Improving Support Of Breastfeeding At A Baby-Friendly™ Designated Hospital In Albuquerque, New Mexico

Purpose: Breastfeeding has conclusively proven to be the healthiest feeding option for infants. Baby-Friendly™designated hospitals and birthing centers follow the Ten Steps to Successful Breastfeeding, which are considered to be the gold standard for supporting mothers who wish to breastfeed. However, even a Baby-Friendly™designated hospital may have room for improvement. The University of New Mexico Hospital (UNMH) is an urban hospital serving a predominantly Hispanic and Native American population, and the majority of pediatric patients are covered by Medicaid. Despite its Baby-Friendly™ designation, UNMH had low rates of physician documentation of discussing the health impacts of breastfeeding in the postpartum setting and discussion of home visitation prior to discharge. We aimed to improve these measures using the Plan-Do-Study-Act (PDSA) model. Methods: We conducted this study from August 2018 to August 2019 in the UNMH Mother Baby Unit. Providers reviewed 61 to 86 charts for each of four medical record reviews (MRR). Based on the results of the first two MRRs, providers decided to focus on increasing home visitation referrals. After the third MRR, providers worked to increase discussion and documentation of the health impacts of breastfeeding. Changes made included creation of a discharge planning checklist, modifying admission and discharge templates, educating attending and resident physicians via emails, meetings, chart reviews, and bulletin boards in the team room, and adding home visitation referral forms to all patient charts. Results: Over the one year study period, rates of discussing home visitation status increased from 49.2% to 89.2%. The rates of discussing health impacts of breastfeeding increased from 31.1% to 86.5%. Conclusions: Implementation of these quality improvement measures resulted in substantial gains in several key breastfeeding metrics, despite having already earned the designation Baby-Friendly.™ All hospitals, including those that are designated Baby-Friendly™, should consider supporting breastfeeding through ongoing quality improvement initiatives

Lei do Abate, guerra às drogas e defesa nacional

O presente artigo analisa o processo de criação e regulamentação da Lei do Abate no Brasil, que autoriza a derrubada em pleno voo de aeronaves civis suspeitas de envolvimento no tráfico de drogas. Investigam-se as relações entre a elaboração da Lei do Abate, a política de guerra às drogas propagada pelos EUA e as preocupações estratégicas dos militares brasileiros acerca da segurança da Região Amazônica. Como parte da contextualização da criação dos programas de interdição aérea baseados no abate de aeronaves, estudam-se as origens e as transformações das políticas antidrogas dos EUA desde a década de 1960 e o modelo de guerra às drogas (War on Drugs). Analisa-se também o processo de discussão parlamentar no Brasil sobre a Lei do Abate e os debates para a sua regulamentação. A pesquisa ocorreu por meio da análise de documentos produzidos pelos governos dos EUA (abertos e sigilosos reclassificados) e do Brasil, da investigação dos anais do Congresso Nacional e do estudo de livros e artigos científicos nacionais e estrangeiros. Verifica-se que os programas que autorizam o abate nascem sob a justificativa do combate ao tráfico, mas se ligam às necessidades militares específicas de Peru e Colômbia. A lei brasileira surge para combater o transporte aéreo ilícito vinculado ao tráfico; contudo, sua origem e os debates posteriores para sua regulamentação submetem-se ao condicionamento dos temores e projetos militares em torno da defesa da soberania sobre a Amazônia brasileira

Domestic and transnational perspectives on democratization

The disciplinary separation between comparative politics and international relations is regularly challenged but persists as a result of institutional inertia and hiring practices. This essay uses the issue of democratization in an attempt to go beyond rhetoric and to develop a framework that integrates the role of transnational activism into the analysis of domestic regime change. Comparative research on democratization confirms that underlying socioeconomic conditions affect the long-term sustainability of democratic reforms. The initiation of such reforms, as well as the process they take, can best be understood using an agency-based framework that links domestic and transnational forces. Outside interventions are a potent factor in challenging authoritarian practices, but they do not simply displace existing domestic practices and conditions. Although transnational activists and scholars often celebrate the empowering role of networking and mobilization, the long-term effects of such interventions are still poorly understood. Transnational ties may distract domestic activists from building effective coalitions at home or undermine their legitimacy overall. Transnational scholars and activists can learn from comparative research how different domestic groups use outside interventions to promote their interests at home