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Health Promot Int ; 2021 Nov 29.
Artículo en Inglés | MEDLINE | ID: mdl-34849866


Brief alcohol advice offered to patients was shown to be a clinically- and cost-effective intervention to prevent and manage alcohol-related health harm. However, this intervention is not yet optimally implemented in practice. A suggested strategy to improve the implementation of brief alcohol advice is through community actions which would enhance the environment in which primary healthcare providers must deliver the intervention. However, there has been scarce research conducted to date regarding which community actions have most influence on the adoption and implementation of brief alcohol advice. The current protocol presents the development of a package of community actions to be implemented in three Latin American municipalities, in Colombia, Mexico and Peru. The community actions were based on the Institute for Health Care Improvement's framework for going to full scale, and include: (i) involvement of a Community Advisory Board, (ii) involvement of a project champion, (iii) adoption mechanisms, (iv) support systems and (v) a communication campaign. By presenting a protocol for developing community actions with input from local stakeholders, this article contributes to advancing the public health field of alcohol prevention by potentially stimulating the sustainable adoption and implementation of brief alcohol advice in routine practice.

Subst Abus ; : 1-9, 2021 Apr 13.
Artículo en Inglés | MEDLINE | ID: mdl-33849396


Background: Screening for unhealthy alcohol use in routine consultations can aid primary health care (PHC) providers in detecting patients with hazardous or harmful consumption and providing them with appropriate care. As part of larger trial testing strategies to improve implementation of alcohol screening in PHC, this study investigated the motivational (role security, therapeutic commitment, self-efficacy) and organizational context (leadership, work culture, resources, monitoring, community engagement) factors that were associated with the proportion of adult patients screened with AUDIT-C by PHC providers in Colombia, Mexico and Peru. Additionally, the study investigated whether the effect of the factors interacted with implementation strategies and the country. Methods: Pen-and-paper questionnaires were completed by 386 providers at the start of their study participation (79% female, Mage = 39.5, 37.6% doctors, 15.0% nurses, 9.6% psychologists, 37.8% other professional roles). They were allocated to one of four intervention arms: control group; short training only; short training in presence of municipal support; and standard (long) training in presence of municipal support. Providers documented their screening practice during the five-month implementation period. Data were collected between April 2019 and March 2020. Results: Negative binomial regression analysis found an inverse relationship of role security with the proportion of screened patients. Self-efficacy was associated with an increase in the proportion of screened patients only amongst Mexican providers. Support from leadership (formal leader in organization) was the only significant organizational context factor, but only in non-control arms. Conclusion: Higher self-efficacy is a relevant factor in settings where screening practice is already ongoing. Leadership support can enhance effects of implementation strategies.

Prim Health Care Res Dev ; 22: e4, 2021 01 28.
Artículo en Inglés | MEDLINE | ID: mdl-33504413


BACKGROUND: Providing alcohol screening and brief advice (SBA) in primary health care (PHC) can be an effective measure to reduce alcohol consumption. To aid successful implementation in an upper middle-income country context, this study investigates the perceived appropriateness of the programme and the perceived barriers to its implementation in PHC settings in three Latin American countries: Colombia, Mexico and Peru, as part of larger implementation study (SCALA). METHODS: An online survey based on the Tailored Implementation for Chronic Diseases (TICD) implementation framework was disseminated in the three countries to key stakeholders with experience in the topic and/or setting (both health professionals and other roles, for example regional health administrators and national experts). In total, 55 respondents participated (66% response rate). For responses to both appropriateness and barriers questions, frequencies were computed, and country comparisons were made using Chi square and Kruskal-Wallis non-parametric tests. RESULTS: Alcohol SBA was seen as an appropriate programme to reduce heavy alcohol use in PHC and a range of providers were considered suitable for its delivery, such as general practitioners, nurses, psychologists and social workers. Contextual factors such as patients' normalised perception of their heavy drinking, lack of on-going support for providers, difficulty of accessing referral services and lenient alcohol control laws were the highest rated barriers. Country differences were found for two barriers: Peruvian respondents rated SBA guidelines as less clear than Mexican (Mann-Whitney U = -18.10, P = 0.001), and more strongly indicated lack of available screening instruments than Colombian (Mann-Whitney U = -12.82, P = 0.035) and Mexican respondents (Mann-Whitney U = -13.56, P = 0.018). CONCLUSIONS: The study shows the need to address contextual factors for successful implementation of SBA in practice. General congruence between the countries suggests that similar approaches can be used to encourage widespread implementation of SBA in all three studied countries, with minor tailoring based on the few country-specific barriers.

Atención Primaria de Salud , Adolescente , Adulto , Anciano , Colombia , Intervención en la Crisis (Psiquiatría) , Estudios Transversales , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Perú , Adulto Joven
Rev. Fac. Med. UNAM ; 58(2): 41-43, mar.-abr. 2015. graf
Artículo en Español | LILACS-Express | LILACS | ID: biblio-957040


Resumen: Presentación del caso: Paciente femenino de 2 años de edad con malformación Anorrectal y fístula rectovestibular a quién se realizó colostograma distal con sulfato de bario provocando concreción lítica de bario en el fondo de saco del colon distal al no enjuagar el contenido. Ante la imposibilidad de retirar el enterolito a través del estoma disfuncional de la derivación intestinal decidimos realizar la extracción al momento de hacer la anorrectoplastía sagital posterior con riesgo aumentado de infección, dehiscencia de herida y lesión de estructuras adyacentes. Enfatizamos la necesidad de recordar a la comunidad médica radiológica y pediátrica de la adecuada realización de este tipo de estudios siempre con medio de contraste hidrosoluble, y aprovechamos para recapitular la técnica de realización del mismo.

Abstract: Case presentation: 2 year-old female patient with anorectal malformation with recto-vestibular fistula to whom a distal colostogram with barium sulfate was done, thus provoking lithic concretion in the distal sac. Since it was deemed impossible to extract the enterolith trough de distal stoma we decided to perform the anorectoplasty and extract the lit at that moment knowing the increased surgical risks such as infection, dehiscence and damage of adjacent structures. We stress the need to remind the radiological and pediatric medical communities to always perform this kind of imaging studies with water-soluble contrast agents and we also annotate the technique for doing so.

Ecology ; 95(5): 1141-52, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-25000746


Identifying factors that may be responsible for regulating the size of animal populations is a cornerstone in understanding population ecology. The main factors that are thought to influence population size are either resources (bottom-up), or predation (top-down), or interspecific competition (parallel). However, there are highly variable and often contradictory results regarding their relative strengths and influence. These varied results are often interpreted as indicating "shifting control" among the three main factors, or a complex, nonlinear relationship among environmental variables, resource availability, predation, and competition. We argue here that there is a "missing link" in our understanding of predator-prey dynamics. We explore whether the landscape-of-fear model can help us clarify the inconsistencies and increase our understanding of the roles, extent, and possible interactions of top-down, bottom-up, and parallel factors on prey population abundance. We propose two main predictions derived from the landscape-of-fear model: (1) for a single species, we suggest that as the makeup of the landscape of fear changes from relatively safe to relatively risky, bottom-up impacts switch from strong to weak as top-down impacts go from weak to strong; (2) for two or more species, interspecific competitive interactions produce various combinations of bottom-up, top-down, and parallel impacts depending on the dominant competing species and whether the landscapes of fear are shared or distinctive among competing species. We contend that these predictions could successfully explain many of the complex and contradictory results of current research. We test some of these predictions based on long-term data for small mammals from the Chihuahuan Desert in the United States, and Mexico. We conclude that the landscape-of-fear model does provide reasonable explanations for many of the reported studies and should be tested further to better understand the effects of bottom-up, top-down, and parallel factors on population dynamics.

Dipodomys/fisiología , Miedo , Modelos Biológicos , Conducta Predatoria , Animales , Ecosistema , Plantas , Densidad de Población