RESUMO
To explore attitudes of physicians attending births in the public and private sectors and at the managerial level toward cesarean birth in Nicaragua. A qualitative study was conducted consisting of four focus groups with 17 physicians and nine in-depth interviews with decision-makers. Although study participants listed many advantages of vaginal birth and disadvantages of cesarean birth, they perceived that the increase in the cesarean birth rate in Nicaragua has resulted in a reduction in perinatal morbidity and mortality. They ascribed high cesarean birth rates to a web of interrelated provider, patient, and health system factors. They identified five actions that would facilitate a reduction in the number of unnecessary cesarean operations: establishing standards and protocols; preparing women and their families for labor and childbirth; incorporating cesarean birth rate monitoring and audit systems into quality assurance activities at the facility level; strengthening the movement to humanize birth; and promoting community-based interventions to educate women and families about the benefits of vaginal birth. Study participants believe that by performing cesarean operations they are providing the best quality of care feasible within their context. They do not perceive problems with their current practice. The identified causes of unnecessary cesarean operations in Nicaragua are multifactorial, so it appears that a multi-layered strategy is needed to safely reduce cesarean birth rates. The recent Nicaraguan Ministry of Health guidance to promote parto humanizado ("humanization of childbirth") could serve as the basis for a collaborative effort among health care professionals, government, and consumer advocates to reduce the number of unnecessary cesarean births in Nicaragua.
Assuntos
Tomada de Decisões , Parto Obstétrico/estatística & dados numéricos , Médicos , Adulto , Atitude do Pessoal de Saúde , Coeficiente de Natalidade , Cesárea/estatística & dados numéricos , Cesárea/tendências , Parto Obstétrico/métodos , Feminino , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Nicarágua , Parto , Gravidez , Pesquisa Qualitativa , Prova de Trabalho de Parto , Nascimento Vaginal Após CesáreaRESUMO
BACKGROUND: The incidence of placenta accreta has increased in recent years and it has been suggested that the rising trend in cesarean delivery and other uterine surgery is the underlying cause. OBJECTIVE: To explore the magnitude of the effect of performing single and repeat cesarean deliveries or other uterine surgery on the incidence of placenta accreta. SEARCH STRATEGY: Relevant databases were searched for papers published before August 1, 2018, using terms including "accreta" and "cesarean." SELECTION CRITERIA: Cohort studies assessing the risk of placenta accreta according to women's history of uterine surgery. DATA COLLECTION AND ANALYSIS: Meta-analyses were performed to assess the risks associated between uterine surgery and placenta accreta, hysterectomy, and uterine rupture. The I2 statistic was used to examine between-study heterogeneity. MAIN RESULTS: The risk of placenta accreta in a second pregnancy increased for women who had undergone a cesarean in their first pregnancy compared with vaginal delivery (OR 3.02; 95% CI, 1.50-6.08). Absolute risk of placenta accreta increased with the number of previous cesareans. The risk of uterine rupture and hysterectomy was also associated with the number of cesareans. CONCLUSIONS: Risk of placenta accreta, hysterectomy, and uterine rupture increases with the number of previous cesarean deliveries. PROSPERO: CRD42016050646.
Assuntos
Recesariana/efeitos adversos , Histerectomia/estatística & dados numéricos , Placenta Acreta/etiologia , Ruptura Uterina/etiologia , Adulto , Feminino , Humanos , Incidência , Gravidez , Estudos Retrospectivos , Fatores de RiscoRESUMO
Introducción. Los antecedentes de cuarentenas han señalado impactos en el corto y largo plazo en la salud mental. Objetivo. Describir las repercusiones generadas en el área de la salud mental en la población uruguaya mayor de 18 años, de las variables ansiedad, tristeza y dificultades para conciliar el sueño, en el periodo comprendido entre el 13 de marzo de 2020 al 10 de junio de 2021. Metodología. Estudio transversal analítico. Se aplicó una encuesta web, auto-administrada. Se analizaron las frecuencias absolutas y relativas porcentuales y sus intervalos de confianza (95 %). Se estimaron modelos logísticos binarios para las variables dicotómicas y modelos logísticos multinomiales para «dificultad para conciliar el sueño¼. Resultados. En relación a los elementos de ansiedad, 27,1 % (IC 95 % 24,8-29,3) y 31,0 % (IC 95 % 28-33,3) respondieron sentirse ansiosos en el primer y segundo corte, respectivamente. El 19,9 % (IC 95 % 17,6 - 21,7) en el primer corte, mientras que el 31,4 % (IC 95 % 20,06-33,89) lo confirmaron en el segundo. El nivel educativo medio se asoció con la presencia de ansiedad (p < 0,001), mientras el bajo se asoció con tristeza (p = 0,005). Se observó un efecto protector en hogares con más de cinco miembros para la variable tristeza con un OR de 0,41 (IC 95 % 0,22 - 0,75). Se encontró relación entre el género femenino y la presencia de ansiedad y tristeza. Los niveles educativos medio y alto se vieron relacionados con la presencia de ansiedad y la tristeza se asoció con el desempleo. Los trastornos del sueño se asociaron al género femenino, desempleo y enfermedades no transmisibles. Conclusión. Los trastornos de ansiedad, la afectación del sueño y los sentimientos de tristeza fueron prevalentes, las familias de mayor número de miembros tuvieron un efecto protector sobre estas manifestaciones
Introduction. The history of quarantines has pointed out impacts in the short and long term on mental health. Objective: Within the framework of the measures decreed to reduce the transmissibility of SarS-Cov2, we propose to analyze the repercussions on the mental health of the Uruguayan population. Methodology. Analytical design. Application of a self-administered web survey. Absolute and relative percentage frequencies and their confidence intervals (95 %) were analyzed. Binary logistic models were estimated for dichotomous variables and multinomial logistic models for «difficulty falling asleep¼. Results. Regarding anxiety elements, 27.1 % (95 % CI, 24.8-29.3) and 31.0 % (95 % CI, 28-33.3) responded feeling anxious in the first and second cut-off, respectively. 19.9 % (95 % CI, 17.6-21.7) and 31.4 % (95 % CI, 20.06-33.89) reported feeling sad in the first and second cut-off. Medium educational level was associated with the presence of anxiety (p < 0.001), while low educational level was associated with sadness (p = 0.005). A protective effect was observed in households with more than five members for the sadness variable with an OR of 0.41 (95 % CI, 0.22-0.75). Female gender was related to the presence of anxiety and sadness. Medium and high educational levels were related to the presence of anxiety and sadness was associated with unemployment. Sleep disorders were associated with female gender, unemployment and non-communicable diseases. Conclusion. The impact on mental health was unequal, especially affecting women from middle socio-educational sectors, between 35 and 59 years of age
Assuntos
Humanos , UruguaiRESUMO
INTRODUCCIÓN. Este artículo presenta una sistematización del Proyecto Redes, Salud y Alimentos llevado adelante por un equipo interdisciplinario de docentes de la Universidad de la República (Udelar) en 2018 en la localidad de San Antonio, Departamento de Canelones, Uruguay. El proyecto tuvo como objetivo promover la creación de un espacio para la promoción integral de la salud y la agroecología desde el enfoque de la Ecosalud. A nivel académico el proyecto se propuso promover la producción de conocimiento interdisciplinario en torno a los ejes de salud humana, construcción social de la salud y producción agroecológica de alimentos. MATERIAL Y MÉTODOS. En el territorio, desde un enfoque de Ecosalud, se generaron acciones de prevención y promoción de la salud a partir de una concepción holística y sistémica de las relaciones ambientales y humanas. Se incorporó la perspectiva agroecológica, considerando a los alimentos y su sistema de producción como determinantes de la sustentabilidad ambiental y de la seguridad y soberanía alimentaria. RESULTADOS. Como resultados destacamos el logro de los objetivos de promover la participación e integración del saber comunitario y haber creado un espacio de promoción de la salud integral, en sintonía con los pilares de la Carta de Shangai, "Promoción de la salud en la Agenda 2030 para el desarrollo sostenible". DISCUSIÓN. Esta experiencia es una respuesta a los desafíos que enfrenta la academia, en su afán de aportar al desarrollo de la sociedad. Sus desarrollos pueden verse también son pilares teóricos y ejes de acción de una nueva Salud Pública. (AU)
INTRODUCTION. This article presents a systematization of the Networks, Health and Food Project carried out by an interdisciplinary team of teachers from the University of the Republic (Ude-lar) in 2018 in the town of San Antonio, Department of Canelones, Uruguay. The main goal was to create a program of health promotion and agroecology from the Eco-health perspective. At an academic level, the project set out to promote the production of interdisciplinary knowledge around the axes of human health, social construction of health and agroecological food production. MATHERIALS AND METHODS. From an Ecohealth approach, health prevention and promotion actions on location were generated from a holistic and systemic conception of the relationship between humans and the environment. The agroecological perspective was incorporated, con-sidering food and its production system as determinants of environmental sustainability and food security and sovereignty. RESULTS. As results we highlight the importance of participation and integration of community knowledge and having created a space for the promotion of comprehensive health, in tune with the pillars of the Shanghai Charter, "Health promotion in the 2030 Agenda for sustainable development". DISCUSSION. This experience is a response to the challenges facing the academy, in its desire to contribute to the development of society. Its developments can also be seen as theoretical support and lines of action of a new Public Health.
Assuntos
Humanos , Atenção Primária à Saúde , Participação da Comunidade , Agricultura Sustentável , Promoção da Saúde/métodos , Serviços Preventivos de Saúde , UruguaiRESUMO
Resumen: La artritis reumatoide es un trastorno autoinmune sistémico que causa inflamación extensa y persistente de las articulaciones. La inflamación persistente da lugar a muchas manifestaciones sistémicas y extraarticulares que afectan a la mayoría de los sistemas orgánicos, dando lugar a complicaciones graves y comorbilidades. El estrés psicológico es un factor provocador importante de los síntomas en las enfermedades inflamatorias crónicas. En los últimos años, el interés por abordar la respuesta al estrés a través de prácticas como la meditación ha aumentado asombrosamente, a pesar de la escasez de pruebas de que los beneficios reportados son específicos de esa práctica. La presente revisión sistemática se propone como objetivo evaluar la eficacia y seguridad de técnicas de meditación como tratamiento complementario de la AR. Se llevó a cabo una revisión sistemática de la literatura. Se consultaron las bases de datos Colaboración Cochrane, MEDLINE, Organización Mundial de la Salud, Plataforma de Registro Internacional de Ensayos clínicos para todos los ensayos registrados y en curso de realización y Clinicaltrials.gov Los datos extraídos se incluyeron en el kit de herramientas COVIDENCE y en el software REVMAN de la colaboración Cochrane. No pudo realizarse meta-análisis realizándose una síntesis narrativa de los resultados. Conclusiones: la técnica de Atención Plena (MBSR) es beneficiosa como tratamiento complementario de la Artritis Reumatoide, modificándose parámetros clínicos, pero con resultados heterogéneos en cuanto a los marcadores séricos de inflamación.
Abstract: Rheumatoid arthritis is a systemic autoimmune disorder that causes extensive and persistent inflammation of the joints. Persistent inflammation leads to many systemic and extra-articular manifestations that affect most of the organ systems, leading to serious complications and comorbidities. Psychological stress is a major provocative factor of symptoms in chronic inflammatory diseases. In recent years, interest in addressing the stress response through practices such as meditation has increased dramatically, despite the paucity of evidence that the benefits reported are specific to that practice. The present systematic review aims to evaluate the effectiveness and safety of meditation techniques as a complementary treatment of RA. A systematic review of the literature was carried out. The databases Cochrane Collaboration, MEDLINE, World Health Organization, International Registry Platform of Clinical Trials for all the trials registered and in progress and Clinicaltrials.gov were consulted. extracted data were included in the COVIDENCE toolkit and in the REVMAN software of the Cochrane collaboration. Meta-analysis could not be performed, making a narrative synthesis of the results. Conclusions: the technique of Full Attention (MBSR) is beneficial as a complementary treatment of Rheumatoid Arthritis, modifying clinical parameters, but with heterogeneous results in terms of serum markers of inflammation.
Resumo: A artrite reumatóide é um distúrbio auto-imune sistêmico que causa inflamação generalizada e persistente das articulações. A inflamação persistente leva a muitas manifestações sistêmicas e extra-articulares que afetam a maioria dos sistemas orgânicos, levando a sérias complicações e comorbidades. O estresse psicológico é um dos principais fatores desencadeantes dos sintomas nas doenças inflamatórias crônicas. Nos últimos anos, o interesse em abordar a resposta ao estresse por meio de práticas como a meditação aumentou dramaticamente, apesar da escassez de evidências de que os benefícios relatados são específicos dessa prática. A presente revisão sistemática tem como objetivo avaliar a eficácia e segurança das técnicas de meditação como tratamento complementar para AR. Uma revisão sistemática da literatura foi realizada. os bancos de dados Cochrane Collaboration, MEDLINE, Organização Mundial da Saúde, Plataforma de Registo Internacional de Ensaios Clínicos para todos os ensaios registrados e em andamento e consultou dados Clinicaltrials.gov extraído incluído no kit de ferramentas e Covidence no software REVMAN da colaboração Cochrane. Meta-análise não pôde ser realizada, fazendo uma síntese narrativa dos resultados. Conclusões técnica Mindfulness (MBSR) é benéfico como tratamento adjuvante de artrite reumatóide, modificando os parâmetros clínicos, mas com heterogénea em marcadores séricos de inflamação resulta.