Parir en tiempos de pandemia: atención al parto en Cataluña en función del diagnóstico de COVID-19 / Giving birth in times of pandemic: childbirth care in Catalonia based on the diagnosis of COVID-19

Objective: To analyze the differences in birth labor care in the pandemic context according to women's diagnosis of COVID-19, specifically considering the information they received, the humanized nature of care and the degree of medicalization of their labor and delivery. People and method: It is a quantitative research where the data result from a survey conducted to women who were pregnant from January 1, 2018 to September 2021. While the larger research project includes care data during the pandemic -target group- and previous to the pandemic -control group- in this article we exclusively analyze data referring to the pandemic context. Using descriptive and inferential statistical analysis by cross-sectional study of cases and control, in this article we compare the experiences of women who gave birth during the pandemic being positive in COVID-19 with those of women who were negative. Results: We obtained 2,600 responses and 2,070 were considered valid (1,862 target group and 208 control group), with a confidence level of 95.5% and a margin of error of ±2.33%. Women with a positive result received less information (84.40% were informed of the procedures versus 91.30% of women with a negative result) and had less possibility to decide on procedures (51.90% versus 70.80% of women with a negative result). They also could be less accompanied (59.4% could be accompanied at all times compared to 81.3% of women with a negative result); they consider to a greater extent that the pandemic has been detrimental to a personalized care (66.7% vs. 34.7% of women with a negative result); and they grade worse both the professional care received and the atmosphere of the spaces in which they gave birth (on average, the treatment received is scored at 3.73 out of 5 for the different spaces compared to 4.11 for women with a negative result). (AU)

Objetivo: Analizar las diferencias en la atención al parto en pandemia según el diagnóstico de COVID-19 de las mujeres, considerando de forma específica la información que recibieron, el carácter humanizado de la atención y el nivel de medicalización de su parto. Personas y método: Se trata de un estudio cuantitativo a partir de una encuesta a mujeres que estuvieron embarazadas del 1 de enero de 2018 hasta finales de septiembre de 2021. Si bien el estudio incluyó datos de atención durante la pandemia -grupo diana- y datos prepandemia -grupo control (experiencia anterior a esa fecha)-, en el presente artículo se analizan exclusivamente datos referentes al contexto pandémico. En el artículo se comparan, mediante análisis estadístico descriptivo e inferencial por estudio transversal de casos y control, las experiencias de mujeres que parieron durante la pandemia siendo positivas en la COVID-19 con aquellas negativas. Resultados: Se obtuvieron 2600 respuestas: 2070 se consideraron válidas (1862 del grupo diana y 208 del grupo control), con un nivel de confianza del 95,5 % y un margen de error de ±2,33 %. Las mujeres con resultado positivo recibieron menos información (al 84,40 % se les informó de los procedimientos frente al 91,30 % de las mujeres con resultado negativo), menos posibilidad de decidir sobre procedimientos (el 51,90 frente al 70,80 % de las mujeres con resultado negativo) y pudieron estar menos acompañadas (el 59,4 % pudo estar acompañada en todo momento frente al 81,3 % de las mujeres con resultado negativo). Consideran en mayor medida que la pandemia ha ido en detrimento de una atención personalizada (el 66,7 frente al 34,7 % de las mujeres con resultado negativo), y valoran peor tanto el trato profesional recibido como el ambiente de los espacios donde dieron a luz (de media, el trato recibido se puntúa en 3,73 sobre 5 para los diferentes espacios, frente al 4,11 de las mujeres con resultado negativo). (AU)

The COVID-19 Pandemic in Care Homes: An Exploration of Its Impact across Regions in Spain.

This article provides an updated picture of the enormous consequences that the first wave of the COVID-19 pandemic (March-June 2020) had for older adults living in Spanish care homes. It aims to describe the regional variation in deaths among home care residents through a methodological triangulation of descriptive quantitative, ecological and documentary analysis. Figures of five different indicators of care home mortality are provided and some factors related to higher mortality rates are presented and analysed in the descriptive ecological analysis in order to depict trends and, in a linear regression, to determine their statistical significance. The clearest trend reflected by the data is that the higher the cumulative incidence and the number of care home beds in the surrounding area, the higher the COVID-19 care home mortality. We argue that the pandemic has brought to light the historical fragility and underdevelopment of the Spanish LTC sector, and that these factors have exacerbated the consequences of the pandemic. Finally, we conclude that publicly available and disaggregated data would allow a deeper and more accurate analysis of potentially explanatory factors such as the type of care home ownership and management, and that further qualitative research would shed more light on people's experiences.

Alcance de la implementación en Cataluña de las estrategias de salud reproductiva (2008-2017) / The extent of the implementation of reproductive health strategies in Catalonia (Spain) (2008-2017)

Objetivo: Analizar la implementación de las estrategias de salud reproductiva en las actividades cotidianas de los servicios y la transformación de las prácticas de profesionales y usuarias. Método: Investigación cartográfica de tipo etnográfico multilocal orientada a captar los procesos de transformación. Técnicas de generación de datos: observación participante y entrevistas situadas. Análisis del discurso del corpus textual a partir de tres líneas de acción promovidas por las estrategias. Resultados: Se observan elementos de transformación en: 1) desmedicalización: aumento de la competencia y autonomía de la matrona, cambios en las episiotomías y facilitación de prácticas de vínculo; 2) calidez en la atención: incorporación de las necesidades y expectativas de la mujer y mejoras en la confortabilidad de los espacios en partos fisiológicos; y 3) participación: acciones que favorecen la toma de decisiones compartida y mayor implicación de la persona acompañante. Conclusiones: La transformación se visibiliza sobre todo en la incorporación de nuevas actitudes, nuevas sensibilidades y nuevas praxis que empiezan alrededor de las viejas estructuras, especialmente en la atención al parto fisiológico. Los espacios más tecnificados han sido menos permeables al cambio. La gestión del riesgo en la toma de decisiones y el abordaje de la diversidad se identifican como campos en los que la transformación es menos evidente

Objective: We analyse how reproductive health strategies have been incorporated into the everyday activities of the services and the resulting transformation of professional and user practices. Method: Cartographic research taking a multi-sited ethnographic approach that seeks to reveal the processes of transformation. Data generation techniques featuring participant observation and situated interviews. Discourse analysis of the text corpus using three analytical axes based on three main lines of action promoted by the strategies. Results: We identified transformations in: 1) demedicalisation: an increase in midwives' know-how and autonomy, changes in episiotomy practice and the facilitation of bonding practices; 2) warmth of care: incorporation of women's needs and expectations and improvements in the comfortableness of birth settings, especially in assistance at physiological birth; and 3) participation: actions that foster shared decision-making and the involvement of the persons accompanying women in labour. Conclusions: Above all, transformation is visible in the incorporation of new attitudes, sensibilities and practices that have developed around the old structures, especially during physiological childbirth. The more technological areas have been less permeable to change. Risk management in decision-making and addressing diversity are identified as areas where transformation is less evident

[The extent of the implementation of reproductive health strategies in Catalonia (Spain) (2008-2017)]. / Alcance de la implementación en Cataluña de las estrategias de salud reproductiva (2008-2017).

OBJECTIVE: We analyse how reproductive health strategies have been incorporated into the everyday activities of the services and the resulting transformation of professional and user practices. METHOD: Cartographic research taking a multi-sited ethnographic approach that seeks to reveal the processes of transformation. Data generation techniques featuring participant observation and situated interviews. Discourse analysis of the text corpus using three analytical axes based on three main lines of action promoted by the strategies. RESULTS: We identified transformations in: 1) demedicalisation: an increase in midwives' know-how and autonomy, changes in episiotomy practice and the facilitation of bonding practices; 2) warmth of care: incorporation of women's needs and expectations and improvements in the comfortableness of birth settings, especially in assistance at physiological birth; and 3) participation: actions that foster shared decision-making and the involvement of the persons accompanying women in labour. CONCLUSIONS: Above all, transformation is visible in the incorporation of new attitudes, sensibilities and practices that have developed around the old structures, especially during physiological childbirth. The more technological areas have been less permeable to change. Risk management in decision-making and addressing diversity are identified as areas where transformation is less evident.

El cuidado informal en tiempos de crisis. Análisis desde la perspectiva enfermera / Informal care in times of crisis. Analysis from the nursing perspective

Objetivos: Cuantificar y caracterizar la producción científica enfermera sobre cuidados informales del período 2007-2016, observar la evolución de la temática durante estos años, adquirir una perspectiva actual sobre el estado de la cuestión y realizar propuestas sobre futuras líneas de investigación e intervención. Metodología: Revisión bibliográfica llevada a cabo mediante dos estrategias: una cuantitativa, y una segunda estrategia cualitativa. Resultados: El tipo de artículo más publicado es el estudio original cuantitativo, aunque se detecta un crecimiento de las publicaciones con enfoque cualitativo. Los temas más tratados son el perfil de la persona cuidadora, los impactos de la atención en su salud y en otros aspectos de su vida cotidiana, las propuestas de intervenciones profesionales para promover el cuidado personal y para evitar la sobrecarga de las personas cuidadoras y, por último, el uso de herramientas de evaluación para la planificación de la atención a las mismas. Conclusiones: Las publicaciones enfermeras identifican con acierto la centralidad del cuidado informal y el giro asistencial hacia el domicilio y la familia. No problematizan, sin embargo, el actual trasvase de responsabilidades hacia el cuidado desde las administraciones públicas hacia el ámbito familiar, ni analizan en profundidad las desigualdades socioeconómicas y de género reinantes en el actual escenario de cuidados. El abordaje a estos dos elementos puede contribuir a abrir nuevas líneas de investigación e intervención en el campo de la enfermería

Goals: To quantify and characterize the scientific production in nursing on informal care from 2007 to 2016, to observe the evolution of the theme during this period, to acquire a current perspective on the state of the arts, and to suggest future directions of both research and professional practice. Methods: Bibliographical review undertaken through two strategies: a quantitative strategy and a qualitative one. Results: The most frequent type of published article is quantitative although there is an increase of qualitative publications. Among the most frequent themes are: the study of the caregiver’s profile, as well as the impacts of care on their health and on their everyday life; practical professional recommendations to promote care and self-care and to prevent caregivers’ overload; and, finally, the use of assessment tools for planning attention of caregivers. Conclusions: While nursing publications rightly identify the centrality of the family and the household in the new care scenario, they do not problematize the current transfer of responsibility for care from public administrations toward the realm of the family. Neither do they problematize the social, economic, and gender inequalities that take place in the context of care. To approach these two themes can contribute to create new research and professional lines in nursing