Rehabilitación física en pacientes con obesidad post COVID19: Una revisión narrativa

El COVID19 ha afectado a millones de personas a nivel mundial. Entre los pacientes contagiados que se agravan y requieren de cuidados intensivos avanzados; además de largas estadías de hospitalización, se encuentran quienes tienen obesidad. Debido a la gran prevalencia de personas con obesidad, tanto en países desarrollados como en en vías de desarrollo, y a las distintas secuelas que experimentan debido al efecto directo del virus como al tratamiento que reciben, es necesario comprender la fisiopatología asociada a la severidad del contagio. Otro aspecto importante a considerar es ¿cómo las secuelas del tratamiento en las unidades de pacientes críticos pueden afectar el estado de salud de estas personas? El propósito de esta revisión fue indagar en la literatura sobre la rehabilitación fisica en pacientes con obesidad que han padecido COVID19 con el objetivo de tener una mirada integral que apunte a potenciar los resultados de la rehabilitación durante todo el curso de la enfermedad. Se revisaron antecedentes en bases de datos como Pubmed, la literatura y ante la escasa evidencia sobre el proceso de rehabilitación en las personas con obesidad se realizó una revisión narrativa del paciente con obesidad que enferma de COVID19 y que luego de una hospitalización prolongada debe ser reintegrado a sus actividades habituales. Se enfatiza en la fisiopatología asociada a la inmovilización prolongada de un paciente con comorbilidades previas y se proponen estrategias de rehabilitación basadas en el entrenamiento físico adaptado a su nueva condición de salud.

ABSTRACT COVID19 is a pandemic that has affected all of humanity and is still far from being eradicated, despite efforts to vaccinate the population. Among infected patients whose symptoms worsen and require advanced intensive care; in addition to long hospital stays, there are people with obesity. Due to the high prevalence of people with obesity, both in developed and developing countries, and the different sequelae they experience due to the direct effect of the virus and the treatment they receive, it is necessary to understand the pathophysiology associated with the severity of the contagion, as well as treatment sequelae among intensive care patients with the goal of having a comprehensive view that aims to enhance the results of rehabilitation throughout the course of the disease. Post-discharge sequelae depend on the severity of the disease, previous comorbidities, and length of hospitalization. This review presents a global panorama of obese patients who become ill with COVID19 and who, after a prolonged hospitalization, return to normal daily routines. Emphasis is placed on the pathophysiology associated with prolonged immobilization of a patient with previous comorbidities and on rehabilitation strategies based on physical training adapted to the new health condition.

Inequalities in access to and quality of abortion services in Mexico: Can task-sharing be an opportunity to increase legal and safe abortion care?

First-trimester abortion became legal in Mexico City in April 2007. Since then, 216 755 abortions have been provided, initially in hospitals, by specialized physicians using surgical techniques. With time and experience, services were provided increasingly in health centers, by general physicians using medical therapies. Meanwhile, abortion remains legally restricted in the remaining 31/32 Mexican states. Demand and need for abortion care have increased throughout the country, while overall abortion-specific mortality rates have declined. In an effort to ensure universal access to and improved quality of reproductive and maternal health services, including abortion, Mexico recently expanded its cadres of health professionals. While initial advances are evident in pregnancy and delivery care, many obstacles and barriers impair the task-sharing/shifting process in abortion care. Efforts to expand the provider base for legal abortion and postabortion care to include midlevel professionals should be pursued by authorities in the new Mexican administration to further reduce abortion mortality and complications.

Ejercicio: una herramienta clave en la prevención cardiovascular: Consenso de la Sociedad Chilena de Cardiología y Cirugía Cardiovascular y de la Sociedad Chilena de Kinesiología en Cardiología y Cirugía Cardiovascular / Excercise, a key intervention in Cardiovascular Prevention: Consensus of the Chilean Society of Cardiology and Cardiovascular Surgery and the Chilean Society of Kinesiology in Cardiology and Cardiovascular Surgery

This is a Document from de Chilean Society of Cardiology and Cardiovascular Surgery, along with the Chilean Society of Physical Therapy of Cardiology and Cardiovascular Surgery.

[Induced abortion in Mexico: what do Mexican Ob/Gyn know, think and do]. / Aborto inducido en México: qué piensan y hacen los ginecoobstetras.

BACKGROUND: The causals for legal abortion in Mexico vary as established by the Constitution of each State; from 2007 it is legal in Mexico City. OBJECTIVE: To identify knowledge, attitudes and practice of abortion between gynecologists and obstetricians. MATERIAL AND METHODS: Survey study conducted between some of the gynaeco-obstetricians attended the 64th Mexican Congress of Gynecology and Obstetrics held in Mexico City, October 2013. RESULTS: From the 1,085 respondents, 77% correctly identified that abortion is legal accord to Constitutional Signs of each State; 17.5% said it is never legal and 5.7% thought that is always legal. The 67% comment that public institutions should have infrastructure and trained medical personnal to legal abortion practice. The 72% response they would attend or denounce the woman who underwent an abortion outlawed. The remaining 28% showed negative attitudes, from informing the couple or parents (18%), scold women (2%) or reporting it to the authorities (8%). In 39%, they felt that the medical profession who practice discriminates abortions; 28% admit stigmatize partener and 27% feel stigmatized if performing abortions. Percentage high hospitalized patients in case of early abortions, for surgical or medical treatment. CONCLUSIONS: It is necessary to increase and improve knowledge technical and legal about abortion, especially among gynaeco-obstetricians, they are who responsibility to comply about prescribed by law, in accordance with international recommendations and the exercise of reproductive rights of women.

Analysis of maternal and abortion-related mortality in Mexico over the last two decades, 1990-2008.

To document the relative contribution of abortion-related deaths to overall maternal deaths in Mexico, official mortality data were analyzed according to International Classification of Diseases (ICD) codes. During 1990-2008, among 24 805 maternal deaths, 1786 (7.2%) were abortion related. Of these, 13.2% occurred in adolescents and 65% in uninsured women; 60% were probably associated with unsafely induced procedures. The study calculated the number of abortion-related deaths per 100,000 abortion-related hospitalizations, expressed as a modified abortion case-fatality rate. During 2000-2008, this rate was 48 at the national level, with wide variations among states: from 140 deaths in Guerrero to 8 in Baja California Sur per 100,000 abortion hospitalizations. Unsafe abortion continues to represent a significant proportion of all maternal deaths in Mexico.

Characteristics of private abortion services in Mexico City after legalization.

In 2007, first trimester abortion was legalized in Mexico City, and the public sector rapidly expanded its abortion services. In 2008, to obtain information on the effect of the law on private sector abortion services, we interviewed 135 physicians working in private clinics, located through an exhaustive search. A large majority of the clinics offered a range of reproductive health services, including abortions. Over 70% still used dilatation and curettage (D&C); less than a third offered vacuum aspiration or medical abortion. The average number of abortions per facility was only three per month; few reported more than 10 abortions monthly. More than 90% said they had been offering abortion services for less than 20 months. Many women are still accessing abortion services privately, despite the availability of free or low-cost services at public facilities. However, the continuing use of D&C, high fees (mean of $157-505), poor pain management practices, unnecessary use of ultrasound, general anaesthesia and overnight stays, indicate that private sector abortion services are expensive and far from optimal. Now that abortions are legal, these results highlight the need for private abortion providers to be trained in recommended abortion methods and quality of private abortion care improved.

Women's perspectives on medical abortion in Mexico, Colombia, Ecuador and Peru: a qualitative study.

In Latin America, where abortion is almost universally legally restricted, medical abortion, especially with misoprostol alone, is increasingly being used, often with the tablets obtained from a pharmacy. We carried out in-depth interviews with 49 women who had had a medical abortion under clinical supervision in rural and urban settings in Mexico, Colombia, Ecuador and Peru, who were recruited through clinicians providing abortions. The women often chose medical abortion to avoid a surgical abortion; they thought medical abortion was less painful, easier or simpler, safer or less risky. They commonly described it as a natural process of regulating their period. The fact that it was less expensive also influenced their decision. Some, who experienced a lot of pain, heavy bleeding or a failed procedure requiring surgical back-up, tended to be more negative about it. Regardless of legal restrictions, medical abortion was being provided safely in these settings and women found the method acceptable. Where feasible, it should be made available but cost should not have to be women's primary reason for choosing it. Psychosocial support during abortion is critical, especially for those who are more vulnerable because they see abortion as a sin, who are young or poor, who have limited knowledge about their bodies, whose partners are not supportive or who became pregnant through sexual violence.

Procesos de reforma del sector salud y programas de salud sexual y reproductiva en América Latina: cinco estudios de caso / Process of health sector reform and reproductive and sexual health programmes in latin américa: five case studies

El objetivo de los estudios es ofrecer evidencias empíricas concretas de la relación entre el proceso de reforma y algunas consecuencias visibles en el acceso o prestación de de servicios de salud sexual y reproductiva en diversos países. Contenido: Presentación. 1) ®La institucionalización de la salud reproductiva en Argentina: desafíos en la organización de los servicios y la definición de las prestaciones en contextos restrictivos, por Valeria Alonso, Mariana Romero. 2) ®La participación ciudadana en la toma de decisiones con respecto a la salud de la mujer en Brasil.¼, por Tania di Giacomo do Lago. 3) ®Participación e incidencia de la sociedad civil chilena en la formulación de políticas públicas en el ámbito de la salud y los derechos sexuales y reproductivos.¼, por Soledad Barría. 4) ®Accesibilidad a los servicios de salud sexual y reproductiva de la población perteneciente al régimen subsidiado en Colombia.¼, por Ana Cristina González Vélez, Claudia Lucía Boada Chaparro. 5) ®Descentralización y disposición de anticonceptivos en México, por Javier Domínguez del Olmo