How can community participation strengthen a health insurance system? The case of health insurer's user associations in Colombia.

BACKGROUND: Colombia's universal health coverage programme has enrolled 98% of the population, thereby improving financial protection and health outcomes. The right to participate in the organisation of healthcare is enshrined in the 1991 Colombian Constitution. One participatory mechanism is the legal and regulatory provision that citizens can form user associations. This study examines the functionality of health insurance user associations and their influence on citizen empowerment and health insurance responsiveness. METHODS: The mixed methods study includes document review (n=72), a survey of beneficiaries (n=1311), a survey of user associations members (n=27), as well as interviews (n=19), focus group discussions (n=6) and stakeholder consultations (n=6) with user association members, government officials, and representatives from insurers, the pharmaceutical industry, and patient associations. Analysis used a content-process-context framework to understand how user associations are designed to work according to policy content, how they actually work in terms of coverage, public awareness, membership, and effectiveness, and contextual influences. FINDINGS: Colombia's user associations have a mandate to represent citizens' interests, enable participation in insurer decision-making, 'defend users' and oversee quality services. Insurers are mandated to ensure their enrollees create user associations, but are not required to provide resources to support their work. Thus, we found that user associations had been formed throughout the country, but the public was widely unaware of their existence. Many associations were weak, passive or entirely inactive. Limited market competition and toothless policies about user associations made insurers indifferent to community involvement. CONCLUSION: Currently, the initiative suffers from low awareness and low participation levels that can hardly lead to empowered enrollees and more responsive health insurance programmes. Yet, most stakeholders value the space to participate and still see potential in the initiative. This warrants a range of policy recommendations to strengthen user associations and truly enable them to effect change.

Popliteal artery pseudoaneurysm after isolated hyperextension of the knee.

We report an unusual case of a traumatic pseudoaneurysm of the popliteal artery after an isolated blunt hyperextension injury to the knee. A 56-year-old man presented with a 1-month history of left knee pain that occurred after a fall onto his buttocks with hyperextension of the knee while transferring a relative out of a wheelchair. A large pulsatile mass in the posterior aspect of the left knee was palpated on physical examination, although he had warm distal extremities and 2+ distal pulses bilaterally. Magnetic resonance angiography revealed a 7.6 × 6.2 × 4.9 cm left popliteral artery pseudoaneurysm, which was subsequently treated with aneurysm exclusion with end to end reverse saphenous vein graft bypass. The development of a popliteal artery pseudoaneurysm after blunt knee injury without dislocation, fracture, or ligament injury is extremely unusual, but requires prompt treatment to avoid the potential complications of permanent functional impairment and limb loss.

A revised Spanish version of the Beck Depression Inventory: psychometric properties with a Puerto Rican sample of college students.

The Beck Depression Inventory (BDI) is a widely used self-report measure for depression. This study has two objectives: (a) to revise, develop, and adapt a Spanish language BDI (BDI-S) that takes the criteria for the diagnosis of major depression according to the DSM-IV into consideration; and (b) to evaluate the psychometric properties (internal reliability and construct validity) of the revised version of the BDI (BDI-S). A sample of 351 undergraduate students at the University of Puerto Rico participated in this study. The participants who agreed to participate in the study and signed the consent form completed self-report measures related to depression (BDI-S, CES-D, and LCSd-7), dysfunctional cognition (DAS-A and IBT), stressful life events (LES), and social support (CAS). The coefficient of internal consistency obtained for the 22 BDI-S items was.88. The correlation coefficients between the BDI-S and instruments that measured other constructs (not depression) were lower than the correlation coefficients between instruments that measured the same constructs. Factor analysis revealed that the factor loading for the BDI-S was congruent with dimensions of depression reported in the literature. These results generally support the internal consistency and the construct validity of the BDI-S.

La alianza psicoterapéutica: Evaluación y desarrollo de instrumentos / Therapeutic alliance: Assessment and instrument development

La siguiente investigación fue una preliminar para desarrollar instrumentos con miras a iniciar estudios de proceso y rendimiento efectivo en la psicoterapia. En ésta participaron 79 personas en su mayoría mujeres, de áreas urbanas, trabajadoras y solteras. La misma tuvo tres objetivos: a) realizar una traducción y adaptación de dos medidas para medir alianza psicoterapéutica; b) evaluar la confiabilidad y validez de estas dos medidas; y c) desarrollar una escala breve a base de las anteriores. Se tradujo y adaptó la Escala de Alianza Psicoterapéutica Integrativa (EAPI) desarrollada por Pinsoff y Catherall (1986) y la escala de Alianza Psicoterapéutica (EAP) desarrollada por Howard (1986). La traducción y adaptación de los instrumentos resultó ser adecuada para el contexto puertorriqueño, demostrando éstos una consistencia interna alta y adecuada...(AU)

La alianza psicoterapéutica: Evaluación y desarrollo de instrumentos / Therapeutic alliance: Assessment and instrument development

La siguiente investigación fue una preliminar para desarrollar instrumentos con miras a iniciar estudios de proceso y rendimiento efectivo en la psicoterapia. En ésta participaron 79 personas en su mayoría mujeres, de áreas urbanas, trabajadoras y solteras. La misma tuvo tres objetivos: a) realizar una traducción y adaptación de dos medidas para medir alianza psicoterapéutica; b) evaluar la confiabilidad y validez de estas dos medidas; y c) desarrollar una escala breve a base de las anteriores. Se tradujo y adaptó la Escala de Alianza Psicoterapéutica Integrativa (EAPI) desarrollada por Pinsoff y Catherall (1986) y la escala de Alianza Psicoterapéutica (EAP) desarrollada por Howard (1986). La traducción y adaptación de los instrumentos resultó ser adecuada para el contexto puertorriqueño, demostrando éstos una consistencia interna alta y adecuada...

Confiabilidad interna y validez de construccion logica de dos instrumentos para medir sintomatologia psicologica en una muestra clinica: el inventario de depresion de Beck y la lista de cotejo de sintomas - 36 / Internal reability and construct validity of two instruments to measure psycological symptoms in a clinical sample: Beck Depression inventory, and Symptom Check List - 36

El estudio evalúa la confiabilidad interna y la validez de construcción lógica del Inventario de Depresión de Beck (IBD) y de la Lista de Cotejo de Síntomas - 36 (LCS-36) en una muestra clinica de 300 personas. El índice de consistencia interna para el IDB fue .8948 y para la LCS-36 fue .9469. Los resultados sugieren la presencia de cuatro factores en el IDB: actitudes negativas, cognitivo -conductual, biológico y somático. Estos resultados apoyan que los factores del IDB en una muestra clínica y puertorriqueña son congruentes con las dimensio-nes que se establecen en la literatura como fundamentales para establecer la nosología de la depresión. Con la LCS-36 encontramos seis factores principales: depresión, hostilidad/sospecha, ansiedad fóbica, somatización, disturbios de pensamiento e impedimento funcional. Los factores en la LCS-36 son congruen-tes con las dimensiones informadas en la literatura, la cual apoya la estructura factorial de este instrumento. También se encontró una correlación alta y significativa (.74) entre el IDB y de la LCS-36. Los resultados obtenidos para el IDB y la LCS-36 son alentadores. Ambos instrumentos ofrecen información consistente y válida de los constructos que pretenden medir. Se discuten las limitaciones del estudio y las posibilidades para futuros estudios.