Evaluation of a Skills Enhancement Training Intervention With Remote Coaching for Young Adults Providing Peer Support.

This column reports on a study that investigated a skills enhancement and role clarification training intervention for young adult peer support specialists (YPSSs). Young adults who had received intensive mental health services­including young adults who had experience as YPSSs­were partners in developing the intervention and in completing all aspects of the study. Study participants were YPSSs who were already providing one-on-one, person-centered planning in community settings before the study. The results, based on YPSSs' self-reports and rated video recordings of YPSSs' practice, showed postintervention gains in participants' skills and confidence in providing person-centered planning to the young people they worked with as well as reduced job-related anxiety and high training satisfaction.

Much more visible now are the inequalities that have always existed in our system and much clearer the need for stronger state intervention.

Dr Armando De Negri Filho is an epide-miologist whose work has centered on development and maintenance of Brazil's universal healthcare system. Along with his training in epidemiology, Dr De Negri has a specialty in emergency medicine and a PhD involving research focused on policy, planning, economics and health systems management. In addition to his other responsibilities, he serves as an expert on the right to development for the UN Human Rights Council. He spoke with MEDICC Review from his hometown in Porto Alegre.

Mixed-methods study identifies key strategies for improving infant and young child feeding practices in a highly stunted rural indigenous population in Guatemala.

Guatemala's rural indigenous population suffers from one of the highest rates of chronic child malnutrition (stunting) in the world. Successfully addressing stunting requires defining the barriers to and opportunities for new behaviour-change initiatives. We undertook a mixed-methods assessment of feeding practices and food purchasing behaviours around infants and young children aged 6-36 months in two rural indigenous Guatemalan communities. We found that most caregivers were aware only of acute forms of child malnutrition and that they greatly underestimated the local prevalence of malnutrition. Despite moderate adherence to exclusive breastfeeding and timing of complementary food introduction, diets had poor diversity and inadequate meal frequency. Furthermore, perceptions of food insecurity were high even in the presence of land ownership and agricultural production. Although fortified foods were highly valued, they were considered expensive. At the same time, proportionally equivalent amounts of money were spent on junk foods or other processed foods by most participants. Biological mothers often lacked autonomy for food purchasing and nutritional decisions because of the power exerted by husbands and paternal grandmothers. Our findings suggest several creative and community-based programming initiatives including education about the acute vs. chronic malnutrition distinction, engaging landowners in discussions about domestic food consumption, engaging with caregivers to redirect funds towards fortified foods rather than junk food purchases and directing behaviour-change initiatives towards all household stakeholders.