Changing levels of income and multidimensional poverty among persons with disabilities in Colombia: A pseudo panel analysis.

In Colombia, more than 4 per cent of the population lives with disability and high levels of income and multidimensional poverty have been recognised within this group. However, there is no information on how the levels of poverty have changed over time or whether households with members with disabilities are more likely to be chronically poorer than households without disabilities in the country. In addition, no evidence exists on the potential effect of the Covid-19 pandemic on the socioeconomic characteristics of persons with disability. This study aims to contribute to the literature on this topic by analysing a nationally representative survey (Quality of Life Survey) from 2018 to 2022 and studying the changes in the levels of income and multidimensional poverty of persons with disabilities and their household, and identifying whether any changes associated with the Covid-19 pandemic.

Acompañamiento creativo para el duelo por muerte en contexto hospitalario: Laexperiencia en un Hospital en Bogotá / Apoio criativo ao luto pela morte no contexto hospitalar: a experiência em umhospital de Bogotá / Creative support for death grief in a hospital context: the experience in a Bogotá hospital

The article presents the results of a participatory research process based on the arts, whichsought to incorporate art and creativity in seven units of a high-complexity university hospital, forsupport at the end of life and bereavement. This was done through the provision of kits with materials with creative potential and the development of awareness and creation workshops with healthand administrative staff, patients, and family members. The process was produced through participant observation and field diaries. Informal, semi-structured interviews and a discussion groupwere also conducted to identify the main barriers and facilitators of the proposal. We conclude that,in order to integrate this type of resources and for care centered on the person and families, healthservices require deep transformations that include death as a significant experience, giving space totheir own mourning and emotions, which would reduce Fatigue due to inflammation is very frequent in health personnel confronted with death in a systematic way. The project was approved bythe respective ethics committee.(AU)

El artículo presenta los resultados de un proceso de investigación participativa basadaen las artes, en el que se buscó incorporar el arte y la creatividad en siete unidades de un hospitaluniversitario de alta complejidad, para el acompañamiento en final de vida y duelo. Esto se hizo através de la disposición de kits con materiales con potencial creativo y el desarrollo de talleres desensibilización y creación con personal sanitario, administrativo, pacientes y familiares. El procesose registró a través de observación participante y diarios de campo. También se realizaron reunionesperiódicas, entrevistas informales, semiestructuradas de seguimiento y un grupo de discusión paraidentificar las principales barreras y facilitadores de la propuesta. Concluimos que, para poderintegrar este tipo de recursos y para una atención centrada en la persona y las familias, los serviciosde salud requieren transformaciones de fondo que incluyan la muerte como experiencia significante, dando espacio a sus propios duelos y emociones, lo que reduciría la fatiga por compasiónmuy frecuente en personal de salud enfrentado a la muerte de manera sistemática. El proyecto contócon la aprobación del comité de ética respectivo.(AU)

O artigo apresenta os resultados de um processo de pesquisa participativa baseado nasartes, que buscou incorporar arte e criatividade em sete unidades de um hospital universitário dealta complexidade, para apoio no final da vida e luto. Isso foi feito por meio da disponibilização dekits com materiais com potencial criativo e do desenvolvimento de oficinas de sensibilização e criação com equipe de saúde e administrativa, pacientes e familiares. O processo foi produzido pormeio de observação participante e diários de campo. Também foram realizadas entrevistas informais semiestruturadas e um grupo de discussão para identificar as principais barreiras e facilitadores da proposta. Concluímos que, para integrar este tipo de recursos e para um cuidado centradona pessoa e na família, os serviços de saúde necessitam de profundas transformações que incluama morte como uma experiência significativa, dando espaço ao seu próprio luto e emoções, o quereduziria a Fadiga por a inflamação é muito frequente em profissionais de saúde confrontados coma morte de forma sistemática. O projeto foi aprovado pelo respectivo comitê de ética.(AU)

Network of actors involved in the identification, care, and follow-up of unhealthy alcohol use in primary care in Colombia.

This article explores the structure of the network of actors involved in the care of individuals with unhealthy alcohol use (UAU) at the primary care level in five primary care centers in Colombia between 2017 and 2018. We use the Actor-Network Theory Framework (ANT) which posits that health outcomes are a product of a multitude of relationships between different stakeholders. The article focuses on the network configuration that develops between the actors and its effects on the processes of identification, care, and follow-up of people with UAU. The data come from five care centers that participated in the pilot phase of an implementation research project that seeks to apply evidence-based interventions for the detection and treatment of depression and unhealthy alcohol use. Semi-structured interviews and focus groups (FG) were conducted with patients, health and administrative staff, and users from Alcoholics Anonymous. The interviews were transcribed and coded using N-Vivo. The analysis identified the ways in which actors are linked by the community to UAU. The results of this qualitative approach based on ANT present the actors identified in a non-linear network with different dimensions.

Toma de decisiones centradas en la familia en la enfermedad renal crónica avanzada. De la autonomía individual a la autonomía familiar o comunitaria / Family Centered Decision Making in Advanced Chronic Kidney Disease. From individual autonomy to family or community autonomy / Tomada de decisões centradas na família na enfermidade renal crônica avançada. Da autonomia individual à autonomia familiar ou comunitária

Resumen El aumento de la tasa de incidencia y prevalencia de la enfermedad renal crónica plantea desafíos y dilemas éticos que tanto pacientes como familiares y profesionales de salud deben enfrentar diariamente. El objetivo de este artículo es reflexionar acerca de que, para la toma decisiones, los pacientes recurren a terceros como partícipes, lo que a nuestro juicio requiere un abordaje desde la autonomía solidaria. Se presenta el análisis de doce entrevistas semiestructuradas, realizadas a pacientes de 60 años o más, de distintos programas de la Unidad de Nefrología del Hospital Universitario San Ignacio, Colombia, entre 2017-2018. El artículo propone la necesidad de toma de decisiones centradas en la familia de los pacientes con enfermedades crónicas, antes de que su estado sea avanzado y los estados de inconciencia impidan su autodeterminación, considerando la determinación social de la autonomía.

Abstract The increase in the incidence and prevalence rate of Chronic Kidney Disease poses challenges and ethical dilemmas that patients, family members and health professionals must face daily. The objective of this article is to present a reflection on the way in which patients make recourse to third parties as participants in their decision-making, which would require an approach based on solidarity autonomy. The analysis of twelve semi-structured interviews conducted with patients 60 years of age and older, from different programs of the Nephrology Unit of the Hospital Universitario San Ignacio in the period 2017-2018 Colombia, is presented. This article proposes the need for family-centered decision making of patients with chronic diseases, before their state is advanced and states of unconsciousness prevent their self-determination, considering the social determination of autonomy.

Resumo O aumento da taxa de incidência e prevalência da enfermidade renal crônica coloca desafios e dilemas éticos que tanto pacientes como familiares e professionais da saúde devem enfrentar diariamente. O objetivo deste artigo é refletir acerca de que, para a tomada de decisões, os pacientes recorrem a terceiros como partícipes, o que a nosso juízo requer uma abordagem a partir da autonomia solidária. Se apresenta a análise de doze entrevistas semiestruturadas, realizadas com pacientes de 60 anos ou mais, de distintos programas da Unidade de Nefrologia do Hospital Universitário San Ignacio, Colômbia, entre 2017-2018. O artigo propõe a necessidade de tomada de decisões centradas na família dos pacientes com enfermidades crônicas, antes que seu estado esteja avançado e estados de inconsciência impeçam sua autodeterminação, considerando a determinação social da autonomia.

A lo largo del siglo XIX, diferentes médicos argumentaron cómo los problemas sanitarios no solo debían recibir respuestas médicas, sino también respuestas políticas, económicas, sociales y culturales.[ Editorial] / Throughout the 19th century, different doctors argued that health problems should not only receive medical responses, but also political, economic, social, and cultural responses. [Editorial]

A lo largo del siglo xix, diferentes médicos argumentaron cómo los problemas sanitarios no solo debían recibir respuestas médicas, sino también respuestas políticas, económicas, sociales y culturales. Rudolf Virchow, influenciado por el pensamiento socio-médico francés, consideraba que la medicina tenía fuertes relaciones con la sociedad, y la salud y la enfermedad estaban entremezcladas en el tejido social. Así, consideró que, por un lado, la acción política entraba dentro del campo de la medicina, y, por el otro, que las reformas sociales eran del interés del médico y sus obligaciones a asumir. Concluyó que la medicina podría pensarse como una ciencia social y la política, principal herramienta de prevención, pasaba a ser un instrumento médico. Este pensamiento quedó registrado en la célebre frase "la medicina es una ciencia social y la política no es más que medicina en una escala más amplia" (Die Medizin ist eine soziale Wissenschaft, und die Politik ist nichts weiter als Medizin im Großen). Salomón Neumann, alineado con Virchow, creía que la salud del pueblo era un problema que concernía a toda la sociedad y, por ende, al Estado, al vincularse directamente con las condiciones contextuales de la vida de las personas. Este médico dejó escrito que "la mayor parte de las enfermedades [...] dependen de condiciones sociales, establecidas culturalmente".

Throughout the nineteenth century, different physicians argued that health problems should not only receive medical responses, but also political, economic, social and cultural responses. Rudolf Virchow, influenced by French socio-medical thought, considered that medicine had strong relations with society, and health and disease were interwoven in the social fabric. Thus, he considered that, on the one hand, political action fell within the field of medicine, and, on the other, that social reforms were in the interest of the physician and his obligations to assume. He concluded that medicine could be thought of as a social science and politics, the main tool of prevention, became a medical instrument. This thought was recorded in the famous phrase "medicine is a social science and politics is nothing more than medicine on a broader scale" (Die Medizin ist eine soziale Wissenschaft, und die Politik ist nichts weiter als Medizin im Großen). Solomon Neumann, aligned with Virchow, believed that the health of the people was a problem that concerned the whole society and, therefore, the state, as it was directly linked to the contextual conditions of people's lives. This physician wrote that "most diseases [...] depend on social conditions, culturally established".

Comparing a Mobile Decision Support System Versus the Use of Printed Materials for the Implementation of an Evidence-Based Recommendation: Protocol for a Qualitative Evaluation.

BACKGROUND: The distribution of printed materials is the most frequently used strategy to disseminate and implement clinical practice guidelines, although several studies have shown that the effectiveness of this approach is modest at best. Nevertheless, there is insufficient evidence to support the use of other strategies. Recent research has shown that the use of computerized decision support presents a promising approach to address some aspects of this problem. OBJECTIVE: The aim of this study is to provide qualitative evidence on the potential effect of mobile decision support systems to facilitate the implementation of evidence-based recommendations included in clinical practice guidelines. METHODS: We will conduct a qualitative study with two arms to compare the experience of primary care physicians while they try to implement an evidence-based recommendation in their clinical practice. In the first arm, we will provide participants with a printout of the guideline article containing the recommendation, while in the second arm, we will provide participants with a mobile app developed after formalizing the recommendation text into a clinical algorithm. Data will be collected using semistructured and open interviews to explore aspects of behavioral change and technology acceptance involved in the implementation process. The analysis will be comprised of two phases. During the first phase, we will conduct a template analysis to identify barriers and facilitators in each scenario. Then, during the second phase, we will contrast the findings from each arm to propose hypotheses about the potential impact of the system. RESULTS: We have formalized the narrative in the recommendation into a clinical algorithm and have developed a mobile app. Data collection is expected to occur during 2018, with the first phase of analysis running in parallel. The second phase is scheduled to conclude in July 2019. CONCLUSIONS: Our study will further the understanding of the role of mobile decision support systems in the implementation of clinical practice guidelines. Furthermore, we will provide qualitative evidence to aid decisions made by low- and middle-income countries' ministries of health about investments in these technologies.