Practice, barriers, and facilitators of healthcare providers in smoking cessation in Mexico.

OBJECTIVE: To assess the clinical practice, barriers, and facilitators in promoting smoking cessation in primary healthcare clinics in Mexico City. MATERIALS AND METHODS: A mixed method design was used. Surveys (n = 70) and semi-structured interviews (n = 9) were conducted with health personnel involved in smoking cessation clinics. RESULTS: Quantitative data revealed that physicians were more likely than nurses to 1) ask patients if they smoke (57.9% vs 34.5%, p = .057), 2) ask patients if they are interested in quitting smoking (65.7% vs 26.9%, p = .003), 3) provide advice to quit smoking (54.3% vs 29.2%, p = .056), and 4) assess whether pharmacotherapy is needed (21.9% vs 10%, p = .285). Qualitative data showed that nurses were more likely than physicians to report lack of resources to refer patients to smoking cessation services, lack of pharmacotherapy availability, and lack of provider training in smoking cessation. Reported barriers include lack of motivation among patients, lack of time for assessment, long appointment wait times, and lack of training. Reported facilitators include existence of smoking cessation programmes and pharmacotherapy at no cost to the patient, and having a multidisciplinary team. CONCLUSIONS: Due to numerous barriers, smoking cessation interventions are partially implemented in primary care clinics in Mexico City. A restructuring of services is necessary, and nurses should be given a more prominent role.

Living Conditions of Adolescents Who Have Attempted Suicide in Mexico.

Suicidal behavior represents a complex public health problem, with a rising number of suicide attempts registered among Mexican adolescents. We undertook a qualitative study in order to understand the living conditions of adolescents who had attempted to take their lives in five Mexican states. We interviewed 37 adolescents who had engaged in suicide attempts in the year prior to our study. To code and analyze the information, we defined the following three categories of living conditions as social determinants of health for adolescents: poverty and vulnerability, education, and health care. To this end, we followed the methodology proposed by Taylor and Bogdan, and used Atlas.ti 7.5.18 software for analyses. Among our findings, we noted that poverty, manifested primarily as material deprivation, rendered the daily lives of our interviewees precarious, compromising even their basic needs. All the young people analyzed had either received medical, psychological, and/or psychiatric care as outpatients or had been hospitalized. School played a positive role in referring adolescents with suicidal behavior to health services; however, it also represented a high-risk environment. Our findings highlight the urgent need to implement a national intersectoral strategy as part of comprehensive public policy aimed at improving the health of adolescents in Mexico.

[Disrespect and abuse during childbirth and abortion in Latin America: systematic review and meta-analysisDesrespeito e maus-tratos durante o parto e o aborto na América Latina: revisão sistemática e meta-análise]. / Irrespeto y maltrato durante el parto y el aborto en América Latina: revisión sistemática y metaanálisis.

OBJECTIVE: This review synthesizes the evidence (quantitative, general, and by typological categories) of disrespect and abuse during childbirth and abortion in health facilities in Latin America and the Caribbean. METHODS: Systematic searches identified 18 primary studies. Q and I2 were calculated, meta-analyses and meta-regressions were performed, and subgroups were analyzed using a DerSimonian and Laird random-effects model grouped by inverse variance and the Freeman-Tukey double arcsine transformation. RESULTS: Studies conducted in five Latin American countries were identified. No studies from the Caribbean were found. The aggregate prevalence of disrespect and abuse during childbirth and abortion was 39%. The aggregated prevalence of the phenomenon in childbirth was 43% and 29% during abortion. The high heterogeneity made it impossible to generate aggregate measures according to typological categories. Nevertheless, the frequencies of specific forms of the phenomenon were grouped typologically. CONCLUSIONS: The evidence suggests that disrespect and abuse during childbirth and abortion care are human-rights and public-health problems that are prevalent in some countries of the Region. It is necessary to reach international consensus on the definition and operationalization of this problem and to develop standardized methods for its measurement. Doing so is essential in order to achieve the targets of the 2030 Agenda related to reducing maternal and newborn morbidity and mortality and eliminating all forms of violence and discrimination against women.

OBJETIVO: Esta revisão sintetiza as evidências quantitativas, gerais e desagregadas por categorias tipológicas do desrespeito e maus-tratos na atenção institucional ao parto e ao aborto na América Latina e Caribe. MÉTODOS: Dezoito estudos primários foram identificados por meio de buscas sistemáticas. Foi feito o cálculo de Q e I2 e realizadas meta-análises, metarregressões e análises de subgrupos com um modelo de DerSimonian e Laird de efeitos aleatórios agrupados com variância inversa e transformação de Freeman-Tukey (duplo arco-seno). RESULTADOS: Foram identificados estudos realizados em cinco países da América Latina. Não foi identificado nenhum estudo no Caribe. Observou-se uma prevalência agregada de 39% de desrespeito e maus-tratos durante o parto e o aborto. A medida agregada para este fenômeno durante o parto foi 43% e a medida agregada nos casos de aborto foi 29%. Devido à alta heterogeneidade, não foi possível gerar medidas agregadas segundo categorias tipológicas. No entanto, são descritas as frequências de formas específicas do fenômeno agrupadas tipologicamente. CONCLUSÕES: As evidências indicam que o desrespeito e os maus-tratos na atenção ao parto e ao aborto são uma questão de direitos humanos e de saúde pública prevalente em alguns países da Região. É preciso chegar a um consenso internacional sobre a definição e a operacionalização deste problema e elaborar métodos padronizados para mensurá-lo. Isso é imprescindível para o alcance das metas da Agenda 2030 relativas à redução da morbidade e mortalidade materna e perinatal e à eliminação de todas as formas de violência e discriminação contra a mulher.

"If we're here, it's only because we have no money " discrimination and violence in Mexican maternity wards.

BACKGROUND: Structural and gender violence in Mexico take on various forms, obstetric violence among them. The objective of our study consisted in analyzing experiences of structural and gender discrimination against women during childbirth care at two public hospitals in Mexico. METHODS: We conducted a cross-sectional mixed methods study including a survey of closed questions administered to all women who received health care for vaginal or cesarean childbirth at two public hospitals from May 7 to June 7, 2012 (N = 512). Those who reported some form of abuse on the part of health-care professionals were then invited to complete a semi-structured interview (20 women agreed to participate). In addition, three focus groups were organized with health-care professionals from both institutions (31 participants): two were composed of nurses and one of obstetrician-gynecologists (OB-GYNs). This work deals with the qualitative component of the study. RESULTS: The narratives of the health-care professionals interviewed contained expressions of health discrimination relating to certain characteristics of their clients, namely poverty, ignorance, failure to understand instructions and being women. The women, on the other hand, perceived themselves as belonging to a low social class and, as a result, behaved passively with staff throughout their hospital stay. They reported both physical and psychological abuse during care. The first included having their legs manipulated roughly, being strapped to the bed, and being subjected to multiple and careless pelvic examinations. Psychological abuse included reprimands, insults, disrespectful remarks, neglect and scowling gestures when requesting assistance. CONCLUSIONS: The results of our study bear implications for the doctor-client relationship and for the health system in general. They suggest a need to dismantle medical practice - particularly with regard to obstetrics and gynecology - as it has been historically learned and internalized in Mexico. It is imperative to design public policies and strategies based on targeted interventions for dismantling the multiple forms of structural and gender violence replicated daily by actors in the health system.