cost-effective for thresholds between £20,000 and £30,000 is around 45%. CONCLUSIONS: There is little evidence that the addition of the intervention had any effect on costs or outcomes. The uncertainty around both estimates of cost and effectiveness mean that it is not reasonable to make recommendations based on cost-effectiveness alone.