RESUMO
Objective: The caesarean section (CS) rate in Switzerland is currently 32 %, well above the WHO recommended rate of 15 %. The study aims were three-fold: to explore the perception of this high rate among Swiss obstetrics-gynecology (Ob-Gyn) professionals; to assess the factors associated with a perception of a too high national CS rate; and to describe professionals' opinions on measures to reduce this rate. Study design: A cross-sectional study was conducted between 1 May and 30 June 2021 using an online questionnaire sent to Ob/Gyn physicians and midwives at a university hospital and members of the Swiss Conference of Heads of Ob/Gyn Divisions. Survey participation was voluntary. The main outcome was the belief that CS was high. Associations were explored between different factors and the main outcome with logistic regression. Results were presented as odds ratios (OR) with 95 % confidence intervals (CIs). Multivariate logistic regression included adjustments for age, gender, place of work and profession. Results: Of 226 health professionals invited, 188 completed the questionnaire (83.2 % participation rate). Among respondents, 50.3 % (n = 94) were Ob/Gyn physicians and 49.7 % were midwives (n = 93); 77.1 % were women (n = 145). Most participants (74.7 % [n = 139]) considered the Swiss CS rate as too high and that it should be reduced (79 % [n = 147]) but, notably, they considered their own CS rate as correct (71.9 % [n = 123]). Improving patient education (57.5 % [n = 108]) and professional training (54.8 % [n = 103]) were considered as strategies to reduce this rate. In multivariate analysis, only length of professional experience was significantly associated with a higher likelihood of considering the CS rate as too high (OR 3.07, 95 % CI 1.01-9.30; p = 0.047). When specialty was added in the model, the length of professional experience disappeared and the perception of having a too high CS rate was associated with being a midwife and obstetrician rather than a gynecologist (OR 3.62, 95 % CI 1.72-7.63; p = 0.001). Conclusions: Clinicians, particularly obstetricians, believed that the current rate of CS in Switzerland was too high and that actions were needed to reduce this rate. Improving patient education and professional training were considered as the main strategies to be explored.
RESUMO
Resumen Introducción: El nivel educativo de los pacientes es una de las variables incluidas en el Registro de Ingreso a Diálisis. El abandono escolar temprano impacta negativamente en la capacidad de autocuidado y la calidad de vida. En nuestro centro asistimos a una población adulta donde se registran individuos analfabetos y con educación primaria incompleta; presentamos nuestra experiencia en la implementación de un programa de escolarización en diálisis. Material y métodos: Participamos como sede del Programa de Educación Permanente de Jóvenes y Adultos de la Provincia de Buenos Aires desde el 2011, con el objeto de ofrecer escolarización a pacientes con educación primaria incompleta. Para tal fin, contamos con la concurrencia de una docente del Programa que adapta la modalidad pedagógica al contexto de la sesión de diálisis, una psicóloga que acompaña el proceso y una asistente social que realiza la evaluación socioeconómica. Resultados: Entre 2011 y 2018, se incluyeron 23 pacientes, edad promedio 58.1 años, tiempo en diálisis promedio 48 meses. No hubo diferencia significativa respecto de edad, sexo, tiempo en hemodiálisis, ni etiología de insuficiencia renal crónica terminal entre los pacientes del programa y el resto de la población. Un paciente se alfabetizó , 6 egresaron del nivel primario y 16 abandonaron, siendo las causas más frecuentes, agravamiento de la enfermedad/óbito. Conclusiones: La escolarización en diálisis, con una modalidad pedagógica acorde, permite capitalizar el tiempo durante las sesiones y mejorar la autoestima, el autocuidado y la calidad de vida.
Introduction: The educational level of patients is one of the variables included in the Dialysis Registry. Early school leaving has a negative impact on self-care and quality of life. In our center we attend an adult population in which illiterate individuals and patients with incomplete primary education are registered. We present our experience in the implementation of a schooling program during dialysis. Methods: As headquarters, we have been participating in the Permanent Education Program for Young and Adult Subjects of the Province of Buenos Aires since 2011, offering schooling to patients with incomplete primary education. For such purpose a Program's teacher adapts the pedagogical modality to the context of the dialysis session, a psychologist accompanies the process and a social worker performs the socio-economic evaluation. Results: Between 2011 and 2018, 23 patients were included; the average age was 58.1 years and the average dialysis time was 48 months. There was no significant difference with respect to age, sex, time on hemodialysis and etiology of end stage renal disease between program patients and the rest of the population. One patient achieved literacy and 6 graduated from primary school; 16 dropped out, the most frequent causes being the worsening of the disease and death. Conclusions: Schooling with an appropriate pedagogical modality while on dialysis allows capitalizing on time during sessions, improving self-esteem, self-care and quality of life.