Sustainability of the Healthy Municipalities Strategy in Guatemala.

OBJECTIVE: Evaluate the sustainability of the Healthy Municipalities strategy in Guatemala in order to have solid evidence to support decision-making. METHODS: A concurrent mixed-methods study was carried out in five phases: 1) theoretical-conceptual (based on a narrative review of the literature on sustainability, dimensions and categories were proposed for evaluation); 2) empirical (four municipalities were selected for convenience and 29 semi-structured interviews and four focus groups were conducted with key actors to explore sustainability; with this information, a score was assigned to each category and dimension); 3) analytical, by category and dimension (content analysis was performed for qualitative information, and totals and averages were calculated for quantitative information); 4) integrative (qualitative data were integrated into matrices by category and dimension, and quantitative data were supported by qualitative information); and 5) meta-inference (consideration was given to the context and its influence on the results). RESULTS: Ninety-two (92) informants participated. In operational terms, progress was observed in the transfer and use of results, and in rotations in leadership. In the legal and political sphere, accountability and local planning were highlighted. In the economic sphere, progressive investment in health, water and sanitation was emphasized, as well as insufficient investment in social determinants of health. In the social sphere, few mechanisms were observed to promote and strengthen social participation. CONCLUSIONS: In the municipalities that participated in the study, a fair level of sustainability was observed in the Healthy Municipalities strategy.

Sustainability of the Healthy Municipalities Strategy in Guatemala

[ABSTRACT]. Objective. Evaluate the sustainability of the Healthy Municipalities strategy in Guatemala in order to have solid evidence to support decision-making. Methods. A concurrent mixed-methods study was carried out in five phases: 1) theoretical-conceptual (based on a narrative review of the literature on sustainability, dimensions and categories were proposed for evaluation); 2) empirical (four municipalities were selected for convenience and 29 semi-structured interviews and four focus groups were conducted with key actors to explore sustainability; with this information, a score was assigned to each category and dimension); 3) analytical, by category and dimension (content analysis was performed for qualitative information, and totals and averages were calculated for quantitative information); 4) integrative (qualitative data were integrated into matrices by category and dimension, and quantitative data were supported by qualitative information); and 5) meta-inference (consideration was given to the context and its influence on the results). Results. Ninety-two (92) informants participated. In operational terms, progress was observed in the transfer and use of results, and in rotations in leadership. In the legal and political sphere, accountability and local planning were highlighted. In the economic sphere, progressive investment in health, water and sanitation was emphasized, as well as insufficient investment in social determinants of health. In the social sphere, few mechanisms were observed to promote and strengthen social participation. Conclusions. In the municipalities that participated in the study, a fair level of sustainability was observed in the Healthy Municipalities strategy.

[RESUMEN]. Objetivo. Evaluar la sostenibilidad de la estrategia Municipios Saludables en Guatemala, para disponer de evidencia sólida que permita apoyar la toma de decisiones. Métodos. Se realizó un estudio mixto concurrente en cinco fases: 1) teórica-conceptual, se realizó una revisión narrativa de literatura en sostenibilidad, con base en la cual se propusieron dimensiones y categorías para su evaluación; 2) empírica, se seleccionaron por conveniencia cuatro municipios y se realizaron 29 entrevistas semiestructuradas y cuatro grupos focales a actores clave para explorar la sostenibilidad; con esta información, se asignó un puntaje a cada categoría y dimensión; 3) analítica, por categoría y dimensión, se realizó el análisis del contenido para la información cualitativa y sumatorias y promedios para la información cuantitativa; 4) integrativa, los datos cualitativos se integraron en matrices por categoría y dimensión; y los datos cuantitativos se respaldaron con información cualitativa; y 5) metainferencia, se reflexionó sobre el contexto y su influencia en los resultados. Resultados. Participaron 92 informantes. En la dimensión operativa, se destacan avances en la transferencia y el uso de resultados, así como en el relevo de liderazgo. En la dimensión legal y política, se destacaron la rendición de cuentas y los planes locales. En la dimensión económica, se destacó la inversión progresiva en salud, agua y saneamiento, con deficiencia de inversiones en determinantes sociales de la salud. En la dimensión social, se observaron pocos mecanismos para impulsar y fortalecer la participación social. Conclusiones. En los municipios que participaron del estudio se observó un nivel regular de sostenibilidad de la estrategia Municipios Saludables.

[RESUMO]. Objetivo. Avaliar a sustentabilidade da estratégia de Municípios Saudáveis na Guatemala para dispor de evidências sólidas para apoiar o processo decisório. Métodos. Foi realizado um estudo de método misto concorrente em cinco fases: 1) fase teórica-conceitual em que foi feita a revisão narrativa da literatura em sustentabilidade a partir da qual foram propostas dimensões e categorias a serem avaliadas; 2) fase empírica em que foi feita a seleção por conveniência de quatro municípios, com 29 entrevistas semiestruturadas e quatro grupos de discussão com as principais partes interessadas para explorar a sustentabilidade; a partir das informações coletadas, foi dada uma pontuação a cada categoria e dimensão; 3) fase analítica, por categoria e dimensão, em que foi realizada a análise do conteúdo para os dados qualitativos e feito o cálculo de somatórias e médias para os dados quantitativos; 4) fase integrativa em que os dados qualitativos foram integrados em matrizes por categoria e dimensão e os dados quantitativos foram respaldados com a informação qualitativa e 5) metainferência em que foi analisado o contexto e sua influência nos resultados. Resultados. O estudo incluiu 92 participantes. Na dimensão operacional, destacam-se os avanços na transferência e no uso de resultados, bem como a ênfase em liderança. Na dimensão jurídico-política, destacam-se a prestação de contas e os planos locais. Na dimensão econômica, destaca-se o investimento progressivo em saúde, água e saneamento, com investimento inadequado nos determinantes sociais da saúde. Na dimensão social, observam-se poucos mecanismos para incentivar e reforçar a participação social. Conclusões. Foi observado nos municípios participantes do estudo um nível constante de sustentabilidade da estratégia de Municípios Saudáveis.

[Sustainability of the Healthy Municipalities strategy in GuatemalaSustentabilidade da estratégia de Municípios Saudáveis na Guatemala]. / Sostenibilidad de la estrategia Municipios Saludables en Guatemala.

OBJECTIVE: Evaluate the sustainability of the Healthy Municipalities strategy in Guatemala in order to have solid evidence to support decision-making. METHODS: A concurrent mixed-methods study was carried out in five phases: 1) theoretical-conceptual (based on a narrative review of the literature on sustainability, dimensions and categories were proposed for evaluation); (2) empirical (four municipalities were selected for convenience and 29 semi-structured interviews and four focus groups were conducted with key actors to explore sustainability; with this information, a score was assigned to each category and dimension); (3) analytical, by category and dimension (content analysis was performed for qualitative information, and totals and averages were calculated for quantitative information); (4) integrative (qualitative data were integrated into matrices by category and dimension, and quantitative data were supported by qualitative information); and 5) meta-inference (consideration was given to the context and its influence on the results). RESULTS: Ninety-two (92) informants participated. In operational terms, progress was observed in the transfer and use of results, and in rotations in leadership. In the legal and political sphere, accountability and local planning were highlighted. In the economic sphere, progressive investment in health, water and sanitation was emphasized, as well as insufficient investment in social determinants of health. In the social sphere, few mechanisms were observed to promote and strengthen social participation. CONCLUSIONS: In the municipalities that participated in the study, a fair level of sustainability was observed in the Healthy Municipalities strategy.

OBJETIVO: Avaliar a sustentabilidade da estratégia de Municípios Saudáveis na Guatemala para dispor de evidências sólidas para apoiar o processo decisório. MÉTODOS: Foi realizado um estudo de método misto concorrente em cinco fases: 1) fase teórica-conceitual em que foi feita a revisão narrativa da literatura em sustentabilidade a partir da qual foram propostas dimensões e categorias a serem avaliadas; 2) fase empírica em que foi feita a seleção por conveniência de quatro municípios, com 29 entrevistas semiestruturadas e quatro grupos de discussão com as principais partes interessadas para explorar a sustentabilidade; a partir das informações coletadas, foi dada uma pontuação a cada categoria e dimensão; 3) fase analítica, por categoria e dimensão, em que foi realizada a análise do conteúdo para os dados qualitativos e feito o cálculo de somatórias e médias para os dados quantitativos; 4) fase integrativa em que os dados qualitativos foram integrados em matrizes por categoria e dimensão e os dados quantitativos foram respaldados com a informação qualitativa e 5) metainferência em que foi analisado o contexto e sua influência nos resultados. RESULTADOS: O estudo incluiu 92 participantes. Na dimensão operacional, destacam-se os avanços na transferência e no uso de resultados, bem como a ênfase em liderança. Na dimensão jurídico-política, destacam-se a prestação de contas e os planos locais. Na dimensão econômica, destaca-se o investimento progressivo em saúde, água e saneamento, com investimento inadequado nos determinantes sociais da saúde. Na dimensão social, observam-se poucos mecanismos para incentivar e reforçar a participação social. CONCLUSÕES: Foi observado nos municípios participantes do estudo um nível constante de sustentabilidade da estratégia de Municípios Saudáveis.

Sostenibilidad de la estrategia Municipios Saludables en Guatemala

[RESUMEN]. Objetivo. Evaluar la sostenibilidad de la estrategia Municipios Saludables en Guatemala, para disponer de evidencia sólida que permita apoyar la toma de decisiones. Métodos. Se realizó un estudio mixto concurrente en cinco fases: 1) teórica-conceptual, se realizó una revisión narrativa de literatura en sostenibilidad, con base en la cual se propusieron dimensiones y categorías para su evaluación; 2) empírica, se seleccionaron por conveniencia cuatro municipios y se realizaron 29 entrevistas semiestructuradas y cuatro grupos focales a actores clave para explorar la sostenibilidad; con esta información, se asignó un puntaje a cada categoría y dimensión; 3) analítica, por categoría y dimensión, se realizó el análisis del contenido para la información cualitativa y sumatorias y promedios para la información cuantitativa; 4) integrativa, los datos cualitativos se integraron en matrices por categoría y dimensión; y los datos cuantitativos se respaldaron con información cualitativa; y 5) metainferencia, se reflexionó sobre el contexto y su influencia en los resultados. Resultados. Participaron 92 informantes. En la dimensión operativa, se destacan avances en la transferencia y el uso de resultados, así como en el relevo de liderazgo. En la dimensión legal y política, se destacaron la rendición de cuentas y los planes locales. En la dimensión económica, se destacó la inversión progresiva en salud, agua y saneamiento, con deficiencia de inversiones en determinantes sociales de la salud. En la dimensión social, se observaron pocos mecanismos para impulsar y fortalecer la participación social. Conclusiones. En los municipios que participaron del estudio se observó un nivel regular de sostenibilidad de la estrategia Municipios Saludables.

[ABSTRACT]. Objective. Evaluate the sustainability of the Healthy Municipalities strategy in Guatemala in order to have solid evidence to support decision-making. Methods. A concurrent mixed-methods study was carried out in five phases: 1) theoretical-conceptual (based on a narrative review of the literature on sustainability, dimensions and categories were proposed for evaluation); (2) empirical (four municipalities were selected for convenience and 29 semi-structured interviews and four focus groups were conducted with key actors to explore sustainability; with this information, a score was assigned to each category and dimension); (3) analytical, by category and dimension (content analysis was performed for qualitative information, and totals and averages were calculated for quantitative information); (4) integrative (qualitative data were integrated into matrices by category and dimension, and quantitative data were supported by qualitative information); and 5) meta-inference (consideration was given to the context and its influence on the results). Results. Ninety-two (92) informants participated. In operational terms, progress was observed in the transfer and use of results, and in rotations in leadership. In the legal and political sphere, accountability and local planning were highlighted. In the economic sphere, progressive investment in health, water and sanitation was emphasized, as well as insufficient investment in social determinants of health. In the social sphere, few mechanisms were observed to promote and strengthen social participation. Conclusions. In the municipalities that participated in the study, a fair level of sustainability was observed in the Healthy Municipalities strategy.

[RESUMO]. Objetivo. Avaliar a sustentabilidade da estratégia de Municípios Saudáveis na Guatemala para dispor de evidências sólidas para apoiar o processo decisório. Métodos. Foi realizado um estudo de método misto concorrente em cinco fases: 1) fase teórica-conceitual em que foi feita a revisão narrativa da literatura em sustentabilidade a partir da qual foram propostas dimensões e categorias a serem avaliadas; 2) fase empírica em que foi feita a seleção por conveniência de quatro municípios, com 29 entrevistas semiestruturadas e quatro grupos de discussão com as principais partes interessadas para explorar a sustentabilidade; a partir das informações coletadas, foi dada uma pontuação a cada categoria e dimensão; 3) fase analítica, por categoria e dimensão, em que foi realizada a análise do conteúdo para os dados qualitativos e feito o cálculo de somatórias e médias para os dados quantitativos; 4) fase integrativa em que os dados qualitativos foram integrados em matrizes por categoria e dimensão e os dados quantitativos foram respaldados com a informação qualitativa e 5) metainferência em que foi analisado o contexto e sua influência nos resultados. Resultados. O estudo incluiu 92 participantes. Na dimensão operacional, destacam-se os avanços na transferência e no uso de resultados, bem como a ênfase em liderança. Na dimensão jurídico-política, destacam-se a prestação de contas e os planos locais. Na dimensão econômica, destaca-se o investimento progressivo em saúde, água e saneamento, com investimento inadequado nos determinantes sociais da saúde. Na dimensão social, observam-se poucos mecanismos para incentivar e reforçar a participação social. Conclusões. Foi observado nos municípios participantes do estudo um nível constante de sustentabilidade da estratégia de Municípios Saudáveis.

SOCIAL REPRESENTATIONS ON BREASTFEEDING AMONG WOMEN LIVING IN URBAN AND RURAL AREAS IN JALISCO, MEXICO: A QUALITATIVE STUDY.

OBJECTIVE: To understand the social representations regarding breastfeeding among women in ru- ral and urban settings in Jalisco (Mexico), between 2016 and 2017. METHODS: Qualitative phenomenological study. Women living in rural and urban communities in the XIIth Health Jurisdiction, Tlaquepaque Center, Jalisco (Mexico), identified through key informants, were interviewed in focus groups, audio-recorded and semiotically analyzed until the technical saturation was reached in the following categories: meaning, meaning-generating players, and wishes pertaining to breastfeeding. RESULTS: Six focus groups of 14 women living in rural areas, aged 29.4 ± 7.8 years, and 9 women living in urban areas, aged 27.3 ± 7.1 years. Qualitatively, meanings were identified in the two set- tings and were categorized as myths, breastfeeding techniques, and infant growth and development. The following meaning-generating players were found: healthcare and hospital staff, social network, family, God, and community. In terms of wishes, women described the benefits of breastfeeding for themselves and their infants. CONCLUSIONS: There are differences and similarities in social representations regarding breastfeeding depending on the geographic context where they are developed; the elements and players that make them up determine the initiation, maintenance or termination of breastfeeding, and must be considered as part of health promotion and education targeted to women and their environment.

TITULO: REPRESENTACIONES SOCIALES FRENTE A LA LACTANCIA MATERNA EN MUJERES RURALES Y URBANAS DE JALISCO, MÉXICO: ESTUDIO CUALITATIVO. OBJETIVO: comprender las representaciones sociales frente a la lactancia materna en mujeres de contextos rural y urbano, en Jalisco (México), entre 2016 y 2017. METODOS: estudio cualitativo fenomenológico. En mujeres de comunidades rurales y urbanas de la Jurisdicción Sanitaria XII, Centro Tlaquepaque, Jalisco (México), identificadas por informantes clave, se realizaron entrevistas en grupos focales, grabadas en audio y analizadas semióticamente hasta llegar a la saturación teórica de las categorías: significado, actores generadores de significado y deseos frente a la lactancia materna. RESULTADOS: 6 grupos focales de 14 mujeres rurales, con edades de 29,4 ± 7,8 años, y 9 mujeres urbanas con edades de 27,3 ± 7,1 años. Cualitativamente, en ambos contextos se identificaron significados que se categorizaron en mitos, técnica de amamantamiento y crecimiento y desarrollo del lactante. Como actores generadores de significados se encontraron: personal de salud y hospital, red social, familia, Dios y comunidad. Como deseos las mujeres describen beneficios propios por amamantar y para el infante. CONCLUSIONES: las representaciones sociales frente a la lactancia materna tienen diferencias y similitudes de acuerdo con el contexto geográfico donde se desarrollan; los elementos y actores que las configuran determinan el inicio, mantenimiento o abandono de la lactancia y deben considerarse en las intervenciones de promoción y educación de la salud dirigidas a las mujeres y su entorno.

Social representations on breastfeeding among women living in urban and rural areas in Jalisco, Mexico: a qualitative study / Representaciones sociales frente a la lactancia materna en mujeres rurales y urbanas de jalisco, méxico: estudio cualitativo

ABSTRACT Objective: To understand the social representations regarding breastfeeding among women in rural and urban settings in Jalisco (Mexico), between 2016 and 2017. Materials and methods: Qualitative phenomenological study of women living in rural and urban communities in the XIIth Health Jurisdiction, Tlaquepaque Center, Jalisco (Mexico), identified through key informants. Focus group interviews were recorded and semiotically analyzed until the technical saturation was reached in the following categories: meaning, meaning-generating players, and wishes pertaining to breastfeeding. Results: Six focus groups of 14 women living in rural areas, aged 29.4±7.8 years, and 9 women living in urban areas, aged 27.3 ± 7.1 years. Qualitatively, meanings were identified in the two settings and were categorized as myths, breastfeeding techniques, and infant growth and development. The following meaning-generating players were found: healthcare and hospital staff, social media networks, family, God, and community. In terms of wishes, women described the benefits of breastfeeding for themselves and their infants. Conclusions: There are differences and similarities in social representations regarding breastfeeding depending on the geographic setting where they develop; the elements and players that shape those representations determine the initiation, maintenance or termination of breastfeeding, and must be considered as part of health promotion and education actions targeted to women and their environment.

RESUMEN Objetivo: comprender las representaciones sociales frente a la lactancia materna en mujeres de contextos rural y urbano, en Jalisco (México), entre 2016 y 2017. Materiales y métodos: estudio cualitativo fenomenológico. En mujeres de comunidades rurales y urbanas de la Jurisdicción Sanitaria XII, Centro Tlaquepaque, Jalisco (México), identificadas por informantes clave, se realizaron entrevistas en grupos focales, grabadas en audio y analizadas semióticamente hasta llegar a la saturación teórica de las categorías: significado, actores generadores de significado y deseos frente a la lactancia materna. Resultados: 6 grupos focales de 14 mujeres rurales, con edades de 29,4 ± 7,8 años, y 9 mujeres urbanas con edades de 27,3 ± 7,1 años. Cualitativamente, en ambos contextos se identificaron significados que se categorizaron en mitos, técnica de amamantamiento y crecimiento y desarrollo del lactante. Como actores generadores de significados se encontraron: personal de salud y hospital, red social, familia, Dios y comunidad. Como deseos las mujeres describen beneficios propios por amamantar y para el infante. Conclusiones: las representaciones sociales frente a la lactancia materna tienen diferencias y similitudes de acuerdo con el contexto geográfico donde se desarrollan; los elementos y actores que las configuran determinan el inicio, mantenimiento o abandono de la lactancia y deben considerarse en las intervenciones de promoción y educación de la salud dirigidas a las mujeres y su entorno.

Técnica del árbol: aprendizajes en su utilización para problematizar necesidades de transformación social, jalisco, méxico / The social learning tree approach: learning in its use to problematize needs of social transformation, jalisco, mexico / Técnica da arvore: aprendizagens em sua utilização para problematizar necessidades de transformação social, jalisco, méxico

Resumen Objetivo: analizar los aprendizajes para gestores y equipos técnicos locales de Promoción de la Salud al utilizar la técnica educativa de "el árbol social", en la problematización de necesidades de transformación social en Jalisco, México, al 2017. Material y métodos: estudio cualitativo fenomenológico desarrollado durante 2017; de 74 participantes de la técnica en cuatro localidades rurales, se seleccionaron a conveniencia 30 informantes, definiéndolos por muestreo teórico. Para el levantamiento de la información, se trabajaron grupos focales, en espacios seleccionados por informantes. Se audio-grabaron entrevistas y analizaron semióticamente. Resultados: aluden ser útil al iniciar procesos de promoción de la salud, identificando y clarificando el trabajo, además de la integración de grupo; así mismo se retoma en la evaluación del proceso. La técnica considera el momento político, histórico y sociocultural del contexto local, interpretando de manera estructural, la situación a abordar. Destacan como limitaciones diversidad de liderazgo y opiniones, lo cual puede desanimar la participación. Finalmente, describen implicaciones éticas como no respetar la cultura y autonomía de las poblaciones para participar. Conclusiones: la técnica educativa permite el encuentro local entre diversos actores para el trabajo intersectorial, revitalizando la gestión territorial con el reconocimiento de los participantes como sujetos auto-reflexivos de su realidad histórica, cambiante y compleja, desarrollándose de manera particular en cada experiencia y contexto, pautado por el momento político, histórico y sociocultural, las habilidades del educador así como la diversidad de liderazgo y opiniones, teniendo presente no perder el respeto a la cultura y la autonomía para participar.

Abstract Objective: To analyze learning for managers and local technical teams of Health Promotion by using the "the social learning tree", educational approach in the problematization of needs of social transformation in Jalisco, Mexico in 2017. Materials and methods: Qualitative phenomenological study developed in 2017 with 74 participants of the approach in four rural localities; 30 informants were selected conveniently defining them through theoretical sampling. For the gathering of information, two focus groups were worked with in spaces selected by informants. Interviews were audio-recorded and semiotically analyzed. Results: The results allude to being useful when initiating processes of Health Promotion, identifying and clarifying the work, in addition to the group integration. Likewise, they are picked up again in the evaluation of the process. The technique considers the political, historical and sociocultural moment of the local context interpreting the situation to be addressed in a structural way. Diversity of leadership and opinions are emphasized as limitations which can discourage participation. Finally, ethical implications such as not respecting the culture and autonomy of the populations to participate are described. Conclusions: The educational approach allows the local gathering of diverse actors for intersectoral work revitalizing territorial management with the recognition of the participants as self-reflective subjects of their changing and complex historical reality developing in a particular way in each experience and context guided by the political, historical and sociocultural moment, the skills of the educator, and the diversity of leadership and opinions keeping in mind not to lose respect for the culture and the autonomy to participate.

Resumo Objetivo: analisar as aprendizagens para gestores e equipes técnicos locais de Promoção da Saúde ao utilizar a técnica educativa "da arvore social", na problematização de necessidades de transformação social em Jalisco, México, ao 2017. Material e métodos: estudo qualitativo fenomenológico desenvolvimento durante 2017; de 74 participantes da técnica em quatro localidades rurais, se selecionaram a conveniência 30 informantes, definindo-os por amostra teórica. Para o levantamento da informação, se trabalharam grupos focais, em espaços selecionados por informantes. Gravaram-se áudios entrevistas e analisaram semiticamente. Resultados: aludem ser útil ao iniciar processos de promoção da saúde identificando e clarificando o trabalho, além da integração de grupo; assim mesmo se retoma na avaliação do processo. A técnica considera o momento político, histórico e sociocultural do contexto local, interpretando de maneira estrutural, a situação a abordar. Destacam como limitações diversidade de liderança e opiniões, o qual pode desanimar a participação. Finalmente, descrevem implicações éticas como não respeitar a cultura e autonomia dos povoados para participar. Conclusões: a técnica educativa permite o encontro local entre diversos atores para o trabalho intersetorial, revitalizando a gestão territorial com o reconhecimento dos participantes como sujeitos auto reflexivos de sua realidade histórica, cambiante e complexa, desenvolvendo-se de maneira particular em cada experiência e contexto, pautado pelo momento político, histórico e sociocultural, as habilidades do educador assim como a diversidade de liderança e opiniões, tendo presente não perder o respeito à cultura e a autonomia para participar.

Perspectiva de las parteras en Jalisco, México, frente al embarazo de alto riesgo: estudio cualitativo / Perspectives of midwives in Jalisco, México, regarding high risk pregnancy: A qualitative study

RESUMEN Objetivo: Comprender la perspectiva de las parteras frente a los factores de riesgo, la detección y el manejo del embarazo de alto riesgo en Jalisco, México, 2013. Materiales y métodos: Estudio cualitativo fenomenológico desarrollado durante 2013; a partir del Censo Estatal de Parteras se aplicó muestreo teórico, definiendo tamaño de muestra por saturación teórica del eje: factores de riesgo, detección y manejo del embarazo de alto riesgo. El trabajo de campo inició con la identificación de informantes clave, quienes invitaron a parteras a un "Encuentro estatal"; se trabajó con las técnicas lluvia de ideas y entrevista grupal; posteriormente se llevaron a cabo 11 entrevistas a profundidad a parteras, realizando análisis semiótico de los datos. Resultados: Fueron 82 parteras informantes, mediana de edad 53 años, parteras tradicionales empíricas 21,95 %, parteras tradicionales capacitadas 42,69 % y parteras enfermeras 35,36 %; 59,75 % tienen 20 años o más como parteras, 63,42 % con estudios de primaria o menos y 78,05 % con más de 10 años sin recibir capacitación institucional. Cualitativamente, el embarazo de alto riesgo para parteras enfermeras implica complicaciones obstétricas o neonatales y el control prenatal debe ser en hospitales. En parteras tradicionales, empíricas y capacitadas, su perspectiva tiene elementos de la medicina institucional y tradicional, por lo que señalan que envían al médico a estas mujeres, asumiendo no poder atender estos embarazos; en parteras tradicionales de población indígena representa un embarazo "de peligro", configurado en el modelo mágico-religioso de la salud. Conclusiones: La perspectiva de las parteras frente al embarazo de alto riesgo está determinada por la medicina tradicional y algunos elementos de la medicina institucional, diferenciada según tipo de partera y zona geográfica de desempeño, señalando la disposición de formarse para alcanzar embarazos saludables y sin riesgos.

ABSTRACT Objective: To understand midwife perspective regarding risk factors, detection and management of high risk pregnancy in Jalisco, Mexico, 2013. Materials and methods: Qualitative phenomenological study conducted during the year 2013. A theoretical sampling was applied on the basis of the State Midwives Census and the sample size was defined by theoretical saturation of each axis: risk factors, detection and management of high risk pregnancy. The field work began by identifying key informants who then invited midwives to a "State Meeting", working with brainstorming techniques and group interviews. This was followed by 11 in-depth interviews with the midwives and a semiotic data analysis. Results: Overall, 82 informant midwives were included, with a median age of 53. Of them, 21.95 % were empirical, 42.69 % were traditional trained midwives, and 35.36 % were midwife nurses. In terms of practice, 59.75 % had been practicing for 20 years or more, 63.42 % had primary schooling or less, and 78.05 % had been working for more than 10 years without receiving institutional training. Qualitatively, high risk pregnancy for nurse midwives entails obstetric or neonatal complications, and antenatal control must take place in the hospital. As for traditional empirical and trained midwives, their perspectives include elements of institutional medicine whereby they refer these women to the physician because they assume that they cannot care for those pregnancies. For traditional midwives of indigenous origin, high risk pregnancy represents the "dangerous pregnancy" under the magical-religious model of health. Conclusions: Midwife perspective regarding high risk pregnancy is determine by traditional medicine and some elements of institutional medicine, differentiated according to the type of midwife and the geographic area where they perform their work. Midwives reported willingness to train in order to contribute to healthy, risk-free pregnancies.

Ejercicio tradicional de la partería frente a su profesionalización: estudio de caso en Jalisco, México / The traditional practice of midwifery and its professionalization: a case study in Jalisco, México / Exercício tradicional do partejo frente a sua profissionalização: estudo de caso em Jalisco, México

RESUMEN Objetivo: analizar el estado de la partería en Jalisco, México, frente al proceso de profesionalización. Metodología: Estudio de caso, realizado desde junio de 2011 a julio de 2013 en tres momentos: I. Entrevistas a profundidad con 20 parteras, II. Cuatro asambleas regionales con 44 parteras, III. Una asamblea estatal con 136 parteras, personal de salud y otros actores sociales, retomando técnicas educativas populares. Los datos cualitativos fueron analizados bajo el modelo actancial semiótico y los datos sociodemográficos de parteras en Epi Info 7, realizando una meta-inferencia con ambos hallazgos. Resultados: 180 parteras informantes, 89% de zona rural, media de edad 56 años, 73% con estudios de secundaria o menos, 95% son parteras tradicionales, adoptando esta práctica desde la adolescencia, capacitándose en instituciones de salud y entre las mismas parteras; 16.7% estudiaron enfermería buscando posicionamiento institucional, sin dejar de ser parteras. Actualmente otorgan atención materno-infantil y a nosologías tradicionales, aludiendo abandono institucional. Existen posturas de rechazo y aceptación de su incorporación al sector salud en médicos y enfermeras, mientras que otros actores sociales, piden su reconocimiento. Conclusiones: la partería en Jalisco, México, es una práctica tradicional vital, con o sin reconocimiento institucional, transformándose en respuesta a necesidades de atención, teniendo que considerar el perfil sociodemográfico de las parteras, su papel actual, la perspectiva del personal de salud y otros actores sociales, junto con la estrecha relación sociocultural y económica del país, frente a su profesionalización.

ABSTRACT Objective: to analyze the status of midwifery in Jalisco, Mexico and its professionalization process. Methodology: a case study conducted from June 2011 to July 2013 in three stages: I. in-depth interviews with 20 midwives, II. four regional assemblies with 44 midwives, and III. a state assembly with 136 midwives, health care staff and other social actors. The three stages employed popular educational techniques. In addition, qualitative data were analyzed using the actantial semiotic model, and the midwives' sociodemographic data were processed in Epi Info 7. Finally, a meta-inference was performed with the findings from both datasets. Results: a total of 180 midwives participated in the study, 89% of which operate in rural areas. The average age was 56, and 73% of the midwives had secondary education or less. Moreover, 95% of them were traditional midwives who adopted this practice since their adolescence and received training from health care providing institutions and from other midwives. In addition, 16.7% studied nursing in order to obtain positions in institutions while remaining midwives. They currently provide care for mothers and children as well as for patients with traditional nosologies. They also mention that they suffer institutional neglect. Among doctors and nurses, there are positions of rejection and acceptance regarding their inclusion in the health sector, while other social actors request their acknowledgement. Conclusions: midwifery in Jalisco, Mexico, is a traditional and vital practice with or without institutional recognition. It is an answer to the need for health care. Likewise, it is necessary to consider the socio-demographic profile of midwives, their current role, the views of the health care staff and other social actors and the close cultural and economic relationship of the Country regarding its professionalization.

RESUMO Objetivo: analisar o estado do partejamento em Jalisco, México, frente ao processo de profissionalização. Métodos: Estudo de caso, realizado desde junho 2011 ao julho 2013 em três momentos: I. Entrevistas em profundidade com 20 parteiras, II. Quatro assembleias regionais com 44 parteiras, III. Uma assembléia estadual com 136 parteiras, funcionários da saúde e outros atores sociais, na retomada das técnicas educacionais populares. Os dados qualitativos foram analisados sob o padrão actancial semiótico e os dados sociais demográficos de parteiras em Epi Info 7, realizando uma meta-inferência com ambos achados. Resultados: 180 parteiras informantes, 89% de zona rural, media de idade 56 anos, 73% com estudos da secundaria ou menos, 95% são parteiras tradicionais, adotando esta prática desde a adolescência, capacitando-se em instituições de saúde e entre as mesmas parteiras; 16.7% estudaram enfermagem procurando posicionamento institucional, sem deixar de ser parteiras. Atualmente outorgam atenção materno-infantil e as nosologías tradicionais, aludindo abandono institucional. Existem posições de rejeito e aceitação da sua incorporação ao setor saúde nos médicos e enfermeiras, entanto que outros atores sociais, pedem o seu reconhecimento. Conclusões: O partejo em Jalisco, México, é uma prática tradicional vital, com ou sem reconhecimento institucional, transformando-se em resposta as necessidades de atenção, tendo que considerar o perfil social demográfico das parteiras, o seu papel atual, a perspectiva dos funcionários da saúde e outros atores sociais, junto com a estreita relação sociocultural e financeira do país, frente a sua profissionalização.

Condiciones socioculturales y experiencia del embarazo en adolescentes de Jalisco, México: estudio cualitativo / Socio-cultural conditions and teenage pregnancy experience in Jalisco, Mexico: a qualitative study

Describir las condiciones socioculturales y la experiencia de adolescentes embarazadas en Guadalajara, Jalisco (México).Materiales y métodos: investigación cualitativa, con enfoque estudio de caso "típico", en el que se identificaron, en un listado de control prenatal a julio 2014, en un centro de salud de Guadalajara, Jalisco, adolescentes embarazadas que vivieran en la zona urbana, llevaran control prenatal en esta unidad de salud y aceptaran participar en el estudio con el consentimiento del tutor. Se analizaron las variables socioculturales en el expediente clínico, la tarjeta de control prenatal y una encuesta elaborada por investigadores. Se levantaron tres grupos focales, indagando: a) significación social del embarazo, b) experiencia del embarazo c) embarazo, familia, pareja y servicios de salud. Las variables socioculturales se analizaron en Epi-Info 7, calculando frecuencias, porcentajes, medidas de tendencia central y dispersión. Las entrevistas cualitativas se analizaron semióticamente.Resultados: se identificaron 48 adolescentes, de las cuales solo 42 reunieron criterios de selección. La mediana de edad fue de 18 (rango de 13 a 19 años); solo 19 % continuaron estudiando; 59,5 % eran amas de casa, 21,4 % tenían ingresos económicos propios y 78,6 % no utilizaron método de planificación familiar previo al embarazo. Cualitativamente, el embarazo les significó "madurar" y ser "más felices"...

To describe the social and cultural conditions and the experience of pregnancy among teenage girls in Guadalajara, Jalisco, Mexico.Materials and methods: Qualitative research with a "typical" case approach based on the identification, from the pre-natal care list of a healthcare centre in Guadalajara, Jalisco, of pregnant teenage girls living in the urban area who received antenatal care in that centre and who agreed to participate in the study with the consent of their guardians, until July 2014. The analysis was based on the social and cultural variables included in the clinical record, the pre-natal care card, and a questionnaire prepared by the researchers. The work was done with three focus groups and the questions covered: a) the social meaning of pregnancy; b) the experience of pregnancy; and c) pregnancy, family, couple and healthcare services. The social and cultural variables were analysed using the Epi-Info 7, estimating frequencies, percentages, central trend measurements and scatter. The semiotic analysis approach was used for the qualitative interviews.Results: Of the 48 teenagers identified, only 42 met the selection criteria. The mean age was 18 years (range 13 to 19). Only 19 % continued with their education, 59.5 % were housewives, 21.4 % earned their own income, and 78.6 % had not used any form of family planning before the pregnancy. Qualitatively, the pregnancy helped them "mature" and made them "happier". They reported having dropped out from school because of clinical symptoms and changes in their physical appearance. They also reported lack of privacy in the healthcare services, and pointed to online media as the primary source of information regarding the topic of sexuality...

Significado y percepción frente al VIH/SIDA en mujeres rurales parejas de migrantes, Jalisco, México / Meaning and perception in relation to HIV/AIDS in rural women couples of migrants, Jalisco, Mexico

ResumenObjetivos:Describir el significado y percepción frente VIH/SIDA en mujeres rurales parejas de migrantes del municipio de Cuautla, Jalisco, México, del 2012 al 2013.Materiales y Métodos:Estudio cualitativo, de tipo fenomenológico. Identificación de primeros informantes a través del muestreo teórico, recurriendo a la entrevista a profundidad. Considerando el criterio de saturación teórica, se recurrió a la técnica bola de nieve, trabajando la técnica grupo focal e imagen proyectiva. Las entrevistas e imágenes, fueron analizadas bajo el modelo actancial semiótico.Resultados:Total de 18 informantes, 32 años edad promedio, 66,6 % con estudios de primaria o menos y 83,3 % se dedicadas al hogar. Para la mujer pareja de migrante, el fenómeno migratorio significa la satisfacción de necesidades económicas familiares y comunitarias, experimentando sentimientos de soledad y abandono. El VIH/SIDA lo representan como una enfermedad no curable y de temor, señalando discriminación social al enfermo. Perciben riesgo de contraer esta enfermedad con su pareja al retornar, pero pedir el uso del condón o realización de pruebas de detección de la patología, les implica que su pareja no regrese, situación de mayor relevancia que el riesgo de contagio.Conclusiones:El significado y percepción frente al VIH/SIDA de mujeres parejas de migrantes en Jalisco, México, se configura dentro de los beneficios económicos del fenómeno migratorio y aspectos socioculturales de género, elementos a considerar en la formulación, implementación y evaluación de intervenciones para mejorar conocimientos, actitudes y la emancipación de la mujer, para tomar acciones ante el riesgo de contagio del VIH/SIDA.

AbstractAim:To describe the meaning and perception towards HIV/AIDS in rural women, couples of migrants, of the municipality of Cuautla, Jalisco, Mexico, from 2012 to 2013.Materials and methods: Qualitative study, phenomenological type. Identification of first informants was performed through theoretical sampling, using an in-depth interview. Considering the theoretical saturation approach, researchers resorted to the snowball technique, working the focus group and projective image techniques. The interviews and images, were analyzed under the actancial semiotic model.Results:A total of 18 respondents, 32 years mean age, 66,6 % with a primary education or less; and 83,3 % is devoted to the home. For the couple of migrant women, the phenomenon of migration means the satisfaction of economic needs family and community, experiencing feelings of loneliness and abandonment. HIV/AIDS is represented as a non-curable disease that creates fear, pointing out social discrimination of the sick. Perceived risk of contracting this disease with their partner upon their return, but requesting the use of a condom or testing for the disease, implies for them the risk that their partner doesn't return, a situation of greater relevance than the risk of contagion.Conclusions:The meaning and perception towards HIV/AIDS in women, couples of migrants, in Jalisco, Mexico, is set within the economic benefits of the phenomenon of migration and sociocultural aspects of gender, elements to be considered in the formulation, implementation, and evaluation of interventions to improve knowledge, attitudes and the emancipation of women, to take action before the risk of transmission of HIV/AIDS.

[Placenta percreta with invasion of the bladder, ureter and abdominal wall. Case report]. / Placenta percreta con invasión a la vejiga, el uréter y la pared abdominal. Caso clínico.

Placental acretism is the abnormal adherence beyond the underlying of the uterine muscle. The penetration of the serous is known as placenta percreta. The following is a clinical study of a 28 year old woman, who had undergone 2 previous C-Sections, who had been admitted to the hospital previously with ultrasounds suggestive of placental acretism. The magnetic resonance show with severe infiltration of the myometrium in the anterior and lateral right, extending until the mesentery of the abdomen, top of the bladder and the proximal portion of the urethra as well as the soft tissue of the perinea. Cesarean section was performed at 35 weeks of gestation, once the complete protocol of the placenta previa, had been completed. The placentary tissue invaded the bladder, wide ligament along the entire right side and the posterior pelvis. A hysterectomy was performed in the fundic region, resulting in a live birth, and no complications for the patients. Later an obstetric hysterectomy was performed. It is important to note the exemplary work of the gynecologist, surgeon, urologist, anesthesiologist, neonatal specialist, hematologist and intensive care workers, working together for a common goal: avoiding the morbidity and mortality of the mother and child.