The Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric and parent-proxy short forms for anxiety: Psychometric properties in the Kids FACE FEARS sample.

There is tremendous need for brief and supported, non-commercial youth- and caregiver-report questionnaires of youth anxiety. The pediatric and parent proxy short forms of the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety scale (8a v2.0) are free, brief, publicly accessible measures of youth- and caregiver-reported anxiety in children and adolescents. Despite increased use of the PROMIS, no study has evaluated performance of its anxiety scales in a sample of treatment-engaged anxious youth. Analyses were conducted on baseline data from the first 265 families (child MAge=11.14 years, 70% racial/ethnic minoritized youth) to enroll in the Kids FACE FEARS trial, a multisite comparative effectiveness trial of therapist-led vs. self-administered treatment for elevated youth anxiety. Confirmatory factor analysis (CFA) examined factor structure; omega coefficients and regression models examined internal consistency, convergent validity, and cross-informant reliability. CFA supported adjusted single-factor solutions across youth and caregiver reports, and internal consistency was high. Convergent validity was supported by medium-to-large associations with anxiety-related impairment and severity. Moderate cross-informant reliability between reports was found. Results showcase the first psychometric study of the PROMIS Anxiety scale short forms among treatment-engaged youth with elevated anxiety. Findings highlight the PROMIS Anxiety scale's utility in typical care settings for youth anxiety.

Group well-child care model for Latino children in immigrant families: Adapting to and learning from the coronavirus disease 2019 (COVID-19) context.

INTRODUCTION: Group well-child care (GWCC) is an alternative to traditional pediatric well-child care designed to increase parental social support and peer learning. This mixed methods study explored the adaptation and implementation of GWCC to a virtual format during coronavirus disease 2019 (COVID-19 pandemic) among Spanish-speaking Latino immigrant families. METHOD: Interviews were conducted with eight providers and 10 mothers from May through September 2020. Qualitative analyses used a priori codes based on an implementation science framework. Quantitative data included demographics, the COVID-19 Impact Scale, and virtual group attendance. Bivariate analyses identified correlates of virtual visit attendance. RESULTS: Eighty percent of mothers reported the pandemic had moderately or extremely impacted at least one major life domain such as daily life, food security, or family conflict. Of 27 mothers offered virtual groups, 67% attended. Mothers who attended virtual groups reported lower English proficiency (p = .087) and fewer friends and family members with COVID-19 (M = 1.0 vs. 5.1, p < .05) than those who did not attend. Women described virtual GWCC as acceptable and a source of social support. Some described differences in group dynamics compared with in-person groups and had privacy concerns. Providers noted scheduling and billing challenges affecting feasibility and sustainability. They reported that visits with good attendance were productive. Mothers and pediatric providers offered recommendations to improve feasibility and privacy and address sustainability. DISCUSSION: Competing demands for those most impacted by COVID-19 may outweigh benefits of attendance. Virtual Spanish language GWCC appears acceptable and feasible for Spanish speaking Latina mothers. Thematic analysis and recommendations identify areas of improvement. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Comparing Healthcare Utilization and Diagnoses in Immigrant Versus Nonimmigrant Youth.

INTRODUCTION: To inform efforts to provide healthcare to uninsurable, immigrant youth, we describe The Access Partnership (TAP) hospital-based charity care program and compare healthcare utilization and diagnoses among TAP and Medicaid patients. METHODS: We use propensity scores to match each TAP patient to three Medicaid patients receiving care at a pediatric clinic from October 2010 to June 2015 on demographic characteristics. We use descriptive statistics to compare healthcare visits and diagnoses. RESULTS: TAP (n = 78) and Medicaid patients (n = 234) had similar healthcare utilization, though Medicaid patients had more outpatient visits (10.8 vs. 7.7, p = .002), and TAP patients were more likely to have ever received subspecialty care (38.5% vs. 22.2%, p = .005). Diagnoses were similar between groups, with some exceptions: TAP patients more likely to present with genital and reproductive disease (33.3% vs. 19.7%, p = .013); Medicaid patients more likely to present with endocrine, metabolic, and nutritional disease (52.1% vs. 28.2%, p < .001), psychiatric, behavioral disease, and substance abuse (41.0, 26.9%, p = .026). CONCLUSIONS: TAP patients had similar healthcare utilization and diagnoses to matched sample of Medicaid patients. Findings indicate policy proposals that extend public health insurance to all children would likely benefit immigrant children and not incur higher costs than those of low-income U.S. citizen children.

Qualitative Review of Organizational Responses to Rumors in the 2014-2016 Ebola Virus Disease Outbreak in Liberia and Sierra Leone.

INTRODUCTION: Rumors and misperceptions were a persistent challenge in the response to the 2014-2016 Ebola Virus Disease (EVD) outbreak in West Africa. This study aimed to document organizational approaches to identifying and addressing rumors and provide practical recommendations for future outbreaks. METHODS: We conducted semistructured interviews with 34 individuals who participated in the EVD response in Liberia and/or Sierra Leone. Interviews focused on the general organizational approach and organizational response to specific rumors. Interviews were recorded and transcribed verbatim. RESULTS: Most respondents reported that rumors were considered an organizational priority and their importance increased over time. Formal rumor identification systems using community-level reporters were described in Liberia and Sierra Leone as well as varied informal systems. A wide range of approaches was used to address rumors including Community Led Ebola Action, Community Led Total Sanitation, drama performances, Ebola Treatment Center/Unit-based approaches, radio, leveraging community leaders as an information source, and organization change. Interpersonal and community-led approaches were described most often. Staff whose professional roles did not involve rumor management reported informally addressing rumors with colleagues and beneficiaries. Rumors reflecting valid concerns with the EVD response, such as potential infection in health care facilities, were addressed through organizational change and improvement. DISCUSSION: Interpersonal and community-led approaches were considered effective by participants and hold promise for future outbreaks. Informal systems developed at Ebola Treatment Centers/Units highlighted how these facilities may be utilized as an information hub. Professionals who interact with beneficiaries, especially local staff, are likely to address rumors informally and organizations may benefit from considering local staff an asset in rumor management. Rumors alerted responders to issues in the EVD response, but this may not be the most efficient mechanism to receive and address concerns.

Maternal health training priorities for nursing and allied professions in Haiti.

OBJECTIVES: This study summarizes the findings of a training needs and priority assessment completed in Haiti. Its objective is to describe the characteristics of nursing and allied professions providing first level maternal health care and identify training needs and priorities to inform planning of Human Resources for Health interventions. METHODS: A cross-sectional survey was completed between October 2016 and March 2017 by the Pan American Health Organization/World Health Organization Haiti office in collaboration with national health authorities. Participants reached consensus to submit one finalized version of the survey. Data were collected on composition, capacities, and training needs and priorities of traditional birth attendants, community health workers, registered nurses, professional midwives, and auxiliary nurses. RESULTS: Haiti relies heavily on community level workers including community health workers, auxiliary nurses, and traditional birth attendants. Traditional birth attendants attend the majority of Haiti's births, despite having low education levels and not being regulated by the Ministry of Public Health and Population. All professional categories prioritize preventive capacities such as timely identification of complications, while none are trained to manage postpartum hemorrhage, preeclampsia, or eclampsia. Management of obstetric emergencies is a training priority for Haiti but is not part of the scope of work of the nursing and allied health professions included in this study. CONCLUSIONS: Community level health workers are key in providing preventive care and referral of complicated pregnancies, but lack of access to providers qualified to treat obstetric complications remains a challenge to reducing maternal mortality.

Maternal health training priorities for nursing and allied professions in Haiti

[ABSTRACT]. Objectives. This study summarizes the findings of a training needs and priority assessment completed in Haiti. Its objective is to describe the characteristics of nursing and allied professions providing first level maternal health care and identify training needs and priorities to inform planning of Human Resources for Health interventions. Methods. A cross-sectional survey was completed between October 2016 and March 2017 by the Pan American Health Organization/World Health Organization Haiti office in collaboration with national health authorities. Participants reached consensus to submit one finalized version of the survey. Data were collected on composition, capacities, and training needs and priorities of traditional birth attendants, community health workers, registered nurses, professional midwives, and auxiliary nurses. Results. Haiti relies heavily on community level workers including community health workers, auxiliary nurses, and traditional birth attendants. Traditional birth attendants attend the majority of Haiti’s births, despite having low education levels and not being regulated by the Ministry of Public Health and Population. All professional categories prioritize preventive capacities such as timely identification of complications, while none are trained to manage postpartum hemorrhage, preeclampsia, or eclampsia. Management of obstetric emergencies is a training priority for Haiti but is not part of the scope of work of the nursing and allied health professions included in this study. Conclusions. Community level health workers are key in providing preventive care and referral of complicated pregnancies, but lack of access to providers qualified to treat obstetric complications remains a challenge to reducing maternal mortality.

[RESUMEN]. Objetivos. En este estudio se resumen los resultados de la evaluación de necesidades y prioridades de capacitación realizada en Haití. Su objetivo es describir las características de la enfermería y las profesiones auxiliares que prestan el primer nivel de atención de salud materna, y establecer las necesidades y las prioridades de capacitación a fin de diseñar la planificación de recursos humanos para las intervenciones de la salud. Métodos. La Representación de la Organización Panamericana de la Salud/Organización Mundial de la Salud en Haití realizó una encuesta transversal entre octubre del 2016 y marzo del 2017, en colaboración con las autoridades nacionales de salud. Los participantes consensuaron presentar una versión ultimada de la encuesta. Se recopilaron datos sobre la composición, las capacidades y las necesidades y las prioridades de capacitación de las parteras tradicionales, los agentes comunitarios de salud, las enfermeras tituladas, las parteras profesionales y las enfermeras auxiliares. Resultados. Haití depende en gran medida de trabajadores comunitarios, entre los que se incluyen los agentes comunitarios de salud, las enfermeras auxiliares y las parteras tradicionales. Las parteras tradicionales atienden la mayoría de los nacimientos en Haití, a pesar de disponer de un nivel bajo de formación y no estar reguladas por el Ministerio de Salud Pública y Población. Todas las categorías profesionales priorizan las capacidades preventivas, como la detección temprana de las complicaciones, si bien no están capacitadas para controlar la hemorragia posparto, la preeclampsia o la eclampsia. El tratamiento de las urgencias obstétricas es una prioridad de la capacitación en Haití, pero no forma parte del ámbito de trabajo de la enfermería y las profesiones auxiliares incluidas en este estudio. Conclusiones. Los trabajadores de salud a nivel comunitario son clave para la prestación de atención preventiva y derivación de los embarazos complicados, pero la falta de acceso a prestadores cualificados para tratar las complicaciones obstétricas es todavía un obstáculo para reducir la mortalidad materna.

[RESUMO]. Objetivos. Este estudo resume os resultados de uma avaliação sobre as necessidades prioritárias na formação de profissionais da saúde no Haiti. Seu objetivo é descrever as características do trabalho de enfermeiros e profissionais da saúde auxiliares na prestação de atenção primária para a saúde materna e identificar as necessidades prioritárias de formação, a fim de fundamentar o planejamento de intervenções voltadas aos recursos humanos para a saúde. Métodos. O Escritório da Organização Pan-Americana da Saúde/Organização Mundial da Saúde no Haiti, em colaboração com as autoridades nacionais de saúde, realizou um inquérito transversal entre outubro de 2016 e março de 2017. Os participantes chegaram a um consenso, apresentando uma versão finalizada do inquérito. Foram coletados dados sobre a composição, as capacidades e as necessidades prioritárias de formação de parteiras tradicionais, agentes comunitários de saúde, enfermeiros, parteiras profissionais e auxiliares de enfermagem. Resultados. O Haiti é muito dependente de trabalhadores de nível comunitário, como agentes comunitários de saúde, auxiliares de enfermagem e parteiras tradicionais. As parteiras tradicionais atendem a maioria dos partos no Haiti, apesar de terem um baixo nível de escolaridade e não serem regulamentadas pelo Ministério de Saúde Pública e População. Todas as categorias profissionais priorizam as capacidades preventivas, como a rápida identificação de complicações, e nenhuma recebe formação para lidar com hemorragia pós-parto, pré-eclâmpsia ou eclâmpsia. A formação para o tratamento de emergências obstétricas é uma prioridade no Haiti, mas não faz parte do escopo de trabalho dos enfermeiros e profissionais da saúde auxiliares incluídos neste estudo. Conclusões. Os profissionais da saúde de nível comunitário são fundamentais na prestação de cuidados preventivos e no encaminhamento de gestações complicadas, mas a falta de acesso a profissionais qualificados para tratar complicações obstétricas ainda é um obstáculo nos esforços para reduzir a mortalidade materna.

Centro SOL Research Consultation Services: Improving Research with Limited English Proficiency Latinx Populations.

From 2014-2019, Centro SOL provided research consultation services to 77 investigators interested in including Latinx and limited English proficiency populations in their research. The most common requests were for study recruitment (the very most common) and for translation and materials review. Challenges to providing services included financial sustainability and variable institutional review board policies, among others.

Maternal health training priorities for nursing and allied professions in Haiti / Prioridades de capacitación en salud materna para la enfermería y profesiones auxiliares en Haití / Prioridades na formação de enfermeiros e profissionais da saúde auxiliares na área da saúde materna no Haiti

ABSTRACT Objectives. This study summarizes the findings of a training needs and priority assessment completed in Haiti. Its objective is to describe the characteristics of nursing and allied professions providing first level maternal health care and identify training needs and priorities to inform planning of Human Resources for Health interventions. Methods. A cross-sectional survey was completed between October 2016 and March 2017 by the Pan American Health Organization/World Health Organization Haiti office in collaboration with national health authorities. Participants reached consensus to submit one finalized version of the survey. Data were collected on composition, capacities, and training needs and priorities of traditional birth attendants, community health workers, registered nurses, professional midwives, and auxiliary nurses. Results. Haiti relies heavily on community level workers including community health workers, auxiliary nurses, and traditional birth attendants. Traditional birth attendants attend the majority of Haiti's births, despite having low education levels and not being regulated by the Ministry of Public Health and Population. All professional categories prioritize preventive capacities such as timely identification of complications, while none are trained to manage postpartum hemorrhage, preeclampsia, or eclampsia. Management of obstetric emergencies is a training priority for Haiti but is not part of the scope of work of the nursing and allied health professions included in this study. Conclusions. Community level health workers are key in providing preventive care and referral of complicated pregnancies, but lack of access to providers qualified to treat obstetric complications remains a challenge to reducing maternal mortality.(AU)

RESUMEN Objetivos. En este estudio se resumen los resultados de la evaluación de necesidades y prioridades de capacitación realizada en Haití. Su objetivo es describir las características de la enfermería y las profesiones auxiliares que prestan el primer nivel de atención de salud materna, y establecer las necesidades y las prioridades de capacitación a fin de diseñar la planificación de recursos humanos para las intervenciones de la salud. Métodos. La Representación de la Organización Panamericana de la Salud/Organización Mundial de la Salud en Haití realizó una encuesta transversal entre octubre del 2016 y marzo del 2017, en colaboración con las autoridades nacionales de salud. Los participantes consensuaron presentar una versión ultimada de la encuesta. Se recopilaron datos sobre la composición, las capacidades y las necesidades y las prioridades de capacitación de las parteras tradicionales, los agentes comunitarios de salud, las enfermeras tituladas, las parteras profesionales y las enfermeras auxiliares. Resultados. Haití depende en gran medida de trabajadores comunitarios, entre los que se incluyen los agentes comunitarios de salud, las enfermeras auxiliares y las parteras tradicionales. Las parteras tradicionales atienden la mayoría de los nacimientos en Haití, a pesar de disponer de un nivel bajo de formación y no estar reguladas por el Ministerio de Salud Pública y Población. Todas las categorías profesionales priorizan las capacidades preventivas, como la detección temprana de las complicaciones, si bien no están capacitadas para controlar la hemorragia posparto, la preeclampsia o la eclampsia. El tratamiento de las urgencias obstétricas es una prioridad de la capacitación en Haití, pero no forma parte del ámbito de trabajo de la enfermería y las profesiones auxiliares incluidas en este estudio. Conclusiones. Los trabajadores de salud a nivel comunitario son clave para la prestación de atención preventiva y derivación de los embarazos complicados, pero la falta de acceso a prestadores cualificados para tratar las complicaciones obstétricas es todavía un obstáculo para reducir la mortalidad materna.(AU)

RESUMO Objetivos. Este estudo resume os resultados de uma avaliação sobre as necessidades prioritárias na formação de profissionais da saúde no Haiti. Seu objetivo é descrever as características do trabalho de enfermeiros e profissionais da saúde auxiliares na prestação de atenção primária para a saúde materna e identificar as necessidades prioritárias de formação, a fim de fundamentar o planejamento de intervenções voltadas aos recursos humanos para a saúde. Métodos. O Escritório da Organização Pan-Americana da Saúde/Organização Mundial da Saúde no Haiti, em colaboração com as autoridades nacionais de saúde, realizou um inquérito transversal entre outubro de 2016 e março de 2017. Os participantes chegaram a um consenso, apresentando uma versão finalizada do inquérito. Foram coletados dados sobre a composição, as capacidades e as necessidades prioritárias de formação de parteiras tradicionais, agentes comunitários de saúde, enfermeiros, parteiras profissionais e auxiliares de enfermagem. Resultados. O Haiti é muito dependente de trabalhadores de nível comunitário, como agentes comunitários de saúde, auxiliares de enfermagem e parteiras tradicionais. As parteiras tradicionais atendem a maioria dos partos no Haiti, apesar de terem um baixo nível de escolaridade e não serem regulamentadas pelo Ministério de Saúde Pública e População. Todas as categorias profissionais priorizam as capacidades preventivas, como a rápida identificação de complicações, e nenhuma recebe formação para lidar com hemorragia pós-parto, pré-eclâmpsia ou eclâmpsia. A formação para o tratamento de emergências obstétricas é uma prioridade no Haiti, mas não faz parte do escopo de trabalho dos enfermeiros e profissionais da saúde auxiliares incluídos neste estudo. Conclusões. Os profissionais da saúde de nível comunitário são fundamentais na prestação de cuidados preventivos e no encaminhamento de gestações complicadas, mas a falta de acesso a profissionais qualificados para tratar complicações obstétricas ainda é um obstáculo nos esforços para reduzir a mortalidade materna.(AU)

Maternal health training priorities for nursing and allied health workers in Colombia, Honduras, and Nicaragua.

OBJECTIVE: To assess maternal health training priorities for primary care human resources for health (HRH) in nursing and allied health workers in Colombia, Honduras, and Nicaragua, to inform maternal care HRH strategic planning efforts. METHODS: This Washington, D.C.-based study utilized cross-sectional survey methodology to collect country-level data. From October 2016 to March 2017, a needs assessment tool was developed by the Pan American Health Organization/World Health Organization (PAHO/WHO) and PAHO/WHO Collaborating Centers. Data collection was completed by PAHO/WHO country offices, in collaboration with national health authorities and other high-level government personnel. The collected data included information on the composition, capacities, and training priorities of traditional birth attendants (TBAs), community health workers (CHWs), registered nurses (RNs), and auxiliary nurses in the three study countries; the findings were summarized in a report. RESULTS: Data on the health workforce composition in the three countries indicated reliance on HRH with low levels of education and training, with limited integration of TBAs. In all three countries, management of obstetric emergencies was a training priority for RNs, and identification of danger signs was a priority for CHWs and TBAs. Training priorities for auxiliary nurses varied widely across the three countries and included health promotion, preconception and prenatal care, and obstetric emergencies. There was also a wide range in the total number of HRH across the three countries. CONCLUSIONS: Reliance on health workers with low levels of training is concerning but can be mitigated through in-service training. Training priorities are consistent with the major causes of maternal mortality, and Latin America and Caribbean region training programs show promise for improving quality of care. In the long term, planning for maternal care HRH should seek to increase the concentration of health professionals that are more highly skilled.

Maternal health training priorities for nursing and allied health workers in Colombia, Honduras, and Nicaragua

[ABSTRACT]. Objective. To assess maternal health training priorities for primary care human resources for health (HRH) in nursing and allied health workers in Colombia, Honduras, and Nicaragua, to inform maternal care HRH strategic planning efforts. Methods. This Washington, D.C.–based study utilized cross-sectional survey methodology to collect country-level data. From October 2016 to March 2017, a needs assessment tool was developed by the Pan American Health Organization/World Health Organization (PAHO/WHO) and PAHO/WHO Collaborating Centers. Data collection was completed by PAHO/WHO country offices, in collaboration with national health authorities and other high-level government personnel. The collected data included information on the composition, capacities, and training priorities of traditional birth attendants (TBAs), community health workers (CHWs), registered nurses (RNs), and auxiliary nurses in the three study countries; the findings were summarized in a report. Results. Data on the health workforce composition in the three countries indicated reliance on HRH with low levels of education and training, with limited integration of TBAs. In all three countries, management of obstetric emergencies was a training priority for RNs, and identification of danger signs was a priority for CHWs and TBAs. Training priorities for auxiliary nurses varied widely across the three countries and included health promotion, preconception and prenatal care, and obstetric emergencies. There was also a wide range in the total number of HRH across the three countries. Conclusions. Reliance on health workers with low levels of training is concerning but can be mitigated through in-service training. Training priorities are consistent with the major causes of maternal mortality, and Latin America and Caribbean region training programs show promise for improving quality of care. In the long term, planning for maternal care HRH should seek to increase the concentration of health professionals that are more highly skilled.

[RESUMEN]. Objetivo. Evaluar las prioridades de capacitación en el ámbito de la salud materna de los recursos humanos de enfermería y otros trabajadores de atención primaria en Colombia, Honduras y Nicaragua, y fundamentar los esfuerzos de planificación estratégica de los recursos humanos para la salud dedicados a la atención materna. Métodos. En este estudio, con sede en Washington, D. C., se empleó una metodología de encuesta transversal para recopilar datos a nivel de país. Entre los meses de octubre del 2016 y marzo del 2017, la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS) y sus centros colaboradores elaboraron una herramienta para la evaluación de las necesidades. Las representaciones de la OPS/OMS, en colaboración con las autoridades nacionales de salud y otros funcionarios gubernamentales de alto nivel, realizaron la recopilación de datos. Los datos reunidos incluyeron información sobre la composición, las aptitudes y las prioridades de capacitación de las parteras tradicionales, los agentes comunitarios de salud, las enfermeras tituladas y las enfermeras auxiliares en los tres países del estudio. Los resultados se resumieron en un informe. Resultados. Los datos sobre la composición del personal de salud en los tres países indicaron que se depende de recursos humanos para la salud que presentan escasos niveles de educación y formación, y que la integración de las parteras tradicionales es limitada. En los tres países, el tratamiento de las urgencias obstétricas constituyó una prioridad de capacitación para las enfermeras tituladas, y la detección de los signos de peligro fue una prioridad en el caso de los agentes comunitarios de salud y las parteras tradicionales. Las prioridades de formación para las enfermeras auxiliares variaron sustancialmente entre los tres países y entrañaron la promoción de la salud, la atención pregestacional y prenatal, y las urgencias obstétricas. Asimismo, el número total de recursos humanos para la salud varió considerablemente entre los países. Conclusiones. Depender de personal de salud de escaso nivel formativo es motivo de preocupación, si bien la capacitación en el servicio puede mitigar este problema. Las prioridades de capacitación están en consonancia con las principales causas de mortalidad materna y los programas formativos de América Latina y el Caribe resultan prometedores para mejorar la calidad de la atención. A largo plazo, la planificación de los recursos humanos para la salud dedicados a la atención materna deberá procurar aumentar la concentración de profesionales de salud más capacitados.

[RESUMO]. Objetivo. Avaliar as prioridades de formação em saúde materna dos recursos humanos na área de atenção primária à saúde entre profissionais de enfermagem e outros profissionais da saúde na Colômbia, Honduras e Nicarágua, a fim de subsidiar os esforços de planejamento estratégico de recursos humanos para saúde materna. Métodos. Foi conduzido um estudo transversal, sediado em Washington, D.C., para coletar dados ao nível nacional. Uma ferramenta de avaliação das necessidades foi desenvolvida, de outubro de 2016 a março de 2017, pela Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS) e Centros Colaboradores da OPAS/OMS. A coleta de dados foi concluída pelas representações da OPAS/OMS nos países, em colaboração com autoridades sanitárias nacionais e pessoal de alto escalão do governo. Foram coletados dados sobre a composição, as competências e as prioridades de formação de parteiras tradicionais, agentes comunitários de saúde, enfermeiros licenciados e assistentes de enfermagem nos três países de estudo. Os resultados foram compilados em um relatório. Resultados. Os dados relativos à composição da força de trabalho em saúde nos três países indicaram que eles contam com pessoal com baixo nível de instrução e formação, com integração limitada das parteiras tradicionais. Observou-se, nos três países, que a atuação em emergências obstétricas era uma prioridade de formação para enfermeiros licenciados e a identificação de sinais de perigo era uma prioridade para agentes comunitários de saúde e parteiras tradicionais. As prioridades de formação para os assistentes de enfermagem foram bastante distintas entre os países: promoção da saúde, cuidados pré-concepcionais e assistência pré-natal e emergências obstétricas. O número total de recursos humanos para a saúde também variou nos três países. Conclusões. É motivo de preocupação ter de contar com profissionais da saúde com baixo nível de formação, porém este problema pode ser reduzido com a capacitação no próprio serviço. As prioridades de formação nos países estudados são condizentes com as principais causas de mortalidade materna e os programas de formação profissional da Região da América Latina e Caribe têm potencial para melhorar a qualidade da atenção. O planejamento dos recursos humanos para saúde materna deve visar a longo prazo aumentar a concentração de profissionais que são mais capacitados.

Maternal health training priorities for nursing and allied health workers in Colombia, Honduras, and Nicaragua / Prioridades de capacitación en el ámbito de la salud materna para el personal de enfermería y otros trabajadores de salud en Colombia, Honduras y Nicaragua / Prioridades em formação em saúde materna para profissionais de enfermagem e outros profissionais da saúde na Colômbia, Honduras e Nicarágua

ABSTRACT Objective To assess maternal health training priorities for primary care human resources for health (HRH) in nursing and allied health workers in Colombia, Honduras, and Nicaragua, to inform maternal care HRH strategic planning efforts. Methods This Washington, D.C.-based study utilized cross-sectional survey methodology to collect country-level data. From October 2016 to March 2017, a needs assessment tool was developed by the Pan American Health Organization/World Health Organization (PAHO/WHO) and PAHO/WHO Collaborating Centers. Data collection was completed by PAHO/WHO country offices, in collaboration with national health authorities and other high-level government personnel. The collected data included information on the composition, capacities, and training priorities of traditional birth attendants (TBAs), community health workers (CHWs), registered nurses (RNs), and auxiliary nurses in the three study countries; the findings were summarized in a report. Results Data on the health workforce composition in the three countries indicated reliance on HRH with low levels of education and training, with limited integration of TBAs. In all three countries, management of obstetric emergencies was a training priority for RNs, and identification of danger signs was a priority for CHWs and TBAs. Training priorities for auxiliary nurses varied widely across the three countries and included health promotion, preconception and prenatal care, and obstetric emergencies. There was also a wide range in the total number of HRH across the three countries. Conclusions Reliance on health workers with low levels of training is concerning but can be mitigated through in-service training. Training priorities are consistent with the major causes of maternal mortality, and Latin America and Caribbean region training programs show promise for improving quality of care. In the long term, planning for maternal care HRH should seek to increase the concentration of health professionals that are more highly skilled.

RESUMEN Objetivo Evaluar las prioridades de capacitación en el ámbito de la salud materna de los recursos humanos de enfermería y otros trabajadores de atención primaria en Colombia, Honduras y Nicaragua, y fundamentar los esfuerzos de planificación estratégica de los recursos humanos para la salud dedicados a la atención materna. Métodos En este estudio, con sede en Washington, D. C., se empleó una metodología de encuesta transversal para recopilar datos a nivel de país. Entre los meses de octubre del 2016 y marzo del 2017, la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS) y sus centros colaboradores elaboraron una herramienta para la evaluación de las necesidades. Las representaciones de la OPS/OMS, en colaboración con las autoridades nacionales de salud y otros funcionarios gubernamentales de alto nivel, realizaron la recopilación de datos. Los datos reunidos incluyeron información sobre la composición, las aptitudes y las prioridades de capacitación de las parteras tradicionales, los agentes comunitarios de salud, las enfermeras tituladas y las enfermeras auxiliares en los tres países del estudio. Los resultados se resumieron en un informe. Resultados Los datos sobre la composición del personal de salud en los tres países indicaron que se depende de recursos humanos para la salud que presentan escasos niveles de educación y formación, y que la integración de las parteras tradicionales es limitada. En los tres países, el tratamiento de las urgencias obstétricas constituyó una prioridad de capacitación para las enfermeras tituladas, y la detección de los signos de peligro fue una prioridad en el caso de los agentes comunitarios de salud y las parteras tradicionales. Las prioridades de formación para las enfermeras auxiliares variaron sustancialmente entre los tres países y entrañaron la promoción de la salud, la atención pregestacional y prenatal, y las urgencias obstétricas. Asimismo, el número total de recursos humanos para la salud varió considerablemente entre los países. Conclusiones Depender de personal de salud de escaso nivel formativo es motivo de preocupación, si bien la capacitación en el servicio puede mitigar este problema. Las prioridades de capacitación están en consonancia con las principales causas de mortalidad materna y los programas formativos de América Latina y el Caribe resultan prometedores para mejorar la calidad de la atención. A largo plazo, la planificación de los recursos humanos para la salud dedicados a la atención materna deberá procurar aumentar la concentración de profesionales de salud más capacitados.

RESUMO Objetivo Avaliar as prioridades de formação em saúde materna dos recursos humanos na área de atenção primária à saúde entre profissionais de enfermagem e outros profissionais da saúde na Colômbia, Honduras e Nicarágua, a fim de subsidiar os esforços de planejamento estratégico de recursos humanos para saúde materna. Métodos Foi conduzido um estudo transversal, sediado em Washington, D.C., para coletar dados ao nível nacional. Uma ferramenta de avaliação das necessidades foi desenvolvida, de outubro de 2016 a março de 2017, pela Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS) e Centros Colaboradores da OPAS/OMS. A coleta de dados foi concluída pelas representações da OPAS/OMS nos países, em colaboração com autoridades sanitárias nacionais e pessoal de alto escalão do governo. Foram coletados dados sobre a composição, as competências e as prioridades de formação de parteiras tradicionais, agentes comunitários de saúde, enfermeiros licenciados e assistentes de enfermagem nos três países de estudo. Os resultados foram compilados em um relatório. Resultados Os dados relativos à composição da força de trabalho em saúde nos três países indicaram que eles contam com pessoal com baixo nível de instrução e formação, com integração limitada das parteiras tradicionais. Observou-se, nos três países, que a atuação em emergências obstétricas era uma prioridade de formação para enfermeiros licenciados e a identificação de sinais de perigo era uma prioridade para agentes comunitários de saúde e parteiras tradicionais. As prioridades de formação para os assistentes de enfermagem foram bastante distintas entre os países: promoção da saúde, cuidados pré-concepcionais e assistência pré-natal e emergências obstétricas. O número total de recursos humanos para a saúde também variou nos três países. Conclusões É motivo de preocupação ter de contar com profissionais da saúde com baixo nível de formação, porém este problema pode ser reduzido com a capacitação no próprio serviço. As prioridades de formação nos países estudados são condizentes com as principais causas de mortalidade materna e os programas de formação profissional da Região da América Latina e Caribe têm potencial para melhorar a qualidade da atenção. O planejamento dos recursos humanos para saúde materna deve visar a longo prazo aumentar a concentração de profissionais que são mais capacitados.

Capacitación de recursos humanos en salud materna en Bolivia, Colombia, Ecuador, Guatemala, Haití, Honduras, Nicaragua y Perú: descripción de la experiencia / Human Resource Training in Maternal Care in Bolivia, Colombia, Ecuador, Guatemala, Haiti, Honduras, Nicaragua and Peru: An Experience Description / Treinamento de recursos humanos em saúde materna na Bolívia, Colômbia, Equador, Guatemala, Haiti, Honduras, Nicarágua e Peru: descrição da experiência

Introducción: América Latina y el Caribe han disminuido la mortalidad materna; sin embargo, aún poseen países con altas tasas, lo que refleja inequidades en el acceso a servicios de salud. La capacitación de recurso humano competente en atención primaria es una de las principales estrategias para abordar la problemática. Objetivo: describir la experiencia de planificación, implementación y evaluación de un programa de capacitaciones en salud materna en países de la región (Bolivia, Colombia, Ecuador, Guatemala, Honduras, Nicaragua, Haití y Perú). Metodología: entre 2016 y 2019, el Departamento de Sistemas y Servicios de Salud y la Unidad de Recursos Humanos de la Organización Panamericana de la Salud, junto a centros colaboradores, universidades y al Centro Latinoamericano de Perinatología y Salud de la Mujer, realizaron un levantamiento de necesidades de capacitación, desarrollaron plan de formación e implementaron capacitaciones para personal profesional y no profesional en salud materna. Resultados: las necesidades de capacitación detectadas fueron liderazgo en salud, cuidados prenatales, parto, posparto, emergencias obstétricas y planificación familiar. Estas se consideraron en capacitaciones presenciales y virtuales, con 71 entrenadores de 7 países, quienes a su vez las reprodujeron para más de 4000 personas. Las evaluaciones fueron muy positivas y se espera determinar el impacto en salud en futuros proyectos. Conclusiones: es fundamental la detección de necesidades y el trabajo colaborativo para realizar capacitaciones acordes en los países de la región, que permita contar con recurso humano motivado y competente para aumentar el acceso y la cobertura en la atención en salud materna de calidad.

Introduction: Latin America and the Caribbean have reduced the maternal mortality rates. However, some of these countries still have high rates, which indicates the inequity in the access to the health services. The human resource training competent in primary health care is one of the main strategies to approach this problem. Objective: To describe the experience of planning, implementing and evaluating a training program in maternal health in countries of this region (Bolivia, Colombia, Ecuador, Guatemala, Honduras, Nicaragua, Haiti and Peru). Methodology: Between 2016 and 2019, the Department of Health Systems and Services and the Human Resource Unit of the Pan-American Health Organization, together with some collaborative centers, universities and the Latin-American Center for Perinatology and Women's Health, carried out a survey on training needs, developed a formation plan and implemented the training among both professional and non-professional staff in relation to maternal health. Results: The training needs identified were Health Leadership, Prenatal Care, Labor, Postpartum Care, Obstetric Emergencies, and Family Planning. These needs are addressed both in the online and in-person training with 71 trainers from seven countries, who reproduced them for more than 4000 people. The evaluations were very positive and the health impact in future Project is yet to be determined. Conclusions: It is crucial to identify the needs and to do collaborative work in order to carry out the pertinent training in our countries. This would allow to count on the human talent, motivated and competent, in order to increase the access and coverage of high quality maternal health care.

Introdução: América Latina e Caribe diminuíram a mortalidade materna; no entanto, ainda têm países com altas taxas, refletindo iniquidades no acesso a serviços de saúde. O treinamento de recurso humano competente em atenção primária é uma das principais estratégias para abordar a problemática. Objetivo: Descrever a experiência de planejamento, implementação e avaliação de um programa de capacitações em saúde materna em países da região (Bolívia, Colômbia, Equador, Guatemala, Honduras, Nicarágua, Haiti e Peru). Metodologia: Entre 2016 e 2019, o Departamento de Sistemas e Serviços de Saúde e a Unidade de Recursos Humanos da Organização Pan-americana da Saúde, junto com centros colaboradores, universidades e o Centro Latino-americano de Perinatologia e Saúde da Mulher realizaram um inquérito de necessidades de treinamento, desenvolveram plano de formação e implementaram treinamentos para pessoal profissional e não profissional em saúde materna. Resultados: As necessidades de treino detectadas foram liderança em saúde, cuidados pré-natais, parto, pós-parto, emergências obstétricas e planejamento familiar. Estas foram consideradas em treinos presenciais e virtuais, com 71 treinadores de 7 países, quem por sua vez as reproduziram para mais de 4000 pessoas. As avaliações foram muito positivas e espera-se determinar o impacto em saúde em projetos futuros. Conclusões: É fundamental a detecção de necessidades e trabalho colaborativo para realizar treinamentos acordes nos países da região, que permitam contar com recurso humano motivado e competente para aumentar o acesso e a cobertura na atenção em saúde materna de qualidade.

Capacitación de recursos humanos en salud materna en Bolivia, Colombia, Ecuador, Guatemala, Haití, Honduras, Nicaragua y Perú: descripción de la experiencia / Human Resource Training in Maternal Care in Bolivia, Colombia, Ecuador, Guatemala, Haiti, Honduras, Nicaragua and Peru: An Experience Description / Treinamento de recursos humanos em saúde materna na Bolívia, Colômbia, Equador, Guatemala, Haiti, Honduras, Nicarágua e Peru: descrição da experiência

Introducción: América Latina y el Caribe han disminuido la mortalidad materna; sin embargo, aún poseen países con altas tasas, lo que refleja inequidades en el acceso a servicios de salud. La capacitación de recurso humano competente en atención primaria es una de las principales estrategias para abordar la problemática. Objetivo: describir la experiencia de planificación, implementación y evaluación de un programa de capacitaciones en salud materna en países de la región (Bolivia, Colombia, Ecuador, Guatemala, Honduras, Nicaragua, Haití y Perú). Metodología: entre 2016 y 2019, el Departamento de Sistemas y Servicios de Salud y la Unidad de Recursos Humanos de la Organización Panamericana de la Salud, junto a centros colaboradores, universidades y al Centro Latinoamericano de Perinatología y Salud de la Mujer, realizaron un levantamiento de necesidades de capacitación, desarrollaron plan de formación e implementaron capacitaciones para personal profesional y no profesional en salud materna. Resultados: las necesidades de capacitación detectadas fueron liderazgo en salud, cuidados prenatales, parto, posparto, emergencias obstétricas y planificación familiar. Estas se consideraron en capacitaciones presenciales y virtuales, con 71 entrenadores de 7 países, quienes a su vez las reprodujeron para más de 4000 personas. Las evaluaciones fueron muy positivas y se espera determinar el impacto en salud en futuros proyectos. Conclusiones: es fundamental la detección de necesidades y el trabajo colaborativo para realizar capacitaciones acordes en los países de la región, que permita contar con recurso humano motivado y competente para aumentar el acceso y la cobertura en la atención en salud materna de calidad.

Introduction: Latin America and the Caribbean have reduced the maternal mortality rates. However, some of these countries still have high rates, which indicates the inequity in the access to the health services. The human resource training competent in primary health care is one of the main strategies to approach this problem. Objective: To describe the experience of planning, implementing and evaluating a training program in maternal health in countries of this region (Bolivia, Colombia, Ecuador, Guatemala, Honduras, Nicaragua, Haiti and Peru). Methodology: Between 2016 and 2019, the Department of Health Systems and Services and the Human Resource Unit of the Pan-American Health Organization, together with some collaborative centers, universities and the Latin-American Center for Perinatology and Women's Health, carried out a survey on training needs, developed a formation plan and implemented the training among both professional and non-professional staff in relation to maternal health. Results: The training needs identified were Health Leadership, Prenatal Care, Labor, Postpartum Care, Obstetric Emergencies, and Family Planning. These needs are addressed both in the online and in-person training with 71 trainers from seven countries, who reproduced them for more than 4000 people. The evaluations were very positive and the health impact in future Project is yet to be determined. Conclusions: It is crucial to identify the needs and to do collaborative work in order to carry out the pertinent training in our countries. This would allow to count on the human talent, motivated and competent, in order to increase the access and coverage of high quality maternal health care.

Introdução: América Latina e Caribe diminuíram a mortalidade materna; no entanto, ainda têm países com altas taxas, refletindo iniquidades no acesso a serviços de saúde. O treinamento de recurso humano competente em atenção primária é uma das principais estratégias para abordar a problemática. Objetivo: Descrever a experiência de planejamento, implementação e avaliação de um programa de capacitações em saúde materna em países da região (Bolívia, Colômbia, Equador, Guatemala, Honduras, Nicarágua, Haiti e Peru). Metodologia: Entre 2016 e 2019, o Departamento de Sistemas e Serviços de Saúde e a Unidade de Recursos Humanos da Organização Pan-americana da Saúde, junto com centros colaboradores, universidades e o Centro Latino-americano de Perinatologia e Saúde da Mulher realizaram um inquérito de necessidades de treinamento, desenvolveram plano de formação e implementaram treinamentos para pessoal profissional e não profissional em saúde materna. Resultados: As necessidades de treino detectadas foram liderança em saúde, cuidados pré-natais, parto, pós-parto, emergências obstétricas e planejamento familiar. Estas foram consideradas em treinos presenciais e virtuais, com 71 treinadores de 7 países, quem por sua vez as reproduziram para mais de 4000 pessoas. As avaliações foram muito positivas e espera-se determinar o impacto em saúde em projetos futuros. Conclusões: É fundamental a detecção de necessidades e trabalho colaborativo para realizar treinamentos acordes nos países da região, que permitam contar com recurso humano motivado e competente para aumentar o acesso e a cobertura na atenção em saúde materna de qualidade.

Evaluation of Training Program for the Maternal and Child Health Workforce at Tulane University.

Objectives Despite significant investments in Maternal and Child Health (MCH), the United States still lags behind other countries in key MCH indicators. A well-trained workforce is needed to improve MCH. The Division of MCH Workforce Development of HRSA's Maternal and Child Health Bureau provides funding to schools of Public Health to support Centers of Excellence in MCH, which is focused on preparing the next generation of MCH leaders through specialized training and mentorship. One such center, the Tulane Center of Excellence in MCH (CEMCH), is housed at the Tulane University School of Public Health and Tropical Medicine. This study evaluated the perceived effectiveness and acceptability of the CEMCH leadership training program. Methods A mixed-methods approach was used, consisting of semi-structured interviews and quantitative surveys which were analyzed through inductive methods based in grounded theory and non-parametric methods respectively. Results Results indicated an overall high level of program satisfaction by all stakeholders. Mentorship and personal attention emerged as an important benefit for both former and current Scholars. The opportunity to gain real-world understanding of MCH work through program activities was an added benefit, although these activities also presented the most challenges. Community stakeholders generally did not view the program as providing immediate organizational benefit, but recognized the distal benefit of contributing to a well-trained MCH workforce. Conclusions for Practice These results will be used to inform other MCH training programs and strengthen Tulane's CEMCH. A well-trained MCH workforce is essential to improving MCH, and high-quality training its foundation.

Infant Feeding Policy and Programming During the 2014-2015 Ebola Virus Disease Outbreak in Sierra Leone.

Optimal breastfeeding is of vital importance to infant and child health and has been adopted by countries as a standard recommendation. However, in the context of an infectious disease outbreak, especially when the disease is poorly understood, policy makers must balance the benefits of breastfeeding against the risk of disease transmission through breastfeeding. During the 2014-2015 Ebola Virus Disease (EVD) outbreak in Sierra Leone, the development of correct and consistent messaging about infant feeding and nutrition programming was considerably delayed by numerous challenges. These challenges included a lack of sufficient information about the risk of transmission through human milk, numerous stakeholders, limited communication between coordination pillars, inconsistent and evolving messages from various stakeholders, and the public's distrust of the health system and international actors. For improved response to future disease outbreaks, research on vertical transmission of EVD should be prioritized, infant and young child feeding experts should be integrated into outbreak response collaboration, and a digital repository of potential and appropriately tailored messages should be created.

Maternal experiences with and sources of information on galactagogues to support lactation: a cross-sectional study.

An increase in the marketing and use of herbal galactagogues among breastfeeding mothers in the US has raised the issue of how best to provide support and information on the use of these products, particularly in light of limited availability of certified lactation counselors and continued suboptimal rates of breastfeeding globally. Currently, no cross-sectional data are available on the experiences and attitudes of mothers regarding the use of herbal and pharmaceutical galactagogues for lactation in the US. The findings of an online survey of 188 breastfeeding mothers on experiences with and sources of information on galactagogues are presented. Most mothers (76%) reported that while breastfeeding, they felt as though they were not making enough milk to meet the needs of their child, and yet 54% also indicated that they had not supplemented with formula. A large proportion of respondents reported utilizing galactagogues to increase lactation and finding them useful. The results indicated that most women learned about galactagogues from the Internet or by word of mouth through friends. Lactation consultants were the third-most reported sources of information on these products. While many respondents reported perceiving galactagogues as innocuous, more evidence on safety and efficacy is needed to support women properly who seek out and use them. Large-scale studies of the prevalence of galactagogue use in the US and rigorous evaluation of use globally are needed to ensure that mothers who choose to breastfeed may safely avail themselves of all options when counseling support is insufficient.

Health provider experiences with galactagogues to support breastfeeding: a cross-sectional survey.

BACKGROUND: Exclusive breastfeeding for infants up to 6 months is widely recommended, yet breastfeeding rates are relatively low in the US. The most common reason women stop breastfeeding early is a perceived insufficiency of milk. Galactagogues are herbal and pharmaceutical products that can help increase milk supply; however, data on their efficacy and safety is limited. Lactation consultants, obstetricians, and other health providers are an important point of contact for breastfeeding women experiencing challenges with lactation. This study explored providers' perceptions, experiences, and practices in relation to galactagogue recommendation. METHOD: A cross-sectional survey was conducted among a convenience sample of English-speaking health providers in the US who counsel breastfeeding women and their infants. RESULTS: More than 70% of respondents reported to recommend galactagogues. The most frequently recommended galactagogue was fenugreek with respondents indicating that they recommend it either 'always' (8.5%) or 'most of the time' (14.9%) and 'sometimes' (46.8%). More than 80% of the respondents indicated that galactagogues were useful for their clients and only one-third reported side effects. Reasons for refraining from recommending galactagogues were insufficient evidence of its efficacy and safety. Respondents reported a wide variety of sources of information used for their own education about galactagogues. DISCUSSION: Despite little evidence regarding safety and efficacy, some galactagogues are widely recommended and often perceived to be useful. However, concerns about their efficacy and safety remain. In order to assure both providers and users about safety and efficacy, more robust studies as well as better pharmacovigilance systems are needed.