RESUMO
A total of 366 individuals of Lutjanus argentiventris (Peters, 1869) were collected over a 5-yr period (October 2018 to June 2022) from Acapulco Bay, Mexico. Parasite communities in Lutjanus argentiventris were quantified and analyzed to determine the main factors that generate changes in species richness and/or species composition over time. The digeneans and copepods were the best-represented parasite groups. The parasite communities were characterized by a high numerical dominance of ectoparasites, mainly isopod larvae. Species richness at the component community level (9-23 species) was similar to the reported richness in other Lutjanus spp. The parasite communities of Lutjanus argentiventris exhibited high variability in species composition, suggesting that each parasite species may respond differently to environmental changes. However, the species richness and diversity were fairly stable over time; therefore, a clear pattern of interannual variation was not observed. Variations in the community structure probably were due to factors such as host traits (e.g., feeding behavior and body size), and possible interannual differences in environmental factors amplified by the occurrence of the anomalous event of La Niña.
Assuntos
Biodiversidade , Copépodes , Doenças dos Peixes , Perciformes , Animais , México/epidemiologia , Perciformes/parasitologia , Doenças dos Peixes/parasitologia , Doenças dos Peixes/epidemiologia , Copépodes/classificação , Copépodes/fisiologia , Isópodes/classificação , Isópodes/fisiologiaRESUMO
Parasitological studies of long-term inter-annual variations provide more precise and reliable information about the biological structure of fish parasite communities, and constitute a reference data base for future studies. A total of 1103 blue sea catfish Ariopsis guatemalensis from a tropical eutrophic coastal lagoon were examined for parasites over a 22-year period (from May 2000 to October 2022), to test the hypothesis that parasite communities of this host, should exhibit greater variations in their structure and species composition mainly over long-term periods. Three species of monoxenous (single-host life cycle), and nine of heteroxenous (multi-host life cycle) parasites were identified. The results indicated that parasite species composition of this catfish has remained stable over a 22-years period. However, the community structure has registered notable changes over periods of several years, mainly due to the replacement of the numerically dominant species. Temporal variations in the infection dynamics of component parasite species, were possibly caused by a combination of biotic and abiotic factors, influenced by the seasonal dry/rainy cycle, which can affect the availability of intermediate host populations, as well as the feeding and reproductive behavior of the host.
Assuntos
Peixes-Gato , Doenças dos Peixes , Estações do Ano , Animais , Peixes-Gato/parasitologia , Doenças dos Peixes/parasitologia , Doenças dos Peixes/epidemiologia , Clima TropicalRESUMO
OBJECTIVE: To present the development of a training model called AMBAR (Atención a la mujer embarazada y al recién nacido [Care for pregnant women and newborns]), which was designed to improve the quality of attention of health personnel responsible for obstetric care. MATERIALS AND METHODS: AMBAR was designed based on the results of a qualitative study exploring public health providers' needs and experiences. It was implemented in three health networks, and a total of 339 health personnel participated. RESULTS: The educational design of the course was appealing to the trained personnel, and the inclusion of simulations in all modules encouraged interest, participation, as well as the integration of new knowledge and skills into practice. CONCLUSION: AMBAR can promote better practices and increase the quality of birth care. With the proper support and willingness of staff and management, AMBAR can be implemented in all health services, both public and private.
Assuntos
Parto Obstétrico , Parto , Gravidez , Recém-Nascido , Feminino , Humanos , Gestantes , Pessoal de Saúde/educação , Pesquisa QualitativaRESUMO
Strange oceanographic events such as El Niño and La Niña may have indirect effects on the local transmission processes of intestinal parasites due to the reduction or increase in populations of potential intermediate or definitive hosts. A total of 713 individuals of Lutjanus inermis (Peters) were collected over an 8-year period (October 2015 to July 2022) from Acapulco Bay, Mexico. Parasite communities in L. inermis were quantified and analysed to determine if they experienced interannual variations in species composition and structure as a result of local biotic and abiotic factors influenced by oceanographic events, such as El Niño-Southern Oscillation (ENSO), or La Niña, the cool phase of the ENSO climate pattern. Twenty-six taxa of metazoan parasites were recovered and identified: two Monogenea, eight Digenea, two Acanthocephala, four Nematoda, one Cestoda, seven Copepoda, and two Isopoda. Species richness at the component community level (8 to 17 species) was similar to reported richness in other species of Lutjanus Bloch. Parasite communities of L. inermis exhibited high inter-annual variation in the abundance of component species of parasite. However, the species richness and diversity were fairly stable over time. Climatic episodes of El Niño and La Niña probably generated notable changes in the structure of local food webs, thus indirectly influencing the transmission rates of intestinal parasite species. Changes in species composition and community structure of parasites possibly were due to variations in feeding behaviour during the events and differences in the host body size.
Assuntos
Acantocéfalos , Nematoides , Parasitos , Perciformes , Humanos , Animais , Perciformes/parasitologia , El Niño Oscilação SulRESUMO
OBJECTIVES: To compare the risk of severe adverse maternal outcomes (SMO) and neonatal outcomes (SNO) and analyse their maternal correlates in adolescent mother-newborn and young mother-newborn dyads in secondary and tertiary care users in Latin America. METHODS: We performed a secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health database in 83 secondary and tertiary hospitals in seven countries in Latin America. We constructed a composite indicator of both SMO and SNO and estimated odds ratios (OR) comparing adolescent mothers (aged 12-19) with young mothers (aged 20-24). Our unit of analysis was the mother-newborn dyad. RESULTS: We found that the combination of SMO and SNO was three times more likely in adolescent mother as compared to young mother dyads (OR 3.56; 95% CI 1.67-7.59). SNO either alone or in combination with SMO were more likely in adolescents aged 12 to 16 than in young women (OR 1.27 and 4.87, respectively). CONCLUSIONS FOR PRACTICE: Adolescent mothers and their newborns are at an increased risk of severe adverse outcomes during child birth and in the first week postpartum compared to young mother dyads, especially young adolescents. Focusing on the dyad as a whole may facilitate a step towards integrated care which maximizes the health benefits of both mother and newborn. Continued efforts are needed to improve health care and prevention initiatives directed towards adolescent women and their newborns in Latin America.
Assuntos
Mães Adolescentes , Parto Obstétrico , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Recém-Nascido , América Latina , Gravidez , Resultado da Gravidez/epidemiologiaRESUMO
Se presenta el caso de una paciente de 68 años con un cuadro de colangitis recurrente y presencia de divertículo duodenal que comprime la vía biliar. El síndrome de Lemmel es una afección infrecuente en la literatura, debido a que los divertículos duodenales rara vez presentan síntomas (10%) y en general se diagnostican de manera incidental. El 75% de estos divertículos son periampulares. Si se localizan a 2.5 cm del ámpula de Vater son yuxtapapilares. Solo el 1% presentan complicaciones. Debe ser considerado en caso de ictericia intermitente y colangitis, y tenerlo en cuenta como diagnóstico diferencial de pseudoquistes, tumor de cabeza de páncreas o metástasis.We present the case of a 68-year-old patient with recurrent cholangitis and the presence of a duodenal diverticulum that compresses the bile duct. Lemmel syndrome is a rare entity reported in the literature, because duodenal diverticula rarely have symptoms (10%) and are usually diagnosed incidentally, 75% of these diverticula are periampullary, if they are located within 2.5 cm from the Vater ampule are juxtapapillary. Only 1% present complications. It should be considered in case of intermittent jaundice, cholangitis, as a differential diagnosis of psuedocysts, pancreatic head tumor or metastases.
Assuntos
Pâncreas , Idoso , HumanosRESUMO
Although COVID-19 in pregnant women and their neonates has been demonstrated, there is not enough evidence about how this vertical transmission occurs. This report describes a SARS-CoV-2 infection in a 21-year-old mother-daughter duo at the time of birth, focusing on the viral RNA detection in the stool of both and the human breast milk.
Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/transmissão , Fezes/virologia , Transmissão Vertical de Doenças Infecciosas , Leite Humano/virologia , Pneumonia Viral/transmissão , Complicações Infecciosas na Gravidez/virologia , COVID-19 , Infecções por Coronavirus/virologia , Feminino , Humanos , Recém-Nascido , México , Pandemias , Pneumonia Viral/virologia , Gravidez , SARS-CoV-2 , Adulto JovemRESUMO
Current data on reproductive biology and population dynamics of the acanthocephalans are scarce mainly in regions from the tropical Pacific. An analysis was done to identify possible factors that influence variation in infection levels of the acanthocephalan Pseudoleptorhynchoides lamothei Salgado-Maldonado, 1976 in its final host, the blue sea catfish Ariopsis guatemalensis (Günther, 1864), and describe its main reproductive traits. A total of 1,094 A. guatemalensis were collected from Tres Palos Lagoon from August 2014 to December 2015. Prevalence of P. lamothei varied from 1.47% to 38.33%, and mean abundance from 0.03 to 4.44 helminths per examined host. In female P. lamothei relative fecundity increased with total length. Temporal variations in P. lamothei infection levels were attributed mainly to changes in host feeding and reproductive behaviour in response to local environmental factors as climatic season, and variations in water temperature.
Assuntos
Acantocéfalos/fisiologia , Peixes-Gato , Doenças dos Peixes/epidemiologia , Helmintíase Animal/epidemiologia , Reprodução , Animais , Feminino , Doenças dos Peixes/parasitologia , Helmintíase Animal/parasitologia , Masculino , México , Estações do AnoRESUMO
BACKGROUND: Continuing education is essential for healthcare workers. Education interventions can help to maintain and improve competency and confidence in the technical skills necessary to address adverse events. However, characteristics of the health provider such as age (related to more critical and reflexive attitude); sex (relationship with gender socialization), profession and work conditions might have an influence on the effect of continuing education efforts. METHODS: A training in the management of obstetric and neonatal emergencies (PRONTO, Spanish acronym for Neonatal and Obstetric Rescue Program: Optimal and Timely treatment) was implemented in 14 hospitals in six Mexican states between 2013 and 2014, with a before-after evaluation design. A total of 351 health providers including physicians, interns, nurses and midwives completed the training and were included in the analytic sample. Mixed-effects regression models were fitted to model changes in knowledge and self-efficacy scores after the training for each training topic. Interaction terms of training with age, gender, profession, and shift were included to evaluate possible heterogeneities of effect. All models considered the within-hospital clustering of participants. RESULTS: After training, all participants showed a significant knowledge gain by an average of 19 percentage points for hemorrhage, 23 for neonatal resuscitation, 19 for shoulder dystocia, and 15 for preeclampsia/eclampsia (p < 0.001). Participants who worked night shifts showed lower scores for overall knowledge, compared with morning shift workers. Interns perceived the lowest self-efficacy while they scored very high in knowledge. Self-efficacy in managing obstetric and neonatal emergencies increased significantly by 16 percentage points in average. CONCLUSIONS: Our results show that PRONTO is generally successful in increasing knowledge and self-efficacy on all topics but knowledge and self efficacy levels vary greatly by factors such as work shift. Training should be particularly aimed at personnel working during weekends and night shifts, as well as interns and nurses.
Assuntos
Educação Médica Continuada/métodos , Serviços Médicos de Emergência , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/educação , Obstetrícia/educação , Adolescente , Adulto , Idoso , Feminino , Humanos , Recém-Nascido , Masculino , México , Pessoa de Meia-Idade , Gravidez , Avaliação de Programas e Projetos de Saúde , Autoeficácia , Inquéritos e Questionários , Adulto JovemRESUMO
PROBLEM: In Mexico, women are often disrespected and abused during birth, evidence-based practices are seldom used, while outdated and dangerous procedures linger. BACKGROUND: Disrespectful and abusive practices in Mexico have been reported but are not necessarily well-documented; none of the reports so far have relied on direct observation of births. AIM: To describe birth practices and factors associated with respectful and evidence-based care at 15 referral hospitals in Mexico. METHODS: We observed 401 births from 2010-2016. We analysed woman, provider, and hospital characteristics and their association with the performance of 14 evidence-based and 15 respectful birth practices via descriptive statistics and multiple logistic regression models. FINDINGS: Only in four births were all the analysed evidence-based and respectful-birth practices performed. Essential interventions like uterine massage was only given to 46.1% of women and the administration of a uterotonic soon after birth only occurred in 58.3% of births. Professionals who were trained in respectful birth care were more likely to address women by their name (Odds Ratio=3.34, p<0.05), allow consumption of liquids during labour (Odds Ratio=31.6, p<0.05), encourage skin-to-skin contact (Odds Ratio=31.82, p<0.05), and examine the placenta after birth (Odds Ratio=16.55, p<0.01); they were less likely to perform episiotomies (Odds Ratio=0.27, p<0.05). DISCUSSION: This study reveals low rates of evidence-based practices and respectful maternity care but shows training in the topic can have a considerable positive impact. Our results call for further efforts to improve the quality of maternal healthcare, a universal right.
Assuntos
Assistência à Saúde Culturalmente Competente , Parto Obstétrico/métodos , Prática Clínica Baseada em Evidências , Serviços de Saúde Materna , Adulto , Educação Continuada , Feminino , Humanos , México , Parto , Gravidez , Centros de Atenção Terciária , Adulto JovemRESUMO
PROBLEM AND BACKGROUND: During the past two decades, Mexico has launched innovative maternal health initiatives to improve maternal and neonatal outcomes, placing emphasis on the incorporation of professional midwifery practices into the healthcare system. This study explored the perceptions of healthcare providers and women using public birth care services regarding professional midwifery practices and how can the inclusion of evidence-based midwifery techniques improve the quality of service. METHODOLOGY: We conducted a qualitative, cross-sectional study of three healthcare networks in Mexico. A content analysis was performed of data collected through 109 semi-structured interviews: 72 with healthcare providers and 37 with women. RESULTS: Healthcare providers and women had minimal knowledge of the competencies and skills of professional midwives. Medical personnel accepted the incorporation of some evidence-based midwifery practices. Women had experienced fear and anguish during childbirth so they considered that incorporating professional midwifery practices into maternal health services would be favourable in that it would render birth care more respectful. DISCUSSION AND CONCLUSIONS: Healthcare providers are willing to consider the inclusion of some evidence-based midwifery practices in health services and regard assistance from professional midwives. They believe that structural conditions will complicate their incorporation. Although the women interviewed had experienced fear, anxiety and loneliness during childbirth, most of them admitted to feeling "safer" in a hospital (secondary-care health centre) setting where possible complications could be resolved. This perception of safety served to justify the delivery of healthcare in a manner that is inattentive to women's needs, which go beyond biomedical issues and include emotions and the positive experience of childbirth.
Assuntos
Parto Obstétrico/psicologia , Pessoal de Saúde/psicologia , Serviços de Saúde Materna/estatística & dados numéricos , Tocologia/métodos , Adolescente , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Humanos , Masculino , México , Parto/psicologia , Gravidez , Pesquisa Qualitativa , Adulto JovemRESUMO
An orally disintegrating film formulation of sildenafil 50 mg (CL Pharm Co, Ltd) was used in this study and compared to the market-available product film coated tablets (Viagra® , Pfizer, Mexico). The objective was to compare the pharmacokinetic properties of these products after a single-dose administration to 47 healthy male volunteers (aged 19-48 years) in a randomized, open-label, 2-way crossover study. Each subject received a single oral dose of 50 mg of sildenafil test or reference product administered under fasting conditions at each of the 2 study periods according to a crossover design. There was a 3-day washout period between drug administrations. Blood samples for pharmacokinetic analysis were collected predose and at different times postdosing. The maximum plasma concentration and area under the curve from administration to last observed concentration time of test and reference products were compared. Pharmacokinetic parameters shown to be within the confidence interval 80% to 125% for log-transformed data and Shuirmann and Anderson Hauck tests showed a high probability that area under the curve values for the test product were within 80% to 125% (P < .05). Adverse events occurred at similar rates for the 2 formulations (8 for each product), headache being the most prevalent. The results suggest that the 2 sildenafil formulations, orally disintegrating films and film-coated tablets, are similar in terms of bioavailability, making the test product a good alternative to treat erectile dysfunction and improving dosing convenience.
Assuntos
Mucosa Bucal/metabolismo , Inibidores da Fosfodiesterase 5/farmacocinética , Citrato de Sildenafila/farmacocinética , Administração Oral , Adulto , Área Sob a Curva , Disponibilidade Biológica , Estudos Cross-Over , Liberação Controlada de Fármacos , Humanos , Masculino , México , Pessoa de Meia-Idade , Inibidores da Fosfodiesterase 5/administração & dosagem , Inibidores da Fosfodiesterase 5/sangue , Inibidores da Fosfodiesterase 5/química , Citrato de Sildenafila/administração & dosagem , Citrato de Sildenafila/sangue , Citrato de Sildenafila/química , Comprimidos , Equivalência Terapêutica , Adulto JovemRESUMO
BACKGROUND: Quality of obstetric care may not be constant within clinics and hospitals. Night shifts and weekends experience understaffing and other organizational hurdles in comparison with the weekday morning shifts, and this may influence the risk of maternal deaths. OBJECTIVE: To analyze the hourly variation of maternal mortality within Mexican health institutions. METHODS: We performed a cross-sectional multivariate analysis of 3,908 maternal deaths and 10,589,444 births that occurred within health facilities in Mexico during the 2010-2014 period, using data from the Health Information Systems of the Mexican Ministry of Health. We fitted negative binomial regression models with covariate adjustment to all data, as well as similar models by basic cause of death and by weekdays/weekends. The outcome was the Maternal Mortality Ratio (MMR), defined as the number of deaths occurred per 100,000 live births. Hour of day was the main predictor; covariates were day of the week, c-section, marginalization, age, education, and number of pregnancies. RESULTS: Risk rises during early morning, reaching 52.5 deaths per 100,000 live births at 6:00 (95% UI: 46.3, 62.2). This is almost twice the lowest risk, which occurred at noon (27.1 deaths per 100,000 live births [95% U.I.: 23.0, 32.0]). Risk shows peaks coinciding with shift changes, at 07:00, and 14:00 and was significantly higher on weekends and holidays. CONCLUSIONS: Evidence suggests strong hourly fluctuations in the risk of maternal death with during early morning hours and around the afternoon shift change. These results may reflect institutional management problems that cause an uneven quality of obstetric care.
Assuntos
Hospitais/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Mortalidade Materna , Qualidade da Assistência à Saúde , Adolescente , Adulto , Criança , Feminino , Humanos , México , Gravidez , Complicações na Gravidez/mortalidade , Fatores de Tempo , Adulto JovemRESUMO
INTRODUCTION: Children under five years of age from developing countries are in risk of not achieving an adequate human development due to stunting and extreme poverty. They were also affected by intestinal helminths. Inhabitants of the state of Chiapas, the poorest population in Mexico, register the highest prevalence of child malnutrition as well as intestinal parasitic infections. With the purpose of fight against poverty and hunger, the Mexican government launched a social program called "Prospera". The aim of this work was to determine the prevalence of stunting and intestinal parasites in school children beneficiaries of that social program, from two marginalized municipalities of Chiapas, Mexico. METHODOLOGY: A total of 106 school-age children were recruited for nutritional assessment as well parasitic load measures. RESULTS: Most children exhibited stunting (88.7%). In these children the prevalence of intestinal parasites was 32.1%, being A. lumbricoides the species with the highest prevalence (25.5%) with moderate parasitic load (15.1%). Positive associations were observed between the presence of intestinal parasites and the municipality where children lived, the type of footwear, or the educational level of the mother. CONCLUSIONS: Extreme poverty conditions in these localities of Mexico are far from reaching the sustainable development goals.
Assuntos
Transtornos do Crescimento/epidemiologia , Enteropatias Parasitárias/epidemiologia , Estado Nutricional , Adolescente , Animais , Ascaris lumbricoides/isolamento & purificação , Criança , Estudos Transversais , Feminino , Transtornos do Crescimento/etiologia , Humanos , Masculino , México/epidemiologia , Carga Parasitária , Pobreza , PrevalênciaRESUMO
Nucleoprotein (N) gene from rabies virus (RABV) is a useful sequence target for variant studies. Several specific RABV variants have been characterized in different mammalian hosts such as skunk, dog, and bats by using anti-nucleocapsid monoclonal antibodies (MAbs) via indirect fluorescent antibody (IFA) test, a technique not available in many laboratories in Mexico. In the present study, a total of 158 sequences of N gene from RABV were used to design eight pairs of primers (four external and four internal primers), for typing four different RABV variants (dog, skunk, vampire bat, and nonhematophagous bat) which are most common in Mexico. The results indicate that the primer and the typing variant from the brain samples, submitted to nested and/or real-time PCR, are in agreement in all four singleplex reactions, and the designed primer pairs are an alternative for use in specific variant RABV typing.
Assuntos
Primers do DNA/genética , Técnicas de Genotipagem/métodos , Proteínas do Nucleocapsídeo/genética , Vírus da Raiva/genética , Reação em Cadeia da Polimerase em Tempo Real/métodos , Animais , Cães , MéxicoRESUMO
OBJECTIVE: To estimate the mean age of sexual intercourse debut (SID) and associated family and individual factors in 14-19-year-olds of both sexes in the 32 states of Mexico in 2007. METHODS: A cross-sectional study was conducted of a representative sample of 9,893 students aged between 14 and 19 years old. The data were collected through a self-administered, anonymous and voluntary questionnaire. Logistic regression models were used to estimate odds ratios (OR) with 95% confidence intervals (95%CI) by category: no SID, SID at 10-15 years and SID at 16-19 years. RESULTS: The national mean age of SID was 16 years, being 15 years for boys (95%CI: 15.88-16.11) and 16 years for girls (95%CI: 15.26-15.42). Factors associated with SID in boys were disadvantaged socioeconomic level (OR=0.66; 95%CI: 0.46-0.94), living with parents (OR=0.65; 95%CI: 0.56-0.75), less offensive communication between parents and boys/girls (OR=0.66; 95%CI: 0.57-0.77), and high social self-esteem (OR=1.68; 95%CI: 1.35-1.77). Factors associated with SID in girls were traditional gender beliefs (OR=0.49; 95%CI: 0.32-0.74), high depressive symptoms (OR=1.88; 95%CI: 1.19-2.99), and high family self-esteem (OR= 0.50; 95%CI: 0.38-0.65). CONCLUSIONS: In Mexico, SID occurred early in boys. In addition, the findings of this study show that in Mexico, the age of SID and associated factors differ in boys and girls. The age of SID is strongly influenced by gender and cultural beliefs.
Assuntos
Comportamento do Adolescente , Coito , Adolescente , Fatores Etários , Estudos Transversais , Cultura , Depressão/epidemiologia , Características da Família , Feminino , Humanos , Masculino , México , Autoimagem , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Ineffective management of obstetric emergencies contributes significantly to maternal and neonatal morbidity and mortality in Mexico. PRONTO (Programa de Rescate Obstétrico y Neonatal: Tratamiento Óptimo y Oportuno) is a highly-realistic, low-tech simulation-based obstetric and neonatal emergency training program. A pair-matched hospital-based controlled implementation trial was undertaken in three states in Mexico, with pre/post measurement of process indicators at intervention hospitals. This report assesses the impact of PRONTO simulation training on process indicators from the pre/post study design for process indicators. METHODS: Data was collected in twelve intervention facilities on process indicators, including pre/post changes in knowledge and self-efficacy of obstetric emergencies and neonatal resuscitation, achievement of strategic planning goals established during training and changes in teamwork scores. Authors performed a longitudinal fixed-effects linear regression model to estimate changes in knowledge and self-efficacy and logistic regression to assess goal achievement. RESULTS: A total of 450 professionals in interprofessional teams were trained. Significant increases in knowledge and self-efficacy were noted for both physicians and nurses (p <0.001- 0.009) in all domains. Teamwork scores improved and were maintained over a three month period. A mean of 58.8% strategic planning goals per team in each hospital were achieved. There was no association between high goal achievement and knowledge, self-efficacy, proportion of doctors or nurses in training, state, or teamwork score. CONCLUSIONS: These results suggest that PRONTO's highly realistic, locally appropriate simulation and team training in maternal and neonatal emergency care may be a promising avenue for optimizing emergency response and improving quality of facility-based obstetric and neonatal care in resource-limited settings. TRIAL REGISTRATION: NCT01477554.
Assuntos
Hospitais/normas , Doenças do Recém-Nascido/terapia , Capacitação em Serviço/métodos , Complicações do Trabalho de Parto/terapia , Equipe de Assistência ao Paciente , Adulto , Emergências , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Masculino , México , Pessoa de Meia-Idade , Complicações do Trabalho de Parto/diagnóstico , Objetivos Organizacionais , Equipe de Assistência ao Paciente/organização & administração , Gravidez , Avaliação de Processos em Cuidados de Saúde , Indicadores de Qualidade em Assistência à Saúde , Ressuscitação/educação , Autoeficácia , Adulto JovemRESUMO
BACKGROUND: the great majority of births in Mexico are attended by physicians. Non-physician health professionals have never been evaluated or compared to the medical model of obstetric care. This study evaluates the relative strengths of adding an obstetric nurse or professional midwife to the physician based team in rural clinics. METHODS: we undertook a cluster-randomised trial in 27 clinics in 2 states with high maternal mortality. Twelve non-physician providers (obstetric nurses (4) and professional midwives (8)) were randomly assigned to clinics; 15 clinics served as control sites. Over an 18-month period in 2009-2010, we evaluated quality of care through chart review and monthly interviews with providers about last three deliveries performed. We analysed practices by creating indices using WHO care guidelines for normal labour and childbirth. Volume of care was assessed using administrative reporting forms. FINDINGS: two thousand two hundred fifty-four pregnancies were followed, and a total of 461 deliveries occurred in study sites. Intervention clinics were more likely to score highly on the index for favourable practices on admission (OR=3.6, 95% CI 2.3-5.8), and during labour, childbirth, and immediately post partum (OR=8.6, 95% CI 2.9-25.6) and less likely to use excessively used or harmful practices during labour, childbirth and immediately post partum (OR=0.2, 95% CI 0.1-0.4). There was a significant increase in volume of care in intervention clinics for antenatal visits (incidence rate ratio (IRR) 1.3, 95% CI 1.2-1.4), deliveries (IRR=2.5, 95% CI 1.7-3.7) and for postpartum visits (IRR=1.4, 95% CI 1.1-1.7). INTERPRETATION: the addition of non-physician skilled birth attendants to rural clinics in Mexico where they independently provided basic obstetric services led to improved care and higher coverage than clinics without. The potential value of including a professional midwife or obstetric nurse in all rural clinics providing obstetric care should be considered. FUNDING: Mexican National Institute for Women, Mexican National Center for Gender Equity and Reproductive Health, MacArthur Foundation, Bill and Melinda Gates Foundation.
Assuntos
Parto Obstétrico , Tocologia , Enfermagem Obstétrica , Assistência Perinatal , Adulto , Competência Clínica , Pesquisa em Enfermagem Clínica , Parto Obstétrico/métodos , Parto Obstétrico/mortalidade , Parto Obstétrico/normas , Feminino , Humanos , Mortalidade Materna , México , Tocologia/métodos , Tocologia/normas , Enfermagem Obstétrica/métodos , Enfermagem Obstétrica/normas , Assistência Perinatal/métodos , Assistência Perinatal/organização & administração , Gravidez , Resultado da Gravidez , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Melhoria de Qualidade , Serviços de Saúde Rural/normasRESUMO
Integrating traditional midwives (TMs) as labor support in cline-based care may be an ideal solution to improving maternity services in the Mexico and worldwide. We conducted interviews and focus groups with 65 TMs and 24 interviews with public health system personnel to assess the acceptability and challenges of this proposal. Both TMs and personnel perceive this new role as having professional benefits. Challenges include TMs' and clinic personnel's previous negative experience with one another and unfamiliarity with the doula role. Interactive trainings introducing the doula role and improving professional relations between TMs and personnel are necessary to assure success of this proposal.
Assuntos
Atitude do Pessoal de Saúde , Hospitais Públicos , Serviços de Saúde Materna/organização & administração , Tocologia/organização & administração , Recursos Humanos em Hospital/psicologia , Adulto , Idoso , Comportamento Cooperativo , Feminino , Grupos Focais , Diretrizes para o Planejamento em Saúde , Necessidades e Demandas de Serviços de Saúde , Hospitais Públicos/organização & administração , Humanos , Medicina Integrativa , Relações Interprofissionais , Masculino , México , Pessoa de Meia-Idade , Tocologia/educação , Papel Profissional , Pesquisa Qualitativa , Salários e Benefícios , Inquéritos e QuestionáriosRESUMO
The need to identify and improve access to evidence-based treatments for depressive disorders and other mental health problems is a public health priority, particularly in relation to racial/ethnic minorities and other underserved groups. One hundred forty-six Mexican American primary care patients who met diagnostic criteria for major depressive disorder, dysthymic disorder, or depressive disorder not otherwise specified (NOS) were offered eight sessions of an evidence-based behavioral treatment, problem-solving treatment for primary care (PST-PC). Among participants who agreed to treatment (N=117), depressive symptom scores decreased over time; a minority of participants completed four or more sessions of PST-PC (N=55), and those participants had greater decreases in depressive symptom severity than participants who completed three or fewer PST-PC sessions (N=62) (Hopkins Symptom Checklist-20 scores declined on average 0.86+/-0.97 and 0.40+/-0.66 points for these groups, respectively, p<.05). More work is needed to enhance the engagement in treatments for depression, especially among Latinos in primary care.