Predictors of a positive birth experience in childbirth: A cross-sectional study.

Background: Recognizing predictors of positive birth experience is viewed as essential for minimizing negative experiences during childbirth that are related to current obstetric care, especially when those could be attributed to intrapartum interventions. The CEQ-E is a suitable instrument for investigating maternal birth experience within the Spanish population, highlighting the necessity to identify predictors for all its domains. This study aimed to identify predictors of positive birth experience based on socio-demographic and clinical variables, and obstetric interventions. Methods: Cross-sectional study conducted with consecutive sampling (N = 301). Quantitative data were collected by the Childbirth Experience Questionnaire (CEQ-E) and an Ad hoc questionnaire. Clinical data was obtained from participants' medical records. Descriptive, bivariant and multivariant analysis were performed. Results: The CEQ overall mean score was 3.18(SD:0.42), showing the highest score for the professional support (3.79; SD: 0.43) and the lowest for the own capacity (2.8; SD:0.57). All domains and overall score showed negative correlations with the number of intrapartum interventions (p ≤ .001). Inductions of labour, instrumental deliveries, and caesarean sections were inversely related to; overall birth experience score (p ≤ .001), perceived safety (p ≤ .001), and own capacity (p ≤ .001). Epidural analgesia was linked to worse values of birth experience (p ≤ .001). Predictors of positive birth experience were identified as having a midwife as birth attendant (p ≤ .001) and neonatal higher Apgar scores at birth (p ≤ .001), whereas higher maternal education grade (p = .04), inductions of labour (p ≤ .001) and caesarean births (p ≤ .001) had worse values on birth experience. Conclusion: Women reported a positive birth experience, and professional support was highly valued. Key predictors of lower scores in birth experience included higher maternal education, caesarean and instrumental deliveries, and neonatal intensive care unit (NICU) admission. Spontaneous labour onset predicted better capacity and safety. Epidural use decreased participation. Midwife-attended births reported better scores on birth experience, highlighting their importance in maternal care.

[Nursing students voice their opinions regarding their profession]. / Los estudiantes de enfermería opinan sobre su profesión.

The authors research the opinions of first year nursing students about why the nursing profession does not receive the same degree of consideration which similar academic professionals receive. At the same time, the authors studied to see if this lower professional consideration is due to the predominant presence of females in the nursing profession. To collect data, the authors ran a transversal, descriptive, qualitative study by means of nominal group and discussion group techniques. Among the main results, the authors highlight that Nursing is considered a socially unknown profession and receives little acknowledgment inside the new health care model; furthermore, the fact that the majority of nurses are female does bear an influence on the vision of the nursing field and this female predominance harms competitiveness in the profession since nurses must conciliate their family lives with their professional lives.

[Efficacy of an antibacterial filter for preventing contamination of respiratory function diagnostic equipment]. / Eficacia de un filtro antibacteriano en la prevención de la contaminación de equipos de exploración funcional respiratoria.

OBJECTIVES: Devices to assess lung function are a potential source of nosocomial infection. Our aims in this study were: 1) to determine the efficacy of an antimicrobial filter to prevent contamination of a multifunctional device; 2) to assess the ability of the filter to prevent cross contamination of individuals being tested; and 3) to evaluate the efficacy of the recommendations of the Spanish Society of Respiratory Diseases and Thoracic Surgery for disinfecting lung function equipment. DESIGN: In this prospective, randomized study in two phases we used filters in phase 1 but not in phase 2. A pharyngeal swab culture was started within 7 days of a patient's lung function test. Swab samples for culturing were taken from three different places in the equipment at the beginning and end of each working day. PATIENTS: Sixty-five patients (31 in phase 1 and 34 in phase 2) were studied. Thirty-two (49.2%) were men and the mean age was 49.4 15.7 years. RESULTS: Significantly less equipment contamination was found in phase 1 (4.2%) than in phase 2 (21%). We detected no cases of cross contamination using the criteria in this study. No cultures from any of the samples taken before exploration were positive. CONCLUSIONS: a) The antimicrobial filter used is effective for preventing the contamination of lung function testing equipment, b) throughout both phases of the study, we observed no cross contamination of patients tested, such that we cannot conclude that the antimicrobial filter is effective for preventing possible nosocomial infections, c) the recommendations of SEPAR for disinfecting lung function equipment are effective.

[Prognostic features of residual pleural thickening in metapneumonic pleural effusion]. / Factores predictivos del engrosamiento pleural residual en el derrame pleural metaneumónico.

Residual pleural thickening (RPT) develops in some patients after metapneumonic pleural effusion (MPE). Our aim was to identify factors that predict the development of RPT by retrospectively analyzing patients with MPE secondary to bacterial pneumonia in our practice from 1992 through April 1997. Patients were assigned to groups based on the presence or not of RPT (> 10 mm) three months or more after diagnosis of MPE. One hundred twenty-eight patients were included in the analysis. Seventy-nine patients (62%) developed RPT and 49 (38%) did not. Patients with RPT had significantly lower glucose levels and pH and higher LDH levels in pleural fluid. A higher percentage of patients with RPT had loculate pleural effusions and empyema, and they more often required insertion of drains. Logistic regression analysis showed that only glucose < 40 mg/dl (OR: 3.4; CI 95%: 2.3 to 4.5; p < 0.05) and the presence of pus collected from the initial thoracocentesis (OR: 3.6; CI 95%: 2.6 to 4.5; p < 0.01) were significantly associated with increased risk of developing residual pachypleuritis in subjects with MPE.

[Peru: reproductive health, abortion and family planning]. / Peru: salud reproductiva, aborto y planificacion familiar.

PIP: The average number of children per woman in Peru declined from 7 to 3.5 between 1960-65 and 1990-95, but the 1991 Demographic and Health Survey indicates that ideal family size was 2.7. Significant socioeconomic and regional fertility differentials persist. Despite the desire for smaller families, 59% of reproductive-age women use no contraceptive method. The most widely used method in Peru is rhythm. Around 34% of women 15-44 years old, some 2 million women, can be considered insufficiently protected against risks of unwanted pregnancy. The 1991 survey found that 1/3 of women using contraceptive methods had experienced failure of their method, with proportions ranging from 32% for rhythm to 1.2% for IUD. Abortion is illegal in Peru, as in most of Latin America, but is known to be widespread. The recurring public debates about abortion are hampered by lack of reliable data. The Alan Guttmacher Institute (AGI) estimate for Peru was based on data from the 1991 Demographic and Health Survey, official hospital discharge statistics, and a survey of 197 professionals and nonprofessionals. The AGI study reveals that a wide variety of techniques are used to induce abortion. There are the safe, modern methods, such as vacuum aspiration or dilatation and curettage, but the most common methods include inserting a probe or catheter, sometimes pouring toxic fluids into the uterus. Women also insert metal objects into the uterus or herbal suppositories into the vagina. They jump, fall, exercise violently, and take injections. 84% of rural women and 64% of poor urban women attempt to induce the abortion themselves or seek the aid of untrained midwives. 95% of wealthier urban women are attended by health professionals. An estimated 1 in 5 illegal abortions in Peru result in hospitalization. Applying this ratio to the estimated 54,230 hospitalizations for induced abortion in 1989 results in an estimate of 271,150 induced abortions in that year, equivalent to 43% of live births.^ieng

Inhalants in Peru.

In Peru, the prevalence and consequences of inhalant abuse appear to be low in the general population and high among marginalized children. Inhalant use ranks third in lifetime prevalence after alcohol and tobacco. Most of the use appears to be infrequent. Among marginalized children, that is, children working in the streets but living at home or children living in the street, the problem of inhalant abuse is a serious problem. Among children working in the streets but living at home, the lifetime prevalence rate for inhalant abuse is high, ranging from 15 to 45 percent depending on the study being cited. For children living in the streets, the use of inhalant is even more severe. As mentioned earlier in this chapter, most of these street children use inhalants on a daily basis. The lack of research on the problem of inhalant abuse is a serious impediment to development of intervention programs and strategies to address this problem in Peru. Epidemiologic and ethnographic research on the nature and extent of inhalant abuse are obvious prerequisites to targeted treatment and preventive intervention programs. The urgent need for current and valid data is underscored by the unique vulnerability of the youthful population at risk and the undisputed harm that results from chronic abuse of inhalants. Nonetheless, it is important to mention several programs that work with street children. Some, such as the Information and Education Center for the Prevention of Drug Abuse, Generation, and Centro Integracion de Menores en Abandono have shelters where street children are offered transition to a less marginal lifestyle. Teams of street educators provide the children with practical solutions and gain their confidence, as well as offer them alternative socialization experiences to help them survive the streets and avoid the often repressive and counterproductive environments typical of many institutions. Most of the children who go through these programs tend to abandon inhalant use as they mature out of street life.

[Infant mortality in Peru. Levels and trends, 1955-1990. Projections, 1990-2000]. / La mortalidad infantil en el Peru: niveles y tendencias 1955-1990, proyecciones 1990-2000.

PIP: The infant mortality rate of 55/1000 estimated for Peru on the basis of the 1991-92 Demographic and Family Health Survey is significantly lower than the official projection of 82/1000. Two demographers with the National Population Council conducted an exhaustive analysis of census and survey information for the period 1972-92 in order to evaluate the infant mortality estimates. They paid particular attention to the quality of data in surveys over the past decade, concluding that, in accordance with the trends demonstrated in all available sources, a continuing infant mortality decline amounting to 17% every 5 years could be expected. They affirmed that the 1993 infant mortality rate was 56/1000 and estimated that it would drop to 46/1000 during 1996-2000. They suggested that results for the 1990s should be verified when definitive results of the 1993 national census become available. Despite declines, Peru's infant mortality rate is still the third highest in Latin America. The decline may be attributed to fertility decline, increased educational attainment of women, massive vaccination campaigns, and urbanization, which apparently overcame the negative effects of poverty and deteriorating living conditions. Infant mortality and other demographic data needed to orient health policies and programs should not continue to be based on externally funded surveys whose timing is beyond the control of national officials.^ieng

[Fertility transition in Peru]. / La transicion de la fecundidad en Peru.

PIP: Data from national censuses and sample surveys are the basis for this examintion of differential fertility and the fertility transition in Peru. Changes in the level and structure of fertility in the 3 major geographic regions are compared, and the role of contraceptive usage and nuptiality changes in the fertility decline are analyzed. Peru's total fertility rate was estimated at 6.85 in 1965 and has since declined to 6.56 in 1965-70, 6.00 in 1970-75, 5.30 in 1975-80, 4.65 in 1980-85, and 4.00 in 1985-90. The fertility decline varied in intensity and timing in the geographic regions. A clear fertility decline began among upper and middle income groups in the principal cities in the 1960s, spreading gradually to the urban low income sectors. Not until the late 1970s did the fertility decline spread to the rest of the population, coinciding with the years of severe economic crisis. The urban total fertility rate declined from 6 to 3.77 during 1961-86, but rural fertility increased through 1972 to 8.12, before declining slightly to 7.62 in 1981 and more markedly to 6.65 in 1986. Sociocultural and economic differences between Peru's natural regions are appreciable, and account for the contrasts in fertility trends. The greatest changes occurred in metropolitan Lima, which already had relatively low fertility in 1961. Its total fertility rate declined 44% from 5.6 in 1961 to 3.13 in 1986. Fertility declined by slightly under 40% in the rest of the coast, by almost 25% in the jungle, and by scarcely 14% in the sierra. The total fertility rates in 1961 and 1986, respectively, were 6.38 and 4.13 on the coast, 6.64 and 6.45 in the highlands, and 7.92 and 5.97 in the lowlands. The fertility decline, especially in the lower classes, was a response initially to the process of cultural modernization which in slightly over 2 decades saw a profound transformation of Peru from a rural, Andean, illiterate, and agrarian society to an urban, coastal, literate, and commercial society. From 1972 on, the fertility decline spread in the rural sectors and was intensified as a response to the profound economic crisis experienced in Peru from 1975 to the present. Increased contraceptive usage was apparently the most important cause of Peru's fertility decline. Overall prevalence increased from 31% in 1977-78 to 46% in 1986, and use of modern methods by women in union doubled in the same years. Regional fertility differences are correlated strongly to contraceptive prevalence and especially to prevalence of modern methods. The 3 most recent national fertility surveys and a series of more limited surveys suggest that women have an increasingly strong desire to control their fertility. The greatest barriers to use of modern contraception are fears of health effects and lack of knowledge.^ieng

Casual recognition of an azygous continuation of the inferior vena cava in a patient with lung cancer.

Anomalous continuation of the inferior vena cava with an azygous vein is a rare vacular anomaly. The enlarged venous system may simulate adenopathies or mediastinal and retroperitoneal masses on the radiographs. We describe the case of a patient with lung cancer - a pathological condition which may cause adenopathies at these sites - and a dilated azygous-hemiazygous system resulting from failure of formation of the hepatic segment of the inferior vena cava.

Initial risk class and length of hospital stay in community-acquired pneumonia.

The total medical costs of community-acquired pneumonia are directly related to the costs of hospital admission and length of stay. The aim of the present study was to evaluate the reasons for prolonged duration of stay in patients stratified in five risk classes for death, and to identify factors associated with prolonged stay. The study population consisted of 295 patients. According to lower (classes I, II, III) or to higher (classes IV, V) risk, the target duration of hospitalization was set at 5 and 7 days, respectively. The causes of prolonged hospitalization were classified as pneumonia-related, complications, unstable comorbid diseases and nonclinical factors. The overall percentage of patients with appropriate duration of hospitalization was 32%. Causes of prolonged hospitalization were related mainly to pneumonia (32%) from all risk classes. Morbid complications and instability of the underlying illness were greater in class V patients. Nonclinical factors were present in 29.5% of cases. Hypoxaemia, anaemia, hypoalbuminaemia, and complications appearing before 72 h were associated with prolonged hospitalization. The cause of prolonged hospitalization of patients with community-acquired pneumonia is multifactorial, depending mainly on pneumonia and comorbid conditions but there is a large number of unnecessary hospitalization days that could be reduced by improving the efficiency of hospital care.

[Eating attitudes and body satisfaction in adolescents: a prevalence study]. / Actitudes alimentarias y satisfacción corporal en adolescentes: un estudio de prevalencia.

OBJECTIVES: To determine the prevalence of possible TCA in a sample of adolescents of either sex, in habitants of Girona, as well as to determine the relations between eating attitudes and body shape concerns in adolescent girls. SU BJECTS AND METHOD: The study sample was composed of all adolescent man and women (n=1025), students from Girona, with ages comprised between 14 and 19. The questionnaires used where the EAT-40 (being values over 30 the cut-off point) and the BSQ. RESULTS: While a 16.3% of adolescent women present potential risk of TCA, only 0.4% adolescent men have the same risk. A 9% of adolescent women show an extreme concern for her body shape and weight, and 13.1% show a moderate worry. Adolescent women that showed the highest symptomatology associated with eating disorders also present a higher dissatisfaction and concern with body shape (r=.65). CONCLUSIONS: The prevalence of possible TCA in Girona city is similar to the one found in other studies. This high prevalence makes necessary the implementation of prevention strategies in younger people.

Seminar on adult mortality and orphanhood in the past: five Latin American cases.

This report concerns a seminar on adult mortality and orphanhood in the past in Latin America that was held in San Jose, Costa Rica, December 12-14, 1984. The first part describes five historical studies presented at the seminar concerning Mexico, Chile, Peru, Brazil, and Argentina. "The second part of this article is an explanation of the calculation involved in a life table derived from information on the incidence of orphanhood according to the age of newly married couples on their marriage."

Evaluación de la capacitación clínica en anticoncepción post-parto y post-aborto: resumen / Evaluation of clinical training in contraception post-partum and post-abortion

Sus objetivos son conocer el efecto de la capacitación clínica en el mejoramiento de la calidad y la cobertura de los servicios de anticoncepción post-parto/post-aborto, estimar la contribución relativa de la capacitación al incremento de la prevelencia del uso de métodos modernos, especialmente el DIU, verificar si los proveedores que recibieron capacitación clínica están todavía trabajando en los establecimientos de salud incluídos en el Programa, examinar la calidad de la atención desde la perspectiva de la clienta, inlcuyendo la calidad de consejería