Educación de la primera infancia en Centroamérica y República Dominicana: conclusiones de un estudio regional

This article presents the results on the landscape analysis of early childhood education in Central America and the Dominican Republic developed by the Central American and Caribbean Early Literacy Network (RedLEI). Good quality educational programs take advantage of the potential of early childhood to develop fundamental skills for the benefit of lifelong learning. It is therefore essential to invest in good quality education and care programs to support human development policies and programs. The results answer the following question: What is the alignment of evidence on early childhood education best practices with the educational policy in Central America and the Dominican Republic and its implementation? The results are divided in main challenges and opportunities that emerged as common problems in the region and potential solutions suggested each of the study's participant countries.Este artículo expone las conclusiones de la investigación sobre el panorama de la educación de la primera infancia en Centroamérica y la República Dominicana desarrollada por la Red para Lectoescritura Inicial de Centroamérica y el Caribe (RedLEI). Los programas educativos de buena calidad aprovechan las potencialidades de la edad infantil para desarrollar habilidades fundamentales en beneficio del aprendizaje a lo largo de la vida. Por ello es fundamental invertir en buenos programas de educación y cuido, en respaldo de las políticas y programas de desarrollo humano. Se presentan los resultados que buscaron responder la siguiente pregunta: ¿Cuál es la alineación entre la evidencia investigativa sobre la educación de la primera infancia con la política educativa de Centroamérica y la República Dominicana y su implementación? Se proponen los desafíos y oportunidades principales que emergen como problemas compartidos en la región en este ámbito y propuestas sugeridas desde los mismos países como potenciales soluciones

Transición a la educación remota en emergencia de docentes y estudiantes en Centroamérica y el Caribe

Closure of higher education institutions in the face of the COVID-19 pandemic forced  a necessary transition to Emergency Remote Teaching (ERT). The objective of this study is to describe the landscape of the ERT transition based on the experiences of tertiary level teachers and students in Guatemala, Honduras, El Salvador, Nicaragua, Costa Rica and the Dominican Republic, in the context of the COVID-19 pandemic. The study is framed within a descriptive quantitative approach. A Google Forms Questionnaire was sent, with 37 questions directed to the faculty and 38 questions for the student body. A total of 426 teachers and 175 students participated in the survey. It was found that 67.4% of teachers and 74% of students were using remote learning modality for the first time. Teachers identified a series of challenges inherent to ERT and also detailed the activities and materials they used the most for their remote classes. Relevant information was also found on adapting classes into ERT, accessing to resources in ERT, motivation and support of their students’ progress, teaching mastery in ERT, university support for both groups, time dedicated to planning and studying, and progress and understanding of content taught.El cierre de instituciones de nivel superior ante la pandemia del COVID-19 representó una necesaria transición a la educación remota en emergencia (ERE). El objetivo de este estudio es describir el panorama de la transición a la ERE a partir de experiencias de docentes y estudiantes de nivel superior de Guatemala, Honduras, El Salvador, Nicaragua, Costa Rica y República Dominicana en el contexto de la pandemia del COVID-19. El estudio se enmarca desde un enfoque cuantitativo, de alcance descriptivo. Se realizó un cuestionario de Google Forms con 37 preguntas dirigidas al cuerpo docente y 38 preguntas al estudiantado. Participaron en la encuesta un total de 426 docentes y 175 estudiantes. Se encontró que el 67.4% de docentes y el 74% de estudiantes transitaron por primera vez a una modalidad remota. Los docentes se identificaron con una serie de desafíos propios de la ERE y también reportaron las actividades y materiales más utilizados para sus clases en remoto; además, se encontró información relevante sobre la adaptación en la ERE, el acceso a recursos en la ERE, la motivación y acompañamiento del avance del estudiantado, el dominio docente en la ERE, el apoyo de la universidad para ambos grupos, el tiempo dedicado a planificar y estudiar, y el avance y comprensión de contenidos

Diagnosis of sustainable collaboration in health promotion – a case study

<p>Abstract</p> <p>Background</p> <p>Collaborations are important to health promotion in addressing multi-party problems. Interest in collaborative processes in health promotion is rising, but still lacks monitoring instruments. The authors developed the DIagnosis of Sustainable Collaboration (DISC) model to enable comprehensive monitoring of public health collaboratives. The model focuses on opportunities and impediments for collaborative change, based on evidence from interorganizational collaboration, organizational behavior and planned organizational change. To illustrate and assess the DISC-model, the 2003/2004 application of the model to the Dutch whole-school health promotion collaboration is described.</p> <p>Methods</p> <p>The study combined quantitative research, using a cross-sectional survey, with qualitative research using the personal interview methodology and document analysis. A DISC-based survey was sent to 55 stakeholders in whole-school health promotion in one Dutch region. The survey consisted of 22 scales with 3 to 8 items. Only scales with a reliability score of 0.60 were accepted. The analysis provided for comparisons between stakeholders from education, public service and public health.</p> <p>The survey was followed by approaching 14 stakeholders for a semi-structured DISC-based interview. As the interviews were timed after the survey, the interviews were used to clarify unexpected and unclear outcomes of the survey as well.</p> <p>Additionally, a DISC-based document analysis was conducted including minutes of meetings, project descriptions and correspondence with schools and municipalities.</p> <p>Results</p> <p>Response of the survey was 77% and of the interviews 86%. Significant differences between respondents of different domains were found for the following scales: organizational characteristics scale, the change strategies, network development, project management, willingness to commit and innovative actions and adaptations. The interviews provided a more specific picture of the state of the art of the studied collaboration regarding the DISC-constructs.</p> <p>Conclusion</p> <p>The DISC-model is more than just the sum of the different parameters provided in the literature on interorganizational collaboration, organization change, networking and setting-approaches. Monitoring a collaboration based on the DISC-model yields insight into windows of opportunity and current impediments for collaborative change. DISC-based monitoring is a promising strategy enabling project managers and social entrepreneurs to plan change management strategies systematically.</p

Educación de la primera infancia y lectoescritura emergente en Centroamérica y República Dominicana

Early childhood education is crucial for children’s cognitive, emotional, and social development. It has a long-term impact because the first years of life are a period of extensive growth and evolution, in part because of the many changes that occur in the brain. Evidence demonstrates that high quality educational programs are those that take advantage of the potential of early childhood to develop fundamental skills for lifelong learning. Therefore, investing in high quality early childhood education and care programs should be part of the foundation for strengthening human development policies and programs. Having access to quality educational opportunities during childhood contributes to improving social equity and closing inequality gaps, especially for the most disadvantaged children. In this study, early childhood education is defined as the stages, levels or programs of formal and non-formal education offered to children from birth to the time of enrolment in the first grade of primary school. A considerable amount of research has been conducted on the status of international early childhood education and best practices with recommendations that enrich decision making. However, in Central America and the Dominican Republic there is a lack of research that provides a regional overview of the topic and evidence to inform decision making in politics – hence the importance of this work.La educación durante la primera infancia es crucial para el desarrollo cognitivo, emocional y social de las personas y tiene un impacto de largo plazo puesto que, en los primeros años de vida, constituye un período de amplio crecimiento y evolución; en parte, por los numerosos cambios que se producen en el cerebro. La evidencia revela que los programas educativos de buena calidad son los que aprovechan las potencialidades de la edad infantil para desarrollar habilidades fundamentales para el aprendizaje a lo largo de la vida. Por ello, invertir en buenos programas de educación y cuido de la primera infancia debe ser parte de una base fundamental de las políticas y programas de desarrollo humano. Tener acceso a oportunidades educativas de calidad durante la infancia contribuye a mejorar la equidad social y a cerrar las brechas de desigualdad, especialmente en la niñez más desfavorecida. En esta investigación se define a la educación en la primera infancia como las etapas, niveles o programas de educación formal y no formal que se ofrecen a la niñez desde el nacimiento hasta antes de iniciar el primer grado de primaria. Se han desarrollado numerosas investigaciones que dan cuenta de la situación internacional en la educación de la primera infancia y de las mejores prácticas con recomendaciones que enriquecen la toma de decisiones. Sin embargo, en Centroamérica y República Dominicana se carece de investigación que ofrezca un panorama regional del tema y evidencias que informen políticas específicas, de ahí la importancia de este trabajo

Early detection of maternal deaths in Senegal through household-based death notification integrating verbal and social autopsy: a community-level case study

Background: Reliable detection of maternal deaths is an essential prerequisite for successful diagnosis of barriers to care and formulation of relevant targeted interventions. In a community-level case study, the use of household-level surveillance in Senegal unveiled an apparent increase in maternal deaths, which triggered a rapid-cycle collaborative response to implement a multipronged set of quick-win and sustained interventions intended to improve quality care. Methods: Part of a multi-country effort, the Millennium Villages Project is implementing a routine community-level information system in Senegal, able to detect maternal deaths in real-time and uncover clinical and social factors contributing to mortality. Within this geographically demarcated area of approximately 32 000 inhabitants, with a well-structured health system with patient referral services, deaths were registered and notified by community health workers, followed by timely verbal and social autopsies. Using the Pathway to Survival conceptual framework, case analysis and mortality reviews were conducted for evaluation and quality improvement purposes. Results: The estimated maternal mortality rates rose from 67/100000 births in 2009 (1 death), to 202/100000 births in 2010 (3 deaths) and 392/100000 births (5 deaths) in 2011. Although absolute numbers of maternal deaths remained too small for robust statistical analysis, following verbal autopsy analyses in 2011, it became evident that an unexpectedly high proportion of maternal deaths were occurring at the referral hospital, mostly post-Caesarian section. Inadequate case management of post-partum haemorrhage at the referral hospital was the most frequently identified probable cause of death. A joint task team systematically identified several layers of inefficiencies, with a potential negative impact on a larger catchment area than the study community. Conclusions: In this study, routine community-based surveillance identified inefficiencies at a tertiary level of care. Community-level surveillance systems that include pregnancy, birth and death tracking through household visits by community health workers , combined with verbal and social autopsy can identify barriers within the continuum of maternal care. Use of mHealth data collection tools sensitive enough to detect small changes in community-level mortality trends in real-time, can facilitate rapid-cycle quality improvement interventions, particularly when associated with social accountability structures of mortality reviews

Buenas prácticas de atención y educación en la primera infancia en Centroamérica y República Dominicana

This study presents evidence-based best practices in early childhood care and education. The results are derived from a literature review used to build a conceptual framework for this regional study, which was carried out by the Central American and Caribbean Early Literacy Network (RedLEI). The evidence is organized into eight dimensions: 1) political and financial environment; 2) supervision, monitoring, and support; 3) teaching and learning: (curriculum); 4) staff capacity, leadership, and management; 5) socio-emotional relationships; 6) classroom design, environment, and safety; 7) families and communities; and 8) health and nutrition.Este artículo presenta las buenas prácticas basadas en la evidencia en la atención y educación de la primera infancia. Los hallazgos provienen de la revisión de la literatura relevante para construir el marco conceptual de la investigación de la Red para la Lectoescritura Inicial en Centroamérica y el Caribe (RedLEI). Las evidencia investigativa identificadas se organizan en ocho dimensiones: 1) ambiente político y financiero, 2) supervisión, monitoreo y acompañamiento, 3) enseñanza-aprendizaje: (currículo), 4) capacidad del personal, liderazgo y gestión, 5) relaciones socio afectivas, 6) diseño de ambiente y seguridad del aula, 7) familia y comunidades y 8) salud y nutrición

A Prediction Model for Successful Increase of Adalimumab Dose Intervals in Patients with Crohn’s Disease:Secondary Analysis of the Pragmatic Open-Label Randomised Controlled Non-inferiority LADI Trial

Background: In the pragmatic open-label randomised controlled non-inferiority LADI trial we showed that increasing adalimumab (ADA) dose intervals was non-inferior to conventional dosing for persistent flares in patients with Crohn’s disease (CD) in clinical and biochemical remission. Aims: To develop a prediction model to identify patients who can successfully increase their ADA dose interval based on secondary analysis of trial data. Methods: Patients in the intervention group of the LADI trial increased ADA intervals to 3 and then to 4 weeks. The dose interval increase was defined as successful when patients had no persistent flare (&gt; 8 weeks), no intervention-related severe adverse events, no rescue medication use during the study, and were on an increased dose interval while in clinical and biochemical remission at week 48. Prediction models were based on logistic regression with relaxed LASSO. Models were internally validated using bootstrap optimism correction. Results: We included 109 patients, of which 60.6% successfully increased their dose interval. Patients that were active smokers (odds ratio [OR] 0.90), had previous CD-related intra-abdominal surgeries (OR 0.85), proximal small bowel disease (OR 0.92), an increased Harvey-Bradshaw Index (OR 0.99) or increased faecal calprotectin (OR 0.997) were less likely to successfully increase their dose interval. The model had fair discriminative ability (AUC = 0.63) and net benefit analysis showed that the model could be used to select patients who could increase their dose interval. Conclusion: The final prediction model seems promising to select patients who could successfully increase their ADA dose interval. The model should be validated externally before it may be applied in clinical practice. Clinical Trial Registration Number: ClinicalTrials.gov, number NCT03172377.</p

Thioguanine is Effective as Maintenance Therapy for Inflammatory Bowel Disease: A Prospective Multicentre Registry Study

Background and Aims: Thioguanine is a well-tolerated and effective therapy for inflammatory bowel disease [IBD] patients. Prospective effectiveness data are needed to substantiate the role of thioguanine as a maintenance therapy for IBD. Methods: IBD patients who previously failed azathioprine or mercaptopurine and initiated thioguanine were prospectively followed for 12 months starting when corticosteroid-free clinical remission was achieved (Harvey-Bradshaw Index [HBI] ≤ 4 or Simple Clinical Colitis Activity Index [SCCAI] ≤ 2). The primary endpoint was corticosteroid-free clinical remission throughout 12 months. Loss of clinical remission was defined as SCCAI > 2 or HBI > 4, need of surgery, escalation of therapy, initiation of corticosteroids or study discontinuation. Additional endpoints were adverse events, drug survival, physician global assessment [PGA] and quality of life [QoL]. Results: Sustained corticosteroid-free clinical remission at 3, 6 or 12 months was observed in 75 [69%], 66 [61%] and 49 [45%] of 108 patients, respectively. Thioguanine was continued in 86 patients [80%] for at least 12 months. Loss of response [55%] included escalation to biologicals in 15%, corticosteroids in 10% and surgery in 3%. According to PGA scores, 82% of patients were still in remission after 12 months and QoL scores remained stable. Adverse events leading to discontinuation were reported in 11%, infections in 10%, myelo- and hepatotoxicity each in 6%, and portal hypertension in 1% of patients. Conclusion: Sustained corticosteroid-free clinical remission over 12 months was achieved in 45% of IBD patients on monotherapy with thioguanine. A drug continuation rate of 80%, together with favourable PGA and QoL scores, underlines the tolerability and effectiveness of thioguanine for IBD

Guatemala

Los programas efectivos en la enseñanza de la lectoescritura tienen, como denominador común, a docentes con una formación especializada. El estudio que se resume en este artículo sugiere que un grupo importante de educadores de la región no adquiere este nivel de formación y, en consecuencia, desconocen cuáles son y cómo se enseñan las habilidades básicas de la Lectoescritura Inicial (LEI). Los programas de formación inicial carecen de cursos basados en la evidencia científica que preparen en esta materia, de acuerdo con el análisis realizado. La investigación, realizada entre 2018 y 2019, analizó el estado de la formación inicial docente (FID) para la enseñanza de la LEI en una universidad guatemalteca. Se aplicó una metodología cualitativa y se trianguló información obtenida de: (1) el mapeo de currículos de FID en el ámbito de la LEI a partir de un marco conceptual basado en la evidencia investigativa sobre el aprendizaje de la LEI y sobre lo que el cuerpo de docentes en formación debe aprender para su instrucción efectiva; (2) entrevistas a docentes formadores y docentes en formación y (3) observaciones de aulas universitarias. Los resultados revelan brechas entre lo que la evidencia propone, lo que el programa incluye y la formación inicial que recibe el alumnado docente, promoviendo la discusión sobre su diseño. Se presentan recomendaciones para la revisión de los programas de FID y su posible reestructuración en alineación a la evidencia actual para abordar algunas de las brechas identificadas