Exploring how non-clinical factors in childbirth care shape users' experiences in public health facilities in rural Chiapas, Mexico: a qualitative study using the WHO health systems responsiveness framework.

INTRODUCTION: Many Mexicans face barriers to receive delivery care from qualified professionals, especially indigenous and poor sectors of the population, which represent most of the population in the state of Chiapas. When access to institutional delivery care is an option, experiences with childbirth care are often poor. This underscores the need for evidence to improve the quality of services from the user's perspective. The present study was conceived with the objective of understanding how non-clinical aspects of care shape women's birthing experiences in public health institutions in Chiapas. METHODS: We conducted an exploratory qualitative study. Data collection consisted in 20 semi-structured interviews to women who had delivered in a public health facility in Chiapas during the last six months prior to the interview. For the design of the interview guide we used the WHO health system responsiveness framework, which focus on the performance of the health system in terms of the extent to which it delivers services according to the "universally legitimate expectations of individuals" and focuses on the non-financial and non-clinical qualities of care. The resulting data were analyzed using thematic analysis methodology. RESULTS: We identified a total of 16 themes from the data, framed in eight categories which followed the eight domains of the WHO health systems responsiveness framework: Choice of the provider and the facility, prompt attention, quality of basic amenities, access to social support, respectful treatment, privacy, involvement in decisions, and communication. We shed light on the barriers women face in receiving prompt care, aspects of health facilities that impact women's comfort, the relevance of being provided with adequate food and drink during institutional delivery, how accompaniment contributes positively to the birthing experience, the aspects of childbirth that women find important to decide on, and how providers' interpersonal behaviors affect the birthing experience. CONCLUSIONS: We have identified non-clinical aspects of childbirth care that are important to the user experience and that are not being satisfactorily addressed by public health institutions in Chiapas. This evidence constitutes a necessary first step towards the design of strategies to improve the responsiveness of the Chiapas health system in childbirth care.

[Enforceability of the right to health protection in obstetric services in Mexico]. / Exigibilidad del derecho a la protección de la salud en los servicios de obstetricia en México.

The inclusion of the framework of human rights in maternal health is mentioned more and more frequently as a feasible proposal to improve the care that women receive in obstetric health care services. Despite the fact Mexico has a solid regulatory framework for obstetric care, mechanisms of enforceability are essential to ensure that health-related human rights are upheld. In addition to being in place, enforceability mechanisms should be effective and accessible to people, particularly in obstetric care, where repeated human rights violations occur that endanger women's health and lives. The objective of this article is to specify the regulatory, legal, and extralegal elements that need to be considered in order to include maternal health in a set of enforceable human rights.

Community-based health care for indigenous women in Mexico: a qualitative evaluation.

INTRODUCTION: Indigenous women in Mexico represent a vulnerable population in which three kinds of discrimination converge (ethnicity, gender and class), having direct repercussions on health status. The discrimination and inequity in health care settings brought this population to the fore as a priority group for institutional action. The objective of this study was to evaluate the processes and performance of the "Casa de la Mujer Indígena", a community based project for culturally and linguistically appropriate service delivery for indigenous women. The evaluation summarizes perspectives from diverse stakeholders involved in the implementation of the model, including users, local authorities, and institutional representatives. METHODS: The study covered five Casas implementation sites located in four Mexican states. A qualitative process evaluation focused on systematically analyzing the Casas project processes and performance was conducted using archival information and semi-structured interviews. Sixty-two interviews were conducted, and grounded theory approach was applied for data analysis. RESULTS: Few similarities were observed between the proposed model of service delivery and its implementation in diverse locations, signaling discordant operating processes. Evidence gathered from Casas personnel highlighted their ability to detect obstetric emergencies and domestic violence cases, as well as contribute to the empowerment of women in the indigenous communities served by the project. These themes directly translated to increases in the reporting of abuse and referrals for obstetric emergencies. CONCLUSIONS: The model's cultural and linguistic competency, and contributions to increased referrals for obstetric emergencies and abuse are notable successes. The flexibility and community-based nature of the model has allowed it to be adapted to the particularities of diverse indigenous contexts. Local, culturally appropriate implementation has been facilitated by the fact that the Casas have been implemented with local leadership and local women have taken ownership. Users express overall satisfaction with service delivery, while providing constructive feedback for the improvement of existing Casas, as well as more cost-effective implementation of the model in new sites. Integration of user's input obtained from this process evaluation into future planning will undoubtedly increase buy-in. The Casas model is pertinent and viable to other contexts where indigenous women experience disparities in care.

Portable Rabies Virus Sequencing in Canine Rabies Endemic Countries Using the Oxford Nanopore MinION.

As countries with endemic canine rabies progress towards elimination by 2030, it will become necessary to employ techniques to help plan, monitor, and confirm canine rabies elimination. Sequencing can provide critical information to inform control and vaccination strategies by identifying genetically distinct virus variants that may have different host reservoir species or geographic distributions. However, many rabies testing laboratories lack the resources or expertise for sequencing, especially in remote or rural areas where human rabies deaths are highest. We developed a low-cost, high throughput rabies virus sequencing method using the Oxford Nanopore MinION portable sequencer. A total of 259 sequences were generated from diverse rabies virus isolates in public health laboratories lacking rabies virus sequencing capacity in Guatemala, India, Kenya, and Vietnam. Phylogenetic analysis provided valuable insight into rabies virus diversity and distribution in these countries and identified a new rabies virus lineage in Kenya, the first published canine rabies virus sequence from Guatemala, evidence of rabies spread across an international border in Vietnam, and importation of a rabid dog into a state working to become rabies-free in India. Taken together, our evaluation highlights the MinION's potential for low-cost, high volume sequencing of pathogens in locations with limited resources.

The inevitability of infidelity: sexual reputation, social geographies, and marital HIV risk in rural Mexico.

Marriage presents the single greatest risk for HIV infection among women in rural Mexico. We drew on 6 months of participant observation, 20 marital case studies, 37 key informant interviews, and archival research to explore the factors that shape HIV risk among married women in one of the country's rural communities. We found that culturally constructed notions of reputation in this community lead to sexual behavior designed to minimize men's social risk (threats to one's social status or relationships), rather than viral risk and that men's desire for companionate intimacy may actually increase women's risk for HIV infection. We also describe the intertwining of reputation-based sexual identities with structurally patterned sexual geographies (i.e. the social spaces that shape sexual behavior). We propose that, because of the structural nature of men's extramarital sexual behavior, intervention development should concentrate on sexual geographies and risky spaces rather than risky behaviors or identities.

Exigibilidad del derecho a la protección de la salud en los servicios de obstetricia en México / Enforceability of the right to health protection in obstetric services in Mexico

La incorporación del marco de los derechos humanos a la salud materna se menciona cada vez con mayor frecuencia como una propuesta factible para mejorar la atención que reciben las mujeres en los servicios de atención obstétrica. Si bien es cierto que en México se cuenta con un sólido marco normativo en la materia, un elemento fundamental para garantizar el cumplimiento los derechos humanos relacionados con la salud son los mecanismos de exigibilidad que, además de encontrarse disponibles, deben ser efectivos y próximos a la población, principalmente en la atención obstétrica, espacio en donde ocurren reiteradas violaciones a los derechos humanos que ponen en riesgo la salud y la vida de las mujeres. El objetivo de este artículo es precisar los elementos normativos, jurídicos y extrajurídicos que deben ser considerados para incorporar la salud materna como un conjunto de derechos humanos exigibles.

The inclusion of the framework of human rights in maternal health is mentioned more and more frequently as a feasible proposal to improve the care that women receive in obstetric health care services. Despite the fact Mexico has a solid regulatory framework for obstetric care, mechanisms of enforceability are essential to ensure that health-related human rights are upheld. In addition to being in place, enforceability mechanisms should be effective and accessible to people, particularly in obstetric care, where repeated human rights violations occur that endanger women's health and lives. The objective of this article is to specify the regulatory, legal, and extralegal elements that need to be considered in order to include maternal health in a set of enforceable human rights.

Actividad cognoscitiva y nivel sociocultural / Cognitive activity and sociocultural level

Se tomaron 109 sujetos normales con un promedio de edad de 25 años provenientes de dos niveles socioculturales (alto y bajo) de la ciudad de México. Se diseñó un procedimiento de evaluación de la actividad cognoscitiva, compuesta por nueve áreas diferentes: funciones motoras, conocimiento somatosensorial, reconocimiento espacial y visoespacial, conocimiento auditivo y lenguaje, procesos intelectuales, leaguaje, lectura, escritura y cálculo. Los resultados mostraron que el grupo de nivel sociocultural alto obtuvo mejores puntajes en todas las áreas que el grupo del nivel sociocultural bajo. Se observó una interacción significativa con el sexo; sin embargo, las diferencias entre sexos aparecen sólo en el nivel bajo. Se analizan las diferencias halladas y sus implicaciones

Los potenciales relacionados con los eventos: CNV y PINV en sujetos normales y disléxicos / Potencials related to events: CNV and PINV in normal and dyslexic subjects

La variación contingente negativa (CNV) es una onda cerebral que ha sido asociada con los procesos de expectancia, atención, anticipación y preparación de una respuesta. La duración o resolución de esta onda es conocida como la variación negativa postimperativa (PINV). En la presente investigación se estudiaron las características dela onda PINV en una población de niños con rendimiento escolar adecuado y niños con transtornos en el proceso de lectura. Con base en el rendimiento, en una batería psicoeducativa previamente administrada a 120 niños mexicanos, se seleccionaron 9 sujetos con rendimiento escolar adecuado y sin antecedentes patológicos y 9 sujetos cuya ejecución en la batería psicoeducativa se encontraba dos desviaciones estándar por debajo de las normas estandarizadas. Se utilizaron registros monopolares referidos a lóbulos auriculares cortocircuitados. Siguiendo el Sistema 10-20 internacional se colocaron electrodos en F3, Cz, P3 y 01. Debido a los resultados estadísticos, se observó que dos grupos de sujetos eran significativamente diferentes en la amplitud de la onda PINV en la zona parietal izquierda. Se discute la participación que puede tener esta zona en este transtorno y se consideran factores tales como espectancia, atención y procesamiento de la información en las diferentes encontradas