Diabetic retinopathy service delivery and integration into the health system in Pakistan-Findings from a multicentre qualitative study.

This paper is based on qualitative research carried out in a diabetic retinopathy (DR) programme in three districts of Pakistan. It analyses the organisation and delivery of DR services and the extent to which the interventions resulted in a fully functioning integrated approach to DR care and treatment. Between January and April 2019, we conducted 14 focus group discussions and 37 in-depth interviews with 144 purposively selected participants: patients, lady health workers (LHWs) and health professionals. Findings suggest that integration of services was helpful in the prevention and management of DR. Through the efforts of LHWs and general practitioners, diabetic patients in the community became aware of the eye health issues related to uncontrolled diabetes. However, a number of systemic pressure points in the continuum of care seem to have limited the impact of the integration. Some components of the intervention, such as a patient tracking system and reinforced interdepartmental links, show great promise and need to be sustained. The results of this study point to the need for action to ensure inclusion of DR on the list of local health departments' priority conditions, greater provision of closer-to-community services, such as mobile clinics. Future interventions will need to consider the complexity of adding diabetic retinopathy to an already heavy workload for the LHWs.

Women empowerment and skilled birth attendance in sub-Saharan Africa: A multi-country analysis.

INTRODUCTION: In 2017, the highest global maternal deaths occurred in sub-Saharan Africa (SSA). The WHO advocates that maternal deaths can be mitigated with the assistance of skilled birth attendants (SBAs) at childbirth. Women empowerment is also acknowledged as an enabling factor to women's functionality and healthcare utilisation including use of SBAs' services. Consequently, this study investigated the association between women empowerment and skilled birth attendance in SSA. MATERIALS AND METHODS: This study involved the analysis of secondary data from the Demographic and Health Surveys of 29 countries conducted between January 1, 2010, and December 3, 2018. For this study, only women who had given birth in the five years prior to the surveys were included, which is 166,022. At 95% confidence interval, Binary Logistic Regression analyses were conducted and findings were presented as adjusted odds ratios (aORs). RESULTS: The overall prevalence of skilled birth attendance was 63.0%, with the lowest prevalence in Tanzania (13.8%) and highest in Rwanda (91.2%). Women who were empowered with high level of knowledge (aOR = 1.60, 95% CI = 1.51, 1.71), high decision-making power (aOR = 1.19, 95% CI = 1.15, 1.23), and low acceptance of wife beating had higher likelihood of skill birth attendance after adjusting for socio-demographic characteristics. Women from rural areas had lesser likelihood (OR = 0.53, 95% CI = 0.51-0.55) of skilled birth attendance compared to women from urban areas. Working women had a lesser likelihood of skilled birth attendance (OR = 0.91, 95% CI = 0.88-0.94) as compared to those not working. Women with secondary (OR = 2.13, 95% CI = 2.03-2.22), or higher education (OR = 4.40, 95% CI = 3.81-5.07), and women in the richest wealth status (OR = 3.50, 95% CI = 3.29-3.73) had higher likelihood of skilled birth attendance. CONCLUSION: These findings accentuate that going forward, successful skilled birth attendant interventions are the ones that can prioritise the empowerment of women.

Evaluation of a blended care programme for caregivers and working pregnant women to prevent adverse pregnancy outcomes: an intervention study.

OBJECTIVE: Work-related activities can be a risk factor for pregnancy complications such as preterm birth. This study evaluates the effectiveness of a blended care programme, Pregnancy and Work, that provides pregnant workers and their obstetrical caregivers with advice on work adjustment. METHODS: Women less than 20 weeks of gestation, in paid employment or self-employed, in the care of four participating hospitals and their referring midwifery practices in the Netherlands received either the blended care programme (n=119), consisting of a training for professionals and a mobile health application, or care as usual (n=122) in a controlled intervention study with a follow-up in intervention and control populations. All participants completed three questionnaires concerning health and working conditions at 16, 24 and 32 weeks of pregnancy. Primary outcome was the percentage of women who received advice from their obstetrical caregiver about work adjustment. Secondary outcomes were work status, realised work adjustment and working conditions. Groups were compared using univariate and multivariate regression analyses. RESULTS: A total of 188 (78%) completed all three questionnaires. In the blended care group, women received more advice from obstetrical caregivers to adjust their work than in the control group, 41 (39%) vs 21 (18%) (adjusted relative risk (aRR) 2.2, 95% CI 1.4 to 3.4), but less from their employer 8 (8%) vs 31 (28%) (aRR 0.29, 95% CI 0.14 to 0.61). There were no significant differences in realised work adjustments. At 24 weeks, 30% of the pregnant women in both groups continued to work in hazardous workplaces. CONCLUSION: Among working pregnant women, the blended care intervention increases advice on work adjustment given by midwives and obstetricians, but does not lead to more work adjustments.

Habitus profissional como expressão da identidade das enfermeiras obstétricas: configurações identitárias a partir da inserção no campo laboral / Professional habitus as an expression of the identity of obstetric nurses: identity configurations from the insertion in the labor field

Trata-se de uma pesquisa exploratória, descritiva com abordagem qualitativa, cujo objeto de estudo é identidade profissional das enfermeiras obstétricas. Este estudo teve por objetivo descrever as disposições incorporadas pelas enfermeiras obstétricas e seus nexos com a formação e com o vivido no mundo do trabalho, analisar os atos de pertencimento e a percepção dos atos de atribuição da identidade profissional das enfermeiras obstétricas e discutir as configurações identitárias das enfermeiras obstétricas segundo a perspectiva de Claude Dubar. Após a aprovação pelo Comitê de Ética, através do Parecer sob o número CAAE 18055319.0.0000.5282, foram realizadas 13 entrevistas semiestruturadas mediante a orientação de um roteiro. Foi realizada análise de conteúdo categorial temática, seguindo as três etapas de Bardin (2011): pré-análise, exploração do material e interpretação. Os dados obtidos foram agrupados em três categorias e recortados em Unidades de Registro (URs): "Disposições incorporadas pelas enfermeiras durante seu processo de socialização", "Atos de pertencimento e atos de atribuição" e "Configurações identitárias apresentadas pelas enfermeiras obstétricas". Os resultados da primeira categoria apontaram que no decorrer da socialização primária, as disposições incorporadas pelas participantes que influenciaram na escolha pela profissão foram: a autonomia financeira através do estudo; a disciplina; cuidar e respeitar o próximo. Além disso, ao ingressarem na especialização, adquiriram novos capitais somados aos pré-existentes, como: domínio do setor, noção de gênero, cuidados com a gestante, educação em saúde, práticas integrativas, empatia e respeito, escuta ativa, singularidade dos sujeitos e olhar integral. Os resultados da segunda categoria mostraram que as enfermeiras obstétricas se veem como mulheres batalhadoras que cuidam do lar e dos filhos, que amam a profissão, defendem o fisiológico e acreditam no parto normal sem intervenções, que tem empatia, que empoderam as mulheres, que veem a integralidade e a singularidade do indivíduo sem expressar julgamentos, que detém muito conhecimento e são anjos da guarda invisíveis. Os resultados da terceira categoria evidenciaram que as enfermeiras obstétricas apresentam traços compatíveis com as configurações identitárias negociatórias por dominarem saberes profissionais, manterem colaboração com a instituição e por reconstruírem a identidade de forma boa para ambos, e afinitária por não manifestarem pertencimento a empresa, terem certeza que valem mais que o cargo que ocupam e buscarem consolidar projetos pessoais alheios aos da instituição. Conclui-se que a socialização primária das enfermeiras obstétricas influenciou na escolha profissional e no modo como elas se vêem e acreditam ser vistas. Além disso, por estarem inseridas num campo laboral que não é compatível com sua identidade real, tendem, com o passar do tempo, a romper com o campo e procurar um novo espaço onde se sintam mais reconhecidas ou podem também permanecer no campo e sofrer desgaste psíquico, afetando assim sua saúde.

It is an exploratory, descriptive research with a qualitative approach, whose object of study is the professional identity of obstetric nurses. This study aimed to describe the provisions incorporated by obstetric nurses and their links with training and with what they have experienced in the world of work, analyze the acts of belonging and the perception of acts of attribution of the professional identity of obstetric nurses and discuss the identity configurations obstetric nurses from the perspective of Claude Dubar. After approval by the Ethics Committee, through the Opinion under the number CAAE 18055319.0.0000.5282, 13 semi-structured interviews were conducted through the guidance of a script. Thematic categorical content analysis was carried out, following the three stages of Bardin (2011): pre-analysis, material exploration and interpretation. The data obtained were grouped into three categories and cut into Registration Units (URs): "Provisions incorporated by nurses during their socialization process" with 42 URs, "Acts of belonging and acts of attribution" with 61 URs and "Identity configurations presented by obstetric nurses "with 37 RUs. The results of the first category showed that during the course of primary socialization, the provisions incorporated by the participants that influenced the choice of the profession were: financial autonomy through the study; the discipline; take care and respect others. In addition, when they entered the specialization, they acquired new capital added to the pre-existing ones, such as: administration, domain of the sector, notion of gender, care for pregnant women, health education, integrative practices, empathy and respect, active listening, singularity of subjects and integral look. The results of the second category showed that obstetric nurses see themselves as hardworking women who care for the home and children, who love the profession, defend the physiological and believe in normal childbirth without interventions, who have empathy, who empower women, who see the integrality and uniqueness of the individual without expressing judgments, who have a lot of knowledge and are invisible guardian angels. The results of the third category showed that the obstetric nurses were divided into two groups and showed traits compatible with the negotiating identity configurations for dominating professional knowledge, maintaining reciprocal collaboration with the institution and reconstructing the identity in a good way for themselves and for the institution, and affinity for not expressing belonging to the company, making sure that they are worth more than the position they occupy and for seeking to consolidate personal projects unrelated to those of the institution. It is concluded that a primary socialization of obstetric nurses influenced the professional choice and how they see themselves and believe to be seen. In addition, as they are inserted in a labor field that is not compatible with their real identity, they tend to spend time breaking off with the field and looking for a new space where they feel more recognized or they can also remain in the field and suffer psychological distress thus affecting their health.

Effects of a work-related stress model based mental health promotion program on job stress, stress reactions and coping profiles of women workers: a control groups study.

BACKGROUND: Work-related stress and its detrimental effects on human health have rapidly increased during the past several years. It causes many different stress reactions, related diseases and unhealthy behavior among workers, but especially women workers. Thus, the aim of this study was to examine the effects of the work-related stress model based Workplace Mental Health Promotion Programme on the job stress, social support, reactions, salivary immunoglobulin A and Cortisol levels, work absenteeism, job performance and coping profiles of women workers. METHODS: This study had a "pre-test post-test non-equivalent control groups" design and included 70 women workers (35 in each study group) selected by randomized sampling from two factories. The programme was delivered as an intervention including 12 weeks of follow-up. Reminder messages, videos, and WhatsApp texts were used at the follow-up stage. The research measurements were; the assessment form, the Brief Job Stress Questionnaire, the Brief Coping Profile Scale, salivary ELISA kits, and a self-reported check-list. RESULTS: There were no differences in sociodemographic characteristics, general health or working conditions between the Intervention and control groups(p > .05). Three months after the intervention, there was a significant decrease in job stress(p ≤ .001), physical and mental reactions' scores(p ≤ .001) and work absenteeism(p < .05), and there was an increase in job performance(p < .05), social support(p ≤ .001) among the intervention group. The programme showed positive effects on coping profiles(p < .05). After the intervention salivary-cortisol and IgA levels showed a statistically significant decrease(p < .05). A majority of effect sizes were very large (ηp2 > .14). CONCLUSIONS: Work-ProMentH was found to be effective and useful in job stress management and promotion of effective coping profiles. It enables its users to holistically assess worker stress and to plan and examine intervention programmes via a systematic approach. There is a need for more empirical studies that may support the data of the present study, but it is thought that the intervention can be maintained for the long-term. We recommend that occupational health professionals at workplaces should consider using this model-based cost-effective intervention, which seems easy and practical to apply in real-life situations. TRIAL REGISTRATION: ISRCTN registration ID: ISRCTN14333710 (2020/10/03, retrospective registration).

Potential benefits of Yoga in pregnancy-related complications during the COVID-19 pandemic and implications for working women.

BACKGROUND: Pregnancy is a vulnerable period of growth and enrichment along with many physiological and psychological challenges. These changes can lead to complications if compounded by external stress and anxiety. COVID-19 has emerged as a chief stressor among the general population and is a serious threat among vulnerable populations. Therefore, there is a need for stress management tools, such as Yoga and physical exercises, both at home and at work. These can be adopted during the pandemic with proper maintenance of social distancing. OBJECTIVE: To evaluate and compile literature that has reported the health outcomes of Yoga intervention on pregnancy at the workplace and analyzes both the restrictions as well as advantages of its beneficial effects in comparison to physical exercises. METHODOLOGY: A comprehensive literature review was conducted utilizing PubMed and Google Scholar. The keywords used for the search include "Yoga", "work", "complications", "physical exercise", "drugs" and "COVID" indifferent permutations and combinations with "pregnancy". We compiled the literature with respect to pregnancy complications and the effects of drugs, physical activity and Yoga for preventing these complications. RESULTS: We noted that pregnancy-related complications are becoming more prevalent because of a sedentary lifestyle, restricted physical activity and growing stress. In such situations, a home or workplace Yoga protocol can combine both exercise and mindfulness-based alleviation of anxiety for both working and non-working women. CONCLUSION: Yoga can be effective for combating stress and anxiety besides boosting immunity in pregnant working women confronted with the COVID-19 pandemic.

A Socioecological Approach to Understanding Workplace Lactation Support in the Health Care Setting.

Introduction: The percentage of working women with children under the age of 3 has nearly doubled since the 1970s, elevating the importance of understanding and improving workplace lactation support. This study aimed to examine employee perceptions of and experiences with workplace lactation support within a single health care system. We used a socioecological approach and included the views of a broad range of employees with and without lactation experience to capture diverse perspectives at multiple levels. Materials and Methods: Employees were recruited from an integrated health care system in the southeastern United States. Five focus groups were conducted during June to August 2017. Transcripts were analyzed using qualitative content analysis, with key themes organized at four levels of analysis: individual, interpersonal, departmental, and organizational. Results: Thirty-five clinical and nonclinical employees participated. Employees shared varied perspectives on workplace lactation support, which emphasized the: (1) importance of having a lactation policy, (2) critical role of leadership in setting the tone for workplace lactation, and (3) differential experience between clinical and non-clinical lactating employees. Conclusion: Employee experiences with lactation support in the health care setting are influenced by individual, interpersonal, departmental, and organizational factors that must be considered in the design of effective workplace lactation support programs. Policies and programs that align with organizational values and accommodate the needs of employees in varying roles are recommended. By using a socioecological perspective, this study identifies practical strategies for implementing, improving, and sustaining workplace lactation support across multiple levels of a large health care organization.

Knowledge and intake of folic acid among teachers of childbearing age in the State of Qatar: a cross-sectional study.

OBJECTIVES: To assess the knowledge and intake of folic acid among teachers of childbearing age and to identify barriers to folic acid intake. SETTING: Governmental schools, which included 14 primary models, 29 primary, 14 preparatory and 16 secondary schools. The proportion of teachers in each stratum was then determined, and a stratified random sampling design had been used with proportional allocation. STUDY DESIGN: Cross-sectional study PARTICIPANTS: A total of 406 non-pregnant teachers of childbearing age enrolled in the study. A validated questionnaire in the Arabic language was used. RESULTS: The overall response rate was 98%. About 34.6% reported the optimal period in which they should take folic acid, 28.3% reported the correct intake duration and only 29.5% could name food rich in folic acid. Friends and healthcare providers were the main sources of information for the participants; however, 44% said that they did not receive enough information from their healthcare providers. CONCLUSION: There is a lack of knowledge and poor intake of folic acid among the participants. In particular, they lacked information about the appropriate time to start folic acid supplementations, the duration of intake and the folic acid-rich food. The most common reason being the limited advice given by their healthcare providers.Awareness campaigns are recommended to emphasise the role of healthcare providers in counselling women about the proper use of folic acid before pregnancy.

Impact of Key Workplace Breastfeeding Support Characteristics on Job Satisfaction, Breastfeeding Duration, and Exclusive Breastfeeding Among Health Care Employees.

Background: Although national breastfeeding rates have improved across recent decades, women continue to face barriers to achieving recommended breastfeeding targets. Returning to work presents a unique set of challenges for breastfeeding continuation, even in health care settings tasked with promoting breastfeeding among patients. This study examined the association between key workplace breastfeeding support characteristics, job satisfaction, and breastfeeding outcomes among health care employees. Materials and Methods: We used data from a cross-sectional survey of employees in a large integrated health care system. The study sample included female employees who had breastfed in the past 3 years (n = 165). The Employee Perceptions of Breastfeeding Support Questionnaire (EPBS-Q) measured organization, manager, and coworker support for breastfeeding. Regression analyses tested the association between workplace support factors and breastfeeding duration, breastfeeding exclusivity, and job satisfaction. Results: Managerial support increased median job satisfaction by 0.39 standard deviations (p < 0.001), and increased the odds of prolonging exclusive breastfeeding (odds ratio [OR] 1.47; confidence interval [CI] 1.03-2.09). Organizational support increased median job satisfaction by 0.27 standard deviations (p < 0.001), and increased the odds of exclusive breastfeeding by nearly twofold (OR 1.80; CI 1.05-3.09). No significant associations were found between workplace support factors (organizational, managerial, and co-worker support) and overall breastfeeding duration. Conclusions: Organizational and managerial support are key aspects of workplace lactation support, which may positively impact job satisfaction, rates of exclusive breastfeeding, and duration of exclusive breastfeeding among female health care employees. This intersection of outcomes salient for the business community and public health practitioners highlights opportunities for collaborations to improve workplace and breastfeeding outcomes.

Climatério, enfrentamento e repercussões no contexto de trabalho: vozes do Extremo Norte do Brasil / Menopause, coping and impact at the work context: voices from the Extreme North of Brazil / Climaterio, enfrentamiento y repercusiones en el contexto de trabajo: voces del Extremo Norte de Brasil

Esta pesquisa tem por objetivo investigar as consequências do climatério no comportamento da mulher no seu lócus laboral. É um trabalho ancorado no método de levantamento de dados e caracteriza-se por ser de natureza descritiva e exploratória. As informações foram categorizadas, pré-codificadas e organizadas qualitativamente, com base na análise de conteúdo proposta por Bardin. Os sujeitos do estudo foram 15 mulheres entre 40 e 60 ou mais anos, profissionais da saúde em uma unidade de saúde da família, em uma cidade do Extremo Norte do Brasil. Dentre as estratégias de enfrentamento utilizadas estão: as atividades físicas (caminhadas na praça, passeio de bicicleta), hábitos alimentares adequados (produtos naturais, tais como soja, linhaça, alimentação sem gordura, pouco sal), religiosidade (Deus, Bíblia, orações, ir à igreja) e a busca por assistência médica (visitas ao ginecologista e a procura pelo serviço médico na unidade de saúde). Observou-se que o climatério é um período importante, porém nem sempre compreendido e atendido de maneira adequada, e que essa fase ainda é vista como um período negativo, que pode alterar a vida conjugal e familiar.

This research aims to investigate the consequences in climacteric women's behaviour in their job locus. It is a work anchored in the data collection method and characterized as descriptive and exploratory in nature. Data were categorized, pre-coded and organized qualitatively, based on the content analysis and interpretation proposed by Bardin. The subjects of the study were 15 women between 40 and 60 years or older, health professionals at a family health unit in a city in the Far North of Brazil. Among the coping strategies used are the following: physical activity (walking in the street, bike ride), proper eating habits (natural products such as soy, flaxseed, no fat diet, low salt), religion (God, the Bible, prayers, go to the church). Besides that, searching for medical care (visits to the gynaecologist and the search for medical service at the clinic). Menopause is an important period of the female life, but it is not always properly understood and cared in an adequate way.

Esta investigación tiene por objetivo investigar las consecuencias del climaterio en el comportamiento de la mujer en su domicilio laboral. Es un trabajo anclado en el método de levantamiento de datos y se caracteriza por ser de naturaleza descriptiva y exploratoria. La información se clasificó, precalifica y organizó cualitativamente, sobre la base del análisis de contenido propuesto por Bardin. Los sujetos del estudio fueron 15 mujeres entre 40 y 60 o más años, profesionales de la salud en una unidad de salud de la familia, en una ciudad del Extremo Norte de Brasil. (Entre las estrategias de enfrentamiento utilizadas están: las actividades físicas (caminatas en la plaza, paseo en bicicleta), hábitos alimentarios adecuados (productos naturales, tales como soja, linaza, alimentación sin grasa, poco sal), religiosidad (Dios, Biblia, oraciones, ir a la iglesia) y la búsqueda de asistencia médica (visitas al ginecólogo y la demanda por el servicio médico en la unidad de salud). Se observó que el climaterio es un período importante, pero no siempre comprendido y atendido de manera adecuada, y que esa fase todavía es vista como un período negativo, que puede alterar la vida conyugal y familiar.

Por el bien de la nación: discursos científicos en favor de la medicalización del parto en el Perú, 1900-1940 / For the good of the nation: scientific discourses endorsing the medicalization of childbirth in Peru, 1900-1940

Resumen A lo largo del siglo XX se sucedió una serie de cambios en la forma de concebir el parto que pasó de ser un fenómeno reproductivo natural propio del ámbito doméstico y femenino a un asunto médico y profesional del ámbito institucional. A través de procedimientos como el uso de anestesia, la cesárea, el ultrasonido y otras intervenciones técnico-científicas se han generado rápidas e importantes mejoras y cambios para la salud y vida de la sociedad y las mujeres. La medicalización del parto a comienzos del siglo XX fue parte de un proceso más amplio de construcción del Estado e institucionalización del patriarcado común en la región.

Abstract Over the course of the twentieth century, a series of changes occurred in the understanding of childbirth, which went from being a natural reproductive phenomenon belonging to the female, domestic sphere to a professional medical matter handled in an institutional setting. Through procedures like the use of anesthesia, Cesarean sections, ultrasound and other techno-scientific interventions, rapid and significant improvements and changes took place in the health and life of society and of women. The medicalization of childbirth in the early twentieth century was part of a broader process of constructing the state and institutionalizing the patriarchy that was common throughout the region.

Systematic review of interventions targeting sickness absence among pregnant women in healthcare settings and workplaces.

OBJECTIVES: The high rate of sickness absence from work during pregnancy is recognised as a problem, and may be higher than necessary from a health perspective. The aim was to evaluate the effectiveness of interventions in healthcare settings and workplaces targeting sickness absence among pregnant women. METHODS: Studies were eligible if they included pregnant women participating in any intervention in healthcare settings or workplaces. The outcome was length of sickness absence in days or number of episodes. Study design had to be either randomised controlled trials (RCTs) or quasi-experimental studies.The search for studies was conducted in PubMed, Scopus, CINAHL, PsycINFO, ClinicalTrials.gov and WHO trial registry. Risk of bias was assessed by the Joanna Briggs Institute standardised quality assessment instrument. RESULTS: A total of nine studies were quality assessed and of these, four were excluded due to insufficient methodological quality. Five RCTs conducted in healthcare settings in Sweden and Norway were included. Due to heterogeneity, meta-analysis was not performed.Two RCTs examined complementary and alternative medicine and three RCTs the effect of physical exercise. In general, the frequency of women on sickness absence was lower in the intervention groups than the control groups, however, only among pregnant women who participated in a 12-week exercise programme, the frequency was significantly lower (22% vs 30%, p=0.04). CONCLUSION: The evidence of interventions targeting sickness absence among pregnant women in healthcare settings is sparse, and no studies were conducted at workplaces.Future interventions including physical activity provided in collaboration with healthcare settings and workplaces are requested. Studies should measure sickness absence based on valid methods, measure compliance to the intervention and provide transparency of statistical methods. PROSPERO REGISTRATION NUMBER: CRD42018084802.

For the good of the nation: scientific discourses endorsing the medicalization of childbirth in Peru, 1900-1940. / Por el bien de la nación: discursos científicos en favor de la medicalización del parto en el Perú, 1900-1940.

Over the course of the twentieth century, a series of changes occurred in the understanding of childbirth, which went from being a natural reproductive phenomenon belonging to the female, domestic sphere to a professional medical matter handled in an institutional setting. Through procedures like the use of anesthesia, Cesarean sections, ultrasound and other techno-scientific interventions, rapid and significant improvements and changes took place in the health and life of society and of women. The medicalization of childbirth in the early twentieth century was part of a broader process of constructing the state and institutionalizing the patriarchy that was common throughout the region.

A lo largo del siglo XX se sucedió una serie de cambios en la forma de concebir el parto que pasó de ser un fenómeno reproductivo natural propio del ámbito doméstico y femenino a un asunto médico y profesional del ámbito institucional. A través de procedimientos como el uso de anestesia, la cesárea, el ultrasonido y otras intervenciones técnico-científicas se han generado rápidas e importantes mejoras y cambios para la salud y vida de la sociedad y las mujeres. La medicalización del parto a comienzos del siglo XX fue parte de un proceso más amplio de construcción del Estado e institucionalización del patriarcado común en la región.

Pathways of the association between maternal employment and weight status among women and children: Qualitative findings from Guatemala.

The double burden of malnutrition, defined by the coexistence of undernutrition and overweight, is well documented in low- and middle-income countries. However, the mechanisms by which employment may be related to maternal and child weight status in low- and middle-income countries are not well understood. We conducted in-depth interviews among 20 mothers who participated in Project MIEL, a contemporary trial which evaluated the effects of an integrated micronutrient supplement and parenting intervention in rural Guatemala. We utilized semi-structured interviews to explore the pathways by which maternal employment might influence bodyweight. Interviews were structured to explore the factors that mothers considered when deciding whether or not to participate in the labor force and how mothers perceived the influence of employment on determinants of their own bodyweight and that of their children. Themes were used to develop a conceptual framework. Mothers described four pathways through which employment could lead to changes in weight status: changes in food purchasing; improved household well-being; changes in time allocation; and psychological effects. Mothers described purchasing increased quantities and more varied types of food, as well as the purchase of energy-dense foods. Less time to devote to food preparation resulted in mothers preparing quicker meals and relying on substitute childcare. Mothers also expressed feelings of worry and neglect in relation to being employed, and perceived that these feelings would affect weight. A better understanding of these mechanisms is important for developing policies and programs to support women in the workplace and also reducing maternal and child overweight in Guatemala.

Comparisons for Effectiveness of Aromatherapy and Acupressure Massage on Quality of Life in Career Women: A Randomized Controlled Trial.

OBJECTIVES: This study was aimed to compare the effectiveness of aromatherapy and acupressure massage intervention strategies on the sleep quality and quality of life (QOL) in career women. DESIGN: The randomized controlled trial experimental design was used in the present study. One hundred and thirty-two career women (24-55 years) voluntarily participated in this study and they were randomly assigned to (1) placebo (distilled water), (2) lavender essential oil (Lavandula angustifolia), (3) blended essential oil (1:1:1 ratio of L. angustifolia, Salvia sclarea, and Origanum majorana), and (4) acupressure massage groups for a 4-week treatment. The Pittsburgh Sleep Quality Index and Short Form 36 Health Survey were used to evaluate the intervention effects at pre- and postintervention. RESULTS: After a 4-week treatment, all experimental groups (blended essential oil, lavender essential oil, and acupressure massage) showed significant improvements in sleep quality and QOL (p < 0.05). Significantly greater improvement in QOL was observed in the participants with blended essential oil treatment compared with those with lavender essential oil (p < 0.05), and a significantly greater improvement in sleep quality was observed in the acupressure massage and blended essential oil groups compared with the lavender essential oil group (p < 0.05). CONCLUSIONS: The blended essential oil exhibited greater dual benefits on improving both QOL and sleep quality compared with the interventions of lavender essential oil and acupressure massage in career women. These results suggest that aromatherapy and acupressure massage improve the sleep and QOL and may serve as the optimal means for career women to improve their sleep and QOL.

A Grounded Theory Study of How Nurses Integrate Pregnancy and Full-Time Employment: Becoming Someone Different.

BACKGROUND: A holistic exploration of the experience of how nurses integrate pregnancy and employment is lacking among the global nursing literature. OBJECTIVE: The purpose of this research was to explore how primiparous U.S. nurses integrated pregnancy and full-time employment. METHODS: Using a grounded theory approach, 20 nurses from the United States, who were pregnant and delivered their first baby-while employed full time on 12-hour work shifts-provided a firsthand account of how they incorporated pregnancy with professional nursing employment. RESULTS: The basic social process, "becoming someone different," emerged to explain how U.S. nurses integrated pregnancy and full-time employment in early and late stages. Four core categories were: (a) "looking different, feeling different,"(b) "expectations while expecting," (c) "connecting differently," and (d) "transitioning labor." DISCUSSION: Within early and late stages, pregnant nurses becoming someone different navigate through various social interactions with peers and patients alike, with meaning assigned to those experiences. Research with pregnant nurses from other countries, nurses working in settings other than acute care, and multiparous nurses is needed to further expand on these findings.

The long-term mortality impact of combined job strain and family circumstances: A life course analysis of working American mothers.

BACKGROUND: Work stress and family composition have been separately linked with later-life mortality among working women, but it is not known how combinations of these exposures impact mortality, particularly when exposure is assessed cumulatively over the life course. We tested whether, among US women, lifelong work stress and lifelong family circumstances would jointly predict mortality risk. PROCEDURES: We studied formerly working mothers in the US Health and Retirement Study (HRS) born 1924-1957 (n = 7352). We used sequence analysis to determine five prototypical trajectories of marriage and parenthood in our sample. Using detailed information on occupation and industry of each woman's longest-held job, we assigned each respondent a score for job control and job demands. We calculated age-standardized mortality rates by combined job demands, job control, and family status, then modeled hazard ratios for death based on family constellation, job control tertiles, and their combination. RESULTS: Married women who had children later in life had the lowest mortality risks (93/1000). The highest-risk family clusters were characterized by spells of single motherhood (132/1000). Generally, we observed linear relationships between job control and mortality hazard within each family trajectory. But while mortality risk was high for all long-term single mothers, we did not observe a job control-mortality gradient in this group. The highest-mortality subgroup was previously married women who became single mothers later in life and had low job control (HR 1.91, 95% CI 1.38,2.63). PRACTICAL IMPLICATIONS: Studies of associations between psychosocial work characteristics and health might consider heterogeneity of effects by family circumstances. Worksite interventions simultaneously considering both work and family characteristics may be most effective in reducing health risks.

Costo del tratamiento en trabajadoras con enfermedad inflamatoria pelviana / Cost of treatment in workers with pelvic inflammatory disease

Se realizó una intervención terapéutica en 39 trabajadoras con inflamación pelviana, diagnosticadas y tratadas desde hacía 5 meses, pertenecientes al área de salud La Caoba del municipio de San Luís, en Santiago de Cuba, de enero a mayo del 2012, con vistas a comparar el costo del tratamiento medicamentoso con el del acupuntural. En la serie se obtuvo que 51,3 por ciento de las féminas con medicación mejorara en 2 semanas y 23,1 por ciento requirió más de 28 días de tratamiento, mientras que 90,0 por ciento de las que recibieron acupuntura se recuperaron en 3 semanas. Esta terapéutica alternativa constituyó un ahorro para las pacientes, al disminuir sus pérdidas económicas por gastos en medicamentos y por certificados médicos; además de reducir la estadía hospitalaria y su costo. Desde el punto de vista social se logró que las trabajadoras afectadas se incorporaran a sus quehaceres laborales y domésticos más tempranamente(AU)

A therapeutic intervention was carried out in 39 workers with pelvic inflammation, diagnosed and treated for 5 months, belonging to the health area from La Caoba of San Luís municipality, in Santiago de Cuba, from January to May, 2012, with the aim of comparing the cost of drug treatment with that of the acupunctural treatment. In the series it was obtained that 51.3 percent of the female with medication improved in 2 weeks and 23.1 percent required more than 28 days of treatment, while 90.0 percent of those who received acupuncture recovered in 3 weeks. This alternative therapy constituted a saving for the patients, as they decreased their economic losses due to expenses in medications and to medical certificates; besides reducing the hospital stay and its cost. From the social point of view it was achieved that the affected workers incorporate to their jobs and domestic work even earlier(AU)