Background: There is ample evidence of associations between short birth interval and adverse maternal and child health outcomes, including infant and maternal mortality. Short birth interval is more common among women in low-and middle-income countries. Identifying actionable aspects of short birth interval is necessary to address the problem. To our knowledge, this is the first systematic review to systematize evidence on risk factors for short birth interval in low-and middle-income countries. Methods: A systematic mixed studies review searched PubMed, Embase, LILACS, and Popline databases for empirical studies on the topic. We included documents in English, Spanish, French, Italian, and Portuguese, without date restriction. Two independent reviewers screened the articles and extracted the data. We used the Mixed Methods Appraisal Tool to conduct a quality appraisal of the included studies. To accommodate variable definition of factors and outcomes, we present only a narrative synthesis of the findings. Results: Forty-three of an initial 2802 documents met inclusion criteria, 30 of them observational studies and 14 published after 2010. Twenty-one studies came from Africa, 18 from Asia, and four from Latin America. Thirty-two reported quantitative studies (16 studies reported odds ratio or relative risk, 16 studies reported hazard ratio), 10 qualitative studies, and one a mixed-methods study. Studies most commonly explored education and age of the mother, previous pregnancy outcome, breastfeeding, contraception, socioeconomic level, parity, and sex of the preceding child. For most factors, studies reported both positive and negative associations with short birth interval. Shorter breastfeeding and female sex of the previous child were the only factors consistently associated with short birth interval. The quantitative and qualitative studies reported largely non-overlapping results.

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BackgroundMalaria is a serious health problem in Colombia. This paper intends to analyse the frequency and tendencies of the disease in Colombia over the last 22 years. The researchers used the Box-Jenkins (ARIMA) methodology for the analysis of time series.MethodsThis descriptive study was done retrospectively by using the morbidity records of the Ministry of Health and of the System for the Monitoring of Public Health (SIVIGILA). The information about the population was obtained from the National Administrative Department of Statistics (DANE). The incidence rate according to age and sex was calculated from 1990 to 2011. Also, the Annual Parasite Index (API) for Plasmodium falciparum and for Plasmodium vivax was calculated. The mortality rates per year, from 1990 to 2011, were determined. Finally, the Box-Jenkins (ARIMA) methodology was used for the analysis of time series, grouped weekly. Information for ARIMA modelling was used from the year 2001.ResultsThe total number of reported cases from 1990 to 2011 was 2,964,818 cases with an annual average of 134,764. In the period from 2001 to 2005 and from 2006 to 2011 a significant decrease of annual cases was observed. In general, a predominance of P. vivax over P. falciparum was observed. With respect to the API, it must be noted that there were peaks in 1994 in the departments of Guainía and Guaviare, and in 1998 in Guaviare and Chocó. The department of Antioquia showed a tendency towards a decrease of the API through the years.In the time series model there were no statistically significant seasonal patterns for the total number of cases of malaria. However, for P. falciparum the number of cases was statistically significant. Lastly, between 1990 and 2009, there were 1,905 deaths caused by malaria in Colombia with a significant tendency towards a decrease in deaths over those years. Plasmodium falciparum was more lethal than P. vivax.ConclusionsIn Colombia, the transmission of malaria occurs in an endemic and epidemic context, which keeps an unstable endemic transmission pattern. Several factors specific to a country such as Colombia encourage the dissemination and permanence of the illness.

Background The Most Significant Change is a story-based evaluation approach used in many international development programs. This practice review summarises practical experience with the approach in complex health interventions in ten countries, with the objective of making it more accessible in evaluation of other complex health interventions. Results Participatory research practitioners and trainees discussed five themes following brief presentations by each of the seven attendees who led the exercise: (i) sampling and recruitment; (ii) phrasing the questions to elicit stories; (iii) story collection strategies; (iv) quality assurance; and (v) analysis. Notes taken during the meeting provided the framework for this article. Recruitment strategies in small studies included universal engagement and, in larger studies, a purposive, systematic or random sampling. Meeting attendees recommended careful phrasing and piloting of the question(s) as this affects the quality and focus of the stories generated. They stressed the importance of careful training and monitoring of fieldworkers collecting stories to ensure full stories are elicited and recorded. For recording, in most settings they preferred note taking with back-checking or self-writing of stories by story tellers, rather than audio-recording. Analysis can combine participatory selection of a small number of stories, deductive or inductive thematic analysis and discourse analysis. Meeting attendees noted that involvement in collection of the stories and their analysis and discussion had a positive impact for research team members. Conclusions Our review confirms the plasticity, feasibility and acceptability of the Most Significant Change technique across different sociopolitical, cultural and environmental contexts of complex interventions. Although the approach can surface unexpected impacts, it is not a 360-degree evaluation. Its strength lies in characterising the changes, where these happen, in the words of the beneficiaries. We hope this distillation of our practice makes the technique more readily available to health sector researchers.

Background Cultural safety encourages practitioners to examine how their own culture shapes their clinical practice and to respect their patients’ worldviews. Lack of cultural safety in health care is linked to stigma and discrimination toward culturally diverse patients. Training in cultural safety poses considerable challenges. It is an unappealing subject for medical students and requires behavioral changes in their clinical practice. Game jams—collaborative workshops to create and play games—have recently shown effectiveness and engaging potential in university-level education. Objective The trial aims to determine if medical students’ participation in a game jam to design an educational game on cultural safety is more effective than a standard lesson on cultural safety in terms of change in the students’ self-reported intended patient-oriented behavior. Methods A parallel-group, 2-arm randomized controlled trial with a 1:1 allocation ratio will randomize 340 medical students and 60 medical interns (n=400) at the Faculty of Medicine at La Sabana University, Colombia (170 students and 30 medical interns to each arm). The intervention group will participate in an 8-hour game jam comprising (1) a preliminary lecture on cultural safety and game design, (2) a game building session where groups of students will create educational games about cultural safety, and (3) a play-test session in which students will play and learn from each other’s games. The control group will receive a standard lesson, including a 2-hour lecture on cultural safety, followed by a 6-hour workshop to create posters about cultural safety. Web-based self-administered 30-item Likert-type questionnaires will assess cultural safety self-reported intended behavior before, immediately after, and 6 months after the intervention. An intention-to-treat approach will use a t-test with 95% CIs to determine the significance of the effect of the intervention, including within- and between-group comparisons. The qualitative most significant change technique will explore the impact of the intervention on the clinical experience of the students. Results Study enrollment began in July 2019. A total of 531 students completed the baseline survey and were randomized. Data collection is expected to be complete by July 2020, and results are expected in October 2020. The study was approved by the institutional review board of the Faculty of Medicine at McGill University (May 31, 2017) and by the Subcommittee for Research of the Faculty of Medicine at La Sabana University (approval number 445). Conclusions The research will develop participatory methods in game-based learning co-design that might be relevant to other subjects. Ultimately, it should foster improved cultural safety skills for medical students, improve the quality of health services for diverse cultural groups, and contribute to enhanced population health. Game learning may provide an innovative solution to a long-standing and neglected problem in medical education, helping to meet the educational expectations and needs of millennial medical students. Trial Registration ISRCTN Registry ISRCTN14261595; http://www.controlled-trials.com/ISRCTN14261595

Objectives This study explored motivation dynamics of medical students engaging with traditional medicine in Colombia. Methods We conducted a qualitative descriptive study as part of a larger participatory research effort to develop a medical education curriculum on cultural safety. Four final-year medical students participated in a five-month program to strengthen knowledge of traditional medicinal plants with schoolchildren in Cota, a municipality outside Bogota with a high proportion of traditional medicine users. Students and schoolteachers co-designed the program aimed to promote the involvement of school children with traditional medicine in their community. The medical students shared written narratives describing what facilitated their work and discussed experiences in a group session. Inductive thematic analysis of the narratives and discussion derived categories of motivation to learn about traditional medicine. Results Five key learning dynamics emerged from the analysis: (1) learning from/with communities as opposed to training them; (2) ownership of medical education as a result of co-designing the exercise; (3) rigorous academic contents of the program; (4) lack of cultural safety training in university; and (5) previous contacts with traditional knowledge. Conclusions We identified potential principles for engaged cultural safety training for medical students. We will use these in our larger training program. Our results may be relevant to other researchers and medical educators wanting to improve the interaction of medical health professionals in multicultural settings with people and communities who use traditional medicine. We expect these professionals will be better prepared to recognize and address intercultural challenges in their clinical practice.

Aims Remdesivir is 1 of the repurposed drugs under investigation to treat patients with COVID‐19. Clinicians and decision‐makers need a summary of the most recent evidence. This scoping review maps the evidence on the efficacy, effectiveness and safety of remdesivir for patients with COVID‐19, up to 14 September 2020. Methods Our scoping review searched Pubmed, Embase (Ovid), Scopus and 17 primary trial registries for empirical publications or active registered clinical trials for data on the efficacy, effectiveness, or safety of remdesivir for COVID‐19 or SARS‐CoV‐2. We conducted a narrative synthesis of the included publications. Results Seventeen empirical studies and 23 clinical trial registrations ( n = 40) accumulated 46 508 participants. We found 4 published randomized–controlled trials accumulating 2293 patients. Two trials reported shorter median recovery time and better clinical status among patients who received remdesivir compared with the control groups. Observational studies report an association between remdesivir treatment and decreased mortality, as well as increased survival. The most common adverse reaction was hepatic impairment, although the trials reported a similar proportion of adverse events in the intervention and control groups. Conclusion Remdesivir might shorten the time to clinical improvement among hospitalized adults with severe COVID‐19. Trial data report a similar proportion of adverse events in treated and control groups. The results of the 23 registered active trials, including more than 30 000 participants, will shed light on the efficacy and safety of the antiviral. The findings of the remaining clinical trials expected to report results in 2020 will allow a quantitative synthesis of available evidence.

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