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Background: Oral health is considered an important public policy. This study aimed to understand which barriers and facilitator occurs during the implementation of oral health programs/policies. Methods: A qualitative study was conducted within personal interviews with decision-makers, at the political, technical, and academic levels. Data were transcribed and analyzed using Maxqda®. Results: The formation of dentists with an emphasis on the public service proved to be a critical knot, also the population´s lack of knowledge about their rights was mentioned. In Chile and Colombia, one of the main facilitators was the previous existence of oral health programs. As barrier, the lack of systematization of epidemiological data. In Brazil, the main facilitators were many dentists available and the political will of politicians to include oral health as public. Managers unprepared to work in public service was one of the main barriers. Conclusions: During the development and implementation of public policies several factors are encountered, it can be concluded that human resources are fundamental elements for the functioning of public service, besides the interest of the managers and politicians for the inclusion of this theme in the political agenda of the country.

Background: The best scientific evidence is required to design effective Non-pharmaceutical interventions to help policymakers to contain COVID-19 Aim: To describe which Non-pharmaceutical interventions used different countries and a when they use them It also explores how Non-pharmaceutical interventions impact the number of cases, the mortality, and the capacity of health systems Methods: We consulted eight web pages of transnational organizations, 17 of international media, 99 of government institutions in the 19 countries included, and besides, we included nine studies (out of 34 identified) that met inclusion criteria Result: Some countries are focused on establishing travel restrictions, isolation of identified cases, and high-risk people Others have a combination of mandatory quarantine and other drastic social distancing measures The timing to implement the interventions varied from the first fifteen days after detecting the first case to more than 30 days The effectiveness of isolated non-pharmaceutical interventions may be limited, but combined interventions have shown to be effective in reducing the transmissibility of the disease, the collapse of health care services, and mortality When the number of new cases has been controlled, it is necessary to maintain social distancing measures, self-isolation, and contact tracing for several months The policy decision-making in this time should be aimed to optimize the opportunities of saving lives, reducing the collapse of health services, and minimizing the economic and social impact over the general population, but principally over the most vulnerable The timing of implementing and lifting interventions could have a substantial effect on those objectives Resumen Antecedentes: Se requiere la mejor evidencia cientifica para disenar intervenciones no farmacologicas efectivas para ayudar a los formuladores de politicas a contener COVID-19 Objetivo: Describir que intervenciones no farmacologicas utilizaron diferentes paises y cuando las implementaron Tambien explora como las intervenciones no farmacologicas afectan el numero de casos, la mortalidad y la capacidad de los sistemas de salud Metodos: Consultamos ocho paginas web de organizaciones transnacionales, 17 de medios internacionales, 99 de instituciones gubernamentales en los 19 paises incluidos, y ademas, incluimos nueve estudios (de 34 identificados) que cumplian con los criterios de inclusion Resultados: Algunos paises implementaron restricciones de viaje, aislamiento de casos identificados y personas de alto riesgo Otros combinaron varias medidas mas drasticas de distanciamiento social El tiempo para implementar las intervenciones vario desde los primeros quince dias despues de detectar el primer caso hasta mas de 30 dias La efectividad de las intervenciones no farmacologicas combinadas ha demostrado ser efectivas para reducir la transmisibilidad de la enfermedad, el colapso de los servicios de salud y la mortalidad Cuando se controle el numero de casos nuevos, es necesario mantener medidas de distanciamiento social, autoaislamiento y rastreo de contactos durante varios meses La toma de decisiones politicas en este momento debe tener como objetivo optimizar las oportunidades de salvar vidas, reducir el colapso de los servicios de salud y minimizar el impacto economico y social sobre la poblacion en general, pero principalmente sobre los mas vulnerables

To contextualize a synthesis of evidence on interventions in student mental health during the COVID-19 pandemic through a deliberative dialogue with Ibero-American universities.An evidence synthesis and synchronous dialogues were previously conducted, consisting of subgroup discussions about the design and implementation of mental health interventions. An analysis of dialogic data was conducted, then organized by topic.Fifty-seven representatives of 17 public and private Ibero-American universities participated in the meeting. In terms of the design of interventions, mental health is perceived as neglected, although its profile was raised by the pandemic. Interventions are guided by detection of needs; scientific evidence is rarely used to design them. Importance was given to forming an interdisciplinary team with continuous training in order to design a specific program that also covers families and teaching/administrative staff. In terms of implementation, problems include saturation of services due to high demand and lack of basic resources among students. Regarding the provision of resources, the influence of the broader context, including the institutional context, is undeniable. The dialogues were perceived as an opportunity to build a new set of interventions.These dialogues enriched the description of interventions already described in the literature on student mental health during the COVID-19 pandemic. However, implementing such interventions in the region means addressing previous neglect and a high level of unmet basic needs.Contextualizar uma síntese de evidências sobre intervenções em saúde mental de estudantes universitários na pandemia de COVID-19, por meio do diálogo deliberativo com universidades ibero-americanas.A partir de uma síntese de evidências previamente elaborada, o diálogo síncrono foi conduzido por meio de discussões em subgrupos sobre o planejamento e a implementação de intervenções em saúde mental. Os dados obtidos foram analisados e resumidos por área temática.Cinquenta e sete integrantes de 17 universidades ibero-americanas públicas e privadas participaram do encontro. Os participantes indicaram que a saúde mental é negligenciada no planejamento das intervenções, mas ganhou visibilidade na pandemia. As intervenções são direcionadas às necessidades identificadas e raramente planejadas com base em evidências científicas. Disseram considerar importante formar uma equipe interdisciplinar com capacitação contínua para planejar um programa específico que englobe também familiares e o corpo docente e administrativo. Implementar intervenções é complicado porque os serviços estão sobrecarregados devido à grande demanda e à falta de recursos básicos para os estudantes. O contexto macro e institucional claramente influencia a disponibilização de recursos. O diálogo foi visto como uma oportunidade para consolidar um novo conjunto de intervenções.O presente diálogo contribuiu para enriquecer a literatura de intervenções de saúde mental para estudantes universitários na pandemia de COVID-19. Implementar intervenções no nosso contexto requer sanar as falhas por negligência passada e as enormes necessidades básicas não atendidas.

Resumen Introduccion Los estudiantes de educacion superior son una poblacion vulnerable a los trastornos mentales, mas aun durante la pandemia por COVID-19. Su salud mental se ha visto afectada por el confinamiento, las dificultades en el desarrollo de las actividades academicas y las exigencias de las nuevas modalidades pedagogicas. Se planteo entonces la pregunta: en las instituciones de educacion superior, ?cuales acciones en torno a a) promocion y prevencion, b) atencion a sintomas mentales y c) adaptaciones pedagogicas pueden desarrollarse con el fin de mejorar la salud mental de sus estudiantes? Metodos Sintesis critica a partir de la revision sistematica de la literatura. Se realizo la busqueda de articulos cientificos de alcance descriptivo, analitico, experimental o evaluativo, asi como recursos web de organizaciones relacionadas con el tema. Se realizo una sintesis en funcion de los 3 focos de la pregunta mediante comparacion constante, hasta realizar la agrupacion de acciones por similitud en los actores que las ejecutarian y recibirian. Se anticipo una baja calidad de la evidencia, por lo que no se realizo evaluacion estandarizada. Resultados Se exploraron 68 articulos y 99 recursos web. Despues de la revision del texto completo se incluyeron 12 articulos cientificos y 11 recursos web. Como lineamentos generales, se encontro que la propuesta mas frecuente es el diseno de un programa estructurado especifico para el tema de salud mental en las instituciones educativas, que sea multidisciplinario, incluyente, dinamico y sensible a la cultura. Las acciones deben ser divulgadas periodicamente para que los estudiantes y demas miembros de la comunidad educativa las tengan claras, e idealmente se propone mantenerlas hasta el periodo pospandemico e incluir a los egresados. Para a) la promocion y prevencion, se encontro la psicoeducacion por via electronica, donde se expliquen estilos de vida saludable, reacciones emocionales en pandemia, estrategias de afrontamiento y signos de alarma. Se propone la participacion de los pares como estrategia de apoyo y espacios de interaccion social que no se enfoquen unicamente en aspectos academicos. Se reporta la necesidad de cribar sintomas mentales por medio de envio frecuente de formularios en linea o aplicaciones moviles, donde tambien se indague por la satisfaccion de las necesidades basicas y tecnologicas. En cuanto a b) atencion de sintomas mentales, una de las acciones que se encontro con mayor frecuencia es disponer de un centro de consultoria que sea capaz de realizar atencion en salud mental por via telefonica, por tecnologias e incluso presencial, con atencion permanente las 24 h o equipos de respuesta rapida ante una situacion de crisis, como la conducta suicida y la violencia domestica. Para c) las adaptaciones pedagogicas, se senala como requisito indispensable la comunicacion fluida para tener instrucciones claras sobre el desarrollo de las actividades academicas para disminuir la incertidumbre y, por ende, la ansiedad y favorecer la gestion del tiempo por el estudiante. Los profesores y pedagogos de la institucion pueden ofrecer asesorias directas (por videollamadas o reuniones de grupos en linea) para proveer apoyo en habitos de estudios, materias propias de cada carrera y salud mental. Conclusiones Los recursos incluidos proponen que la institucion educativa cree un programa que aborde especificamente la salud mental de los estudiantes. Esta sintesis puede proveer lineamientos que faciliten la toma de decisiones, sin perder de vista que la institucion y el estudiante estan inmersos en un contexto complejo, con circunstancias y otros actores en varios niveles que tambien intervienen en la salud mental. Se requieren investigaciones sobre la evolucion de la situacion de salud mental y el efecto de las acciones que se vayan tomando.

Background: Ischemic Cerebrovascular Accident (CVA) is the second cause of death and one of the leading causes of disability in the world. In Colombia, there is a prevalence of 0.16% and a mortality rate of 16.82 deaths per 100,000 inhabitants. This study assessed the Colombian Ministry of Health’s Emergency Department Triage Policy (TP) on the timeliness of hospital care, the mortality, and change in reperfusion therapy of patients with the first episode of an CVA in the Emergency Department (ED) of a hospital in the city of Medellín.Methods: A controlled interrupted time series analysis between January 2011 and November 2017 was performed in one emergency department using segmented regression analysis. The emergency department of other hospital was used as a control. Data were aggregated by month for both ED, including 60 pre-intervention and 23 intervention points.Results: No decrease in the timeliness of care in the ED was found in patients with a stroke after implementing the Colombian Ministry of Health’s TP (12.55 minutes, IC -17.07, 42.17; p: 0.4). The TP intervention produced a level change in the timeliness of care in Triage I and II subgroups, of 28.34 minutes (IC 95% 16.9, 39.79; p valor 0.00), there was no change in the trend. The classification of Triage I and II was more frequent in the post-intervention period. There was evidence of the increase in reperfusion therapy with tissue plasminogen activator (rTPA) in 4% (95% CI – 0.08, - 0.01; p value 0.01). Mortality increased 4% in the post-intervention period without being statistically significant (0.04, IC 95% - 0.08 – 0; p valor 0.06). There were no significant changes in the same outcomes in the control group.Conclusions: The implementation of the triage policy allowed improving the timeliness of ED care only in patients with ischemic CVA classified as Triage I and II, in an Emergency Department in the city of Medellín, Colombia.

Background The issue of lower extremity amputation has been in the Colombian political agenda for its relationship with the armed conflict and antipersonnel mines. In 2015 the Colombian Ministry of Health published a national clinical practice guideline (CPG) for amputee patients. However, there is a need to design implementation strategies that target end-users and the context in which the CPG will be used. This study aims to identify users’ perceptions about the barriers and facilitators for implementing the guideline for the care of amputee patients in a middle-income country such as Colombia. Methods Semi-structured interviews were conducted with 38 users, including patients, health workers, and administrative staff of institutions of the health system in Colombia. Individuals were purposively selected to ensure different perspectives, allowing a balance of individual positions. Results According to participants’ perceptions, barriers to implementation are classified as individual barriers (characteristics of the amputee patient and professionals), health system barriers (resource availability, timely care, information systems, service costs, and regulatory changes), and barriers related to clinical practice guidelines (utility, methodological rigour, implementation flexibility, and characteristics of the group developing the guidelines). Conclusions Our study advances knowledge on the perceived individual and health system barriers and facilitators for the implementation of the CPG for amputee patients in Colombia. Importantly, the governance, financial, and service delivery arrangements of the Colombian health system are determining factors in implementing CPGs. For example, the financial arrangements between the insurance companies and the health care provider institutions were identified as barriers for the implementation of recommendations related to the continuity and opportunity of care of patients with amputations. The design of implementation strategies that successfully address the individual behaviours and the contextual health systems arrangements may significantly impact the health care process for amputee patients in Colombia.

Introduction Clinical practice guidelines (CPGs) are designed to improve the quality of care and reduce unjustified individual variation in clinical practice. Knowledge of the barriers and facilitators that influence the implementation of the CPG recommendations is the first step in creating strategies to improve health outcomes. The present systematic meta-review sought to explore the barriers and facilitators for the implementation of CPGs. Methods A search was conducted in the PubMed, Embase, Cochrane, Health System Evidence and International Guideline Library (G-I-N) databases. Systematic reviews of qualitative, quantitative or mixed-methods studies that identified barriers or facilitators for the implementation of CPGs were included. The selection of the title and abstract, the evaluation of the full text, extraction of the data and the quality assessment were carried out by two independent reviewers. To summarise the evidence, we grouped the barriers and facilitators according to the following contexts: political and social, health organisational system, guidelines, health professionals and patients. Results Overall, 25 systematic reviews were selected. The relevant barriers in the social-political context were the absence of a leader, difficulties with teamwork and a lack of agreement with colleagues. Relevant barriers in the health system were a lack of time, financial problems and a lack of specialised personnel. Barriers of the CPGs included a lack of clarity and a lack of credibility in the evidence. Regarding the health professional, a lack of knowledge about the CPG and confidence in oneself were relevant. Regarding patients, a negative attitude towards implementation, a lack of knowledge about the CPG and sociocultural beliefs played a role. Some of the most frequent facilitators were consistent leadership, commitment of the members of the team, administrative support of the institution, existence of multidisciplinary teams, application of technology to improve the practice and education regarding the guidelines. Conclusions The barriers and facilitators described in this review are factors that influence the implementation of evidence in clinical practice. Knowledge of these factors should contribute to the development of a theoretical basis for the creation of CPG implementation strategies to improve professional practice and health outcomes for patients.

La pandemia por Coronavirus 2019 (Covid-19) ha profundizado las desigualdades preexistentes de las personas con discapacidad. Los afectados por Covid-19 se encuentran entre los grupos más vulnerables al ser uno de los grupos más excluidos de la sociedad. El objetivo del presente estudio esidentificarlas declaracionesyrecomendaciones que las organizacionessupranacionales han emitido para garantizar los derechos de las personas con discapacidad en la actual pandemia. Se realizó una búsqueda amplia y sistemática; fueron consultadas 20 organizaciones y analizados 58 documentos en esta síntesis rápida. Los documentos encontrados fueron asignados en cuatro categorías dependiendo de su enfoque principal: principio de igualdad y no discriminación (25,8%), derecho al respeto de la dignidad inherente (10,3%), derecho a la accesibilidad (36,2%) y derecho a la salud (27,6%). Las organizaciones supranacionales hacen un llamado a los gobiernos a garantizar la protección y promoción de los derechos de las personas con discapacidad y a implementar medidas y estrategias razonables que aborden las necesidades especiales de esta población en la actual pandemia.