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Resumen El presente artículo expone el resultado de una evaluación cualitativa sobre las acciones que los servicios públicos de salud desarrollan para la prevención de embarazos subsiguientes en adolescentes, en un estado en el centro-norte de México. El objetivo fue documentar los obstáculos percibidos para prevenir embarazos subsiguientes en madres adolescentes. La información se obtuvo entre 2016-2018, mediante entrevistas individuales en los domicilios de jóvenes usuarias de servicios públicos de salud. El análisis de la información se hizo a partir de la propuesta de Strauss y Corbin para teoría fundamentada. Las experiencias compartidas por las jóvenes madres fueron analizadas y clasificadas en dos categorías, obstáculos asociados a: (1) competencias profesionales, y (2) a imaginarios morales. Se concluye que las limitaciones más importantes tienen que ver con el hecho de que la estrategia de servicios amigables para adolescentes deja de implementarse en aquellas que han sido madres, sin considerar el impacto biológico y psicosocial que tienen los embarazos subsiguientes en la adolescencia y la necesidad de postergar la reproducción hasta la edad adulta.

Abstract This article presents the result of a qualitative evaluation of the actions that the public health services develop for the prevention of subsequent adolescent pregnancies in a state in north-central Mexico. The objective was to document the perceived obstacles to preventing subsequent teenage pregnancies in teenage mothers. The information was obtained in the period 2016-2018, by individual interviews in the homes of young users of public health services. The analysis of the information was based on Strauss and Corbin's proposal for the grounded theory. The experiences shared by the young mothers were analyzed and classified into two categories, obstacles associated with: (1) professional competences, and (2) with moral imagery. It is concluded that the most important limitations are related to the fact that the strategy of adolescent friendly services is no longer implemented in those who have been mothers, without considering the biological and psychosocial impact that subsequent pregnancies have in adolescence and the need to delay reproduction until adulthood.

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Kidney transplant is the optimal treatment for renal disease according to biomedical criteria, but the technology is highly expensive. The aim of this article was to examine the economic hardships experienced by kidney transplant patients and the impact on their lives, specifically when they lack social protection in health. The article reports on a qualitative study conducted in Mexico. Twenty-one kidney transplant patients participated. Semi-structured interviews were performed and submitted to content analysis. Patients experience extreme economic hardship due to the high cost of renal therapies, particularly medicines. Such economic problems adversely affect their condition, since many patients report difficulties in maintaining their immunosuppressant medication, attending medical appointments, and curtailing household expenditures, further aggravated by loss of earnings. In conclusion, kidney transplantation is associated with patients' impoverishment when they lack social protection in health. A protection system is urgently needed for this group.

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El trasplante es el mejor tratamiento para la insuficiencia renal, de acuerdo con la biomedicina; sin embargo, es una tecnología cara. Este artículo examina las dificultades económicas y sus efectos en personas con trasplante renal, pero sin protección social en salud. Para el estudio se desarrolló una investigación cualitativa en México. Participaron 21 pacientes trasplantados; se aplicaron entrevistas semiestructuradas, y se realizó un análisis de contenido. Los resultados muestran que las personas enfermas enfrentan dificultades económicas, debido a los costes de las terapias renales, particularmente, de las medicinas. Todo ello tiene efectos negativos: las personas con pocos recursos dejan el tratamiento con medicamentos, abandonan el protocolo, no asisten a las consultas médicas y disminuyen los gastos domésticos, incluyendo el de alimentación; además de suponer una merma en los ingresos familiares. En conclusión, el trasplante renal empobrece a las personas enfermas sin protección social en salud; es urgente la implementación de un sistema de protección social para esta población.

Kidney transplant is the optimal treatment for renal disease according to biomedical criteria, but the technology is highly expensive. The aim of this article was to examine the economic hardships experienced by kidney transplant patients and the impact on their lives, specifically when they lack social protection in health. The article reports on a qualitative study conducted in Mexico. Twenty-one kidney transplant patients participated. Semi-structured interviews were performed and submitted to content analysis. Patients experience extreme economic hardship due to the high cost of renal therapies, particularly medicines. Such economic problems adversely affect their condition, since many patients report difficulties in maintaining their immunosuppressant medication, attending medical appointments, and curtailing household expenditures, further aggravated by loss of earnings. In conclusion, kidney transplantation is associated with patients’ impoverishment when they lack social protection in health. A protection system is urgently needed for this group.

O transplante é o melhor tratamento para a insuficiência renal de acordo com a biomedicina; mas é uma tecnologia cara. Este artigo examina as dificuldades econômicas e os seus efeitos em pessoas com transplante renal, mas sem proteção social em saúde. Uma pesquisa qualitativa foi desenvolvida no México. Participaram 21 doentes transplantados; aplicaram-se entrevistas semiestruturadas, e foi realizada análise de conteúdo. Os resultados mostram que as pessoas doentes enfrentam dificuldades econômicas devido aos custos das terapias renais, particularmente das medicinas. Tudo isso tem efeitos negativos: as pessoas com poucos recursos abandonam o tratamento medicamentoso, deixam o protocolo, não comparecem às consultas médicas e diminuem as despensas domésticas, incluindo a comida; além da perda de ingressos. Em conclusão, o transplante renal empobrece as pessoas doentes sem proteção social em saúde; é urgente a implementação de um sistema de proteção social a esta população.

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CONTEXT: Donation coordinators play an important role in the success or failure of organ donation and transplant programs. Nevertheless, these professionals' perspectives and practices have hardly been explored, particularly in low- and middle-income countries. OBJECTIVE: To examine donation coordinators' discourse on the organ donation process and the barriers they perceive. DESIGN: A critical qualitative study was carried out in Guadalajara, Mexico. SETTING AND PARTICIPANTS: Twelve donation coordinators from public and private hospitals participated. DATA GATHERING AND ANALYSIS: Data were gathered by using semistructured interviews and critical discourse analysis. RESULTS: Participants indicated that partial results have been achieved in deceased organ donation. Concomitantly, multiple obstacles have adversely affected the process and outcomes: at the structural level, the fragmentation of the health system and the scarcity of financial and material resources; at the relational level, nonegalitarian relationships between coordinators and hospital personnel; at the ideational level, the transplant domain and its specialists overshadow the donation domain and its coordinators. Negative images are associated with donation coordinators. CONCLUSIONS: Organ donation faces structural, relational, and ideational barriers; hence, complex interventions should be undertaken. Donation coordinators also should be recognized by the health system.

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These consensus guidelines have been developed by a group of Latin American experts in pain management, to point out patterns and make practical recommendations to guide the diagnosis, identify warning signs (yellow and red flags), and establish comprehensive medical management (pharmacologic and nonpharmacologic treatment) and monitoring plans for patients enduring neuropathic pain. From the viewpoint of pharmacologic management, drugs are classified into groups according to efficacy, availability/accessibility, and safety criteria. Drugs are recommended for use depending on the disease and particular circumstances of each patient, with an approach that favors multimodal treatment while taking into consideration the idiosyncrasies of medical practice in Latin America.

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La Medicina Legal a través del estudio detallado de su historia, se constituye en una ciencia cuya característica fundamental es la de haber presentado notables cambios en su enfoque a lo largo del tiempo, según las necesidades de cada época, siempre muy relacionada con la evolución misma de la humanidad; desde los primeras técnicas de conservación de cadáveres de los antiguos egipcios, hasta las modernas técnicas de biología molecular. Sin embargo, la gran responsabilidad médico-legal, no ha variado, ya que desde la antigüedad, el médico ha estado expuesto a grandes penas, debido a tratamientos fallidos o mala práctica, llegando incluso a pagar en la edad antigüa con la vida y con la libertad en la edad contemporánea...

Legal medicine through the study of the clinical history has been a science with the main characteristic of change the focus of the it, through time according to the needs of each period of time, even though the human evolution; since the first techniques by the Egyptians until the latest techniques of molecular biology. However the medical responsibility has not change, still now the doctor is responsible for a failing treatment or a bad practice and his punishment can be injust depending on the time and the place...

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Las enfermedades crónicas constituyen las primeras causas de morbi-mortalidad e implican costos crecientes para los servicios sanitarios en numerosos países. Sin embargo, poco se conoce la forma como diversos grupos las perciben y enfrentan. Este trabajo compara las perspectivas de dos tipos de profesionales sanitarios y población enferma sobre tales enfermedades y sobre las relaciones existentes entre los actores involucrados. Un estudio cualitativo, multicéntrico, se realizó en tres ciudades de México: Guadalajara, San Luis Potosí y México DF. Participaron sujetos con enfermedades crónicas, médicos y profesionales sanitarios no médicos. La información se obtuvo mediante grupos focales y entrevistas individuales, analizándose mediante análisis del discurso. La perspectiva de los participantes sobre tales enfermedades varía entre la mirada medicalizada de los médicos, frente a la de los sujetos enfermos centrada en los padecimientos y la vida diaria. Los participantes coinciden en la existencia de relaciones desiguales entre los trabajadores de la salud, la familia y las personas enfermas, así como en relaciones más igualitarias entre los enfermos. Se discuten múltiples implicaciones de los resultados.

Chronic diseases are leading causes of morbidity, mortality, and increasing expenditures in numerous countries. However, little is known about how chronic diseases are perceived and managed by social actors. This article aims to compare the perspectives of health professionals and patients towards chronic diseases, besides analyzing the relationship between these two groups. A qualitative, multi-center study was conducted in three Mexican cities: Guadalajara, San Luis Potosí, and Mexico City. Participants included chronically ill individuals, physicians, and other health professionals from primary and secondary health care centers. Data collection used focus groups and interviews. The data were analyzed using discourse analysis. Participants' perceptions varied, from the medicalized view of physicians to that of patients focused on illness and the lifeworld. The participants agreed that there are unequal relationships between health professionals, families, and the chronically ill, but that relationships are more equal among the chronically ill themselves. The article includes by discussing various implications of the findings.

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Chronic diseases are leading causes of morbidity, mortality, and increasing expenditures in numerous countries. However, little is known about how chronic diseases are perceived and managed by social actors. This article aims to compare the perspectives of health professionals and patients towards chronic diseases, besides analyzing the relationship between these two groups. A qualitative, multi-center study was conducted in three Mexican cities: Guadalajara, San Luis Potosí, and Mexico City. Participants included chronically ill individuals, physicians, and other health professionals from primary and secondary health care centers. Data collection used focus groups and interviews. The data were analyzed using discourse analysis. Participants' perceptions varied, from the medicalized view of physicians to that of patients focused on illness and the lifeworld. The participants agreed that there are unequal relationships between health professionals, families, and the chronically ill, but that relationships are more equal among the chronically ill themselves. The article includes by discussing various implications of the findings.

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Presentamos una casuística de 101 pacientes con cáncer avanzado de la mama, quienes fueron sometidas a cirugía ablativa hormonal en el Hospital Oncológico "Padre Machado", analizando edad, paridad, stadio clínico, tratamiento primario, intervalo libre, sitio de metástasis, tipo de cirugía ablativa, control y sobrevida

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