ABSTRACT
Maternal mental health problems during pregnancy, childbirth, and the postpartum period are a challenge for public health. Not recognizing them hinders a timely diagnosis and treatment and has an impact on the mother and the establishment of the fundamental bond of the mother-child dyad. We must recognize the risk factors (age, socioeconomic status, mental health history, family dysfunction, unfavorable environment), clinical manifestations, and screening tools. There is evidence that the effect of stress, anxiety, and depression during pregnancy negatively affect fetal neurodevelopment and condition child developmental outcomes. Here we describe the negative impact of postpartum depression during the first months of life, which affects mother-child bonding, postnatal development (emotional, behavioral, cognitive, language), and the maintenance of breastfeeding. We also recognize protective factors that mitigate its effects. It is essential to establish preventive strategies and interdisciplinary diagnostic and therapeutic approaches to minimize the risks to the mother and her children.
Los problemas de salud mental materna durante el embarazo, parto y puerperio son un desafío para la salud pública. Su falta de reconocimiento atenta contra el diagnóstico y tratamientos oportunos, e impacta en la madre y el establecimiento del vínculo fundamental del binomio. Debemos reconocer los factores de riesgo (edad, situación socioeconómica, antecedentes psicopatológicos, disfunción familiar, entorno desfavorable), las manifestaciones clínicas y las herramientas de detección. Existen evidencias de que el efecto del estrés, la ansiedad y la depresión durante el embarazo afectan negativamente el neurodesarrollo fetal y condicionan los resultados del desarrollo infantil. Describimos el impacto negativo de la depresión puerperal durante los primeros meses de vida, que afecta el vínculo madre-hija/o, el desarrollo posnatal (emocional, conductual, cognitivo, lenguaje) y el mantenimiento de la lactancia materna. También reconocemos factores protectores que atemperan sus efectos. Es fundamental establecer estrategias preventivas y abordajes diagnósticos y terapéuticos interdisciplinarios para minimizar los riesgos sobre la madre y sus hijas/os.
Subject(s)
Depression, Postpartum , Humans , Female , Pregnancy , Infant , Depression, Postpartum/diagnosis , Depression, Postpartum/etiology , Pregnant Women/psychology , Mother-Child Relations/psychology , Mothers/psychology , Parturition , CognitionABSTRACT
OBJECTIVE: To explore people's decision-making regarding whether or not to get vaccinated against COVID-19. METHODS: A purposive sample of people over the age of 18 who had not yet been vaccinated against COVID-19 was studied. Data were gathered using semi-structured interviews in focus groups and personal in-depth interviews. All interviews were conducted on the Zoom® platform and were recorded for subsequent verbatim transcription. Using a grounded theory approach, both open and axial coding of the narrative data were performed. RESULTS: Information saturation was reached after eight focus group meetings and 14 in-depth interviews (n = 55). Six principal themes emerged, with the fear of possible adverse side-effects and the worries generated by the speed of the development and commercialization of the vaccine amongst the main expressed anxieties. Social pressure to get vaccinated was a recurrent subject, as was the desire for clear and understandable information from reliable sources. CONCLUSIONS: The willingness to get vaccinated against COVID-19 is determined by a complex series of interconnected factors that define an explanatory model, which has evolved concurrently with the development of the vaccines and the progress of the vaccination campaigns. This model will be useful for deciding social scenarios aimed at tackling this or future pandemics and for designing formulas that will increase the initial acceptance of these vaccines.
Subject(s)
COVID-19 , Vaccines , Humans , Adult , Middle Aged , SARS-CoV-2 , COVID-19/prevention & control , COVID-19 Vaccines/therapeutic use , Anxiety , Fear , VaccinationABSTRACT
La pseudoartrosis congénita de la clavícula es una malformación rara y benigna, caracterizada por la ausencia del tercio medio de la clavícula. Suele ser unilateral y mayoritaria en el lado derecho. La etiología es desconocida y se postulan diversas teorías etiopatogénicas (vascular, embriológica y genética).Puede detectarse en el período neonatal o, más frecuentemente, durante la infancia. En ocasiones, puede ser sintomática. Puede requerir tratamiento mediante reconstrucción quirúrgica por injerto óseo.Se presentan 2 casos, uno de diagnóstico neonatal y otro de 3 años de edad realizados con 24 h de diferencia. Se destaca la consideración de este diagnóstico como diferencial de fractura obstétrica o postraumática, displasia cleidocraneal y neurofibromatosis de tipo 1.
The congenital pseudoarthrosis of the clavicle is a rare and benign malformation, characterized by the absence of the middle third of the clavicle. It is usually unilateral and the majority on the right side. The etiology is unknown, postulating diverse etiopathogenic theories (vascular, embryological and genetic).It can be detected in the neonatal period or, more frequently, during childhood. Occasionally it can be symptomatic. It may require treatment by surgical reconstruction by bone graft. Two cases are presented, one of neonatal diagnosis and another one of 3 years of age performed with 24 hours of difference. We emphasize on its consideration as a differential diagnosis of obstetric or post-traumatic fracture, cleidocranial dysplasia and neurofibromatosis type I.
Subject(s)
Humans , Female , Infant, Newborn , Child, Preschool , Pseudarthrosis/congenital , Clavicle/abnormalities , Pseudarthrosis/diagnostic imaging , Congenital Abnormalities , Diagnosis, DifferentialABSTRACT
The congenital pseudoarthrosis of the clavicle is a rare and benign malformation, characterized by the absence of the middle third of the clavicle. It is usually unilateral and the majority on the right side. The etiology is unknown, postulating diverse etiopathogenic theories (vascular, embryological and genetic). It can be detected in the neonatal period or, more frequently, during childhood. Occasionally it can be symptomatic. It may require treatment by surgical reconstruction by bone graft. Two cases are presented, one of neonatal diagnosis and another one of 3 years of age performed with 24 hours of difference. We emphasize on its consideration as a differential diagnosis of obstetric or post-traumatic fracture, cleidocranial dysplasia and neurofibromatosis type I.
La pseudoartrosis congénita de la clavícula es una malformación rara y benigna, caracterizada por la ausencia del tercio medio de la clavícula. Suele ser unilateral y mayoritaria en el lado derecho. La etiología es desconocida y se postulan diversas teorías etiopatogénicas (vascular, embriológica y genética). Puede detectarse en el período neonatal o, más frecuentemente, durante la infancia. En ocasiones, puede ser sintomática. Puede requerir tratamiento mediante reconstrucción quirúrgica por injerto óseo. Se presentan 2 casos, uno de diagnóstico neonatal y otro de 3 años de edad realizados con 24 h de diferencia. Se destaca la consideración de este diagnóstico como diferencial de fractura obstétrica o postraumática, displasia cleidocraneal y neurofibromatosis de tipo 1.
Subject(s)
Clavicle/abnormalities , Pseudarthrosis/congenital , Child, Preschool , Clavicle/diagnostic imaging , Diagnosis, Differential , Female , Humans , Infant, Newborn , Pseudarthrosis/diagnostic imaging , RadiographyABSTRACT
Existe, actualmente, una tendencia a reducir el tiempo de consulta. En algunas regiones de España, se fija en 6 minutos por paciente. Esto tiene impacto en varios planos: literal, en el que, muchas veces, es imposible realizar el acto médico; emocional, en el que se reduce la posibilidad de establecer una relación médico-paciente adecuada; y simbólico, en el que se señalan como prescindibles los aspectos principales de la atención humanizada. Esto ocurre en una sociedad que tiende a ver la atención médica como mercancía sujeta a reglas de mercado y que prioriza lo inmediato por sobre lo importante. Pacientes, médicos y responsables de gestión participan de este cambio que influye negativamente en la medicina actual. El aumento de exámenes complementarios innecesarios, tratamientos evitables, costos por iatrogenia, menor adhesión a tratamientos, reconsultas innecesarias son consecuencias observadas. En el caso de la pediatría, aumenta el riesgo de pérdida de oportunidades de pesquisa en áreas fundamentales.
At present, there is a trend towards reducing the duration of office visits. In some regions of Spain, it has been set at 6 minutes per patient. This impacts on several levels: literally, many times it is impossible to complete the medical act; at an emotional level, because there is little possibility to establish an adequate doctor-patient relationship; and symbolically, for considering that the main aspects of humane health care are expendable. This takes place in a society that tends to see health care as a merchandise subject to market rules that gives priority to the immediate over the important. Patients, physicians, and managing authorities are participants of this change which negatively affects current medical practice. The increase in unnecessary additional testing, avoidable treatments, the costs of iatrogenesis, a lower treatment adherence, and unnecessary reconsultations are proven consequences. In the field of pediatrics, this increases the risk of losing screening opportunities in critical areas.
Subject(s)
Humans , Health Services Administration , Time Management , Empathy , HumanismABSTRACT
At present, there is a trend towards reducing the duration of office visits. In some regions of Spain, it has been set at 6 minutes per patient. This impacts on several levels: literally, many times it is impossible to complete the medical act; at an emotional level, because there is little possibility to establish an adequate doctor-patient relationship; and symbolically, for considering that the main aspects of humane health care are expendable. This takes place in a society that tends to see health care as a merchandise subject to market rules that gives priority to the immediate over the important. Patients, physicians, and managing authorities are participants of this change which negatively affects current medical practice. The increase in unnecessary additional testing, avoidable treatments, the costs of iatrogenesis, a lower treatment adherence, and unnecessary reconsultations are proven consequences. In the field of pediatrics, this increases the risk of losing screening opportunities in critical areas.
Existe, actualmente, una tendencia a reducir el tiempo de consulta. En algunas regiones de España, se fija en 6 minutos por paciente. Esto tiene impacto en varios planos: literal, en el que, muchas veces, es imposible realizar el acto médico; emocional, en el que se reduce la posibilidad de establecer una relación médico-paciente adecuada; y simbólico, en el que se señalan como prescindibles los aspectos principales de la atención humanizada. Esto ocurre en una sociedad que tiende a ver la atención médica como mercancía sujeta a reglas de mercado y que prioriza lo inmediato por sobre lo importante. Pacientes, médicos y responsables de gestión participan de este cambio que influye negativamente en la medicina actual. El aumento de exámenes complementarios innecesarios, tratamientos evitables, costos por iatrogenia, menor adhesión a tratamientos, reconsultas innecesarias son consecuencias observadas. En el caso de la pediatría, aumenta el riesgo de pérdida de oportunidades de pesquisa en áreas fundamentales.
