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OBJECTIVE: Explore the use of two abortion care models in Argentina over the period 2016-2019: pro-rights private medical service providers and abortion accompaniment (via self-management and via health institutions); and compare the profile of who accesses these models and when. METHODS: We used data from accompaniment collectives in the Socorristas en Red and private service providers. We estimated annual abortion rates via these service models and compared the profile of the populations by type of service and gestational age (2019) using descriptive statistics and chi-square tests. RESULTS: In 2016, 37 people per 100,000 women of reproductive age obtained accompanied self-managed abortions, and the number increased to 111 per 100,000 in 2019, a threefold increase. The rate of abortions via care providers was 18 per 100,000 in 2016 and 33 in 2019. Higher proportions of those who obtained abortion via care providers were 30 years or older. A higher proportion of those accompanied were 19 years or younger; 11% of those who obtained accompanied self-managed abortions were more than 12 weeks gestation compared with 7% among those who had accompanied abortions via health institutions and 0.2% among those who had abortions with private providers. A higher proportion of those who accessed accompanied abortions after 12 weeks gestation had lower educational levels, did not work or have social security coverage, had more past pregnancies, and attempted to terminate their pregnancies prior to contacting the Socorristas compared to those who had accompanied abortions at 12 weeks or earlier. CONCLUSIONS: In Argentina, prior to Law 27.610 models of care guaranteed access to safe abortion. It is important to continue making visible and legitimizing these models of care so that all those who decide to have an abortion, whether inside or outside health institutions, have safe and positive experiences.

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OBJECTIVE: To describe factors associated with subsequent abortions in Colombia and evaluate whether high-efficacy contraceptive availability (IUD) post-index abortion was associated with higher efficacy contraceptive initiation and fewer subsequent abortions within 2 years. METHODS: The study population comprised patients aged 15-44 years who underwent index abortion in 2017 at four clinics in Bogotá, Colombia. Using charts, we conducted a retrospective cohort study with 2-year follow-up (2017-2019) after the index abortion for outcomes of contraceptive initiation and subsequent abortion. We evaluated associations between demographic or clinical characteristics and outcomes using Pearson chi-square and multivariate logistic regression. RESULTS: Of 9175 patients with index abortion, 3409 (37.2%) initiated an intrauterine device (IUD) and 467 (5.1%) had a subsequent abortion within the study period (2017-2019). IUD availability (adjusted odds ratio [aOR], 1.64; 95% confidence interval [CI], 1.39-1.93) and insurance use (aOR, 5.03; 95% CI, 4.37-5.78) were associated with high-efficacy contraceptive initiation; medication abortion was inversely associated (aOR, 0.24; 95% CI, 0.22-0.27). Initiation of no (aOR, 4.94; 95% CI, 3.59-6.80) or moderate-efficacy (injection: aOR, 4.21 [95% CI, 3.14-5.62]; oral contraceptive pill: aOR, 4.60 [95% CI, 3.21-6.59]) methods were associated with subsequent abortion. CONCLUSION: Subsequent abortion is inversely associated with initiated postabortion contraceptive efficacy, which is modifiable on a systems level by improving access to effective postabortion contraception.

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El consumo de opioides ha venido incrementando en los últimos años, generando una crisis de salud pública que afecta a todo tipo de población. El uso de sustancias opiáceas ilegales en embarazadas también está en incremento, por lo que, en la práctica clínica se evidencian con mayor frecuencia resultados neonatales adversos como el síndrome de abstinencia neonatal (NAS). Adicionalmente, los niños expuestos prenatalmente a estas sustancias pueden sufrir alteraciones cognitivas, motoras o psiquiátricas durante el transcurso de su vida. Este artículo tiene como objetivo proporcionar una revisión de la literatura actualizada acerca del uso de opioides durante el embarazo y las consecuencias para los niños expuestos a estas sustancias.

Opioid consumption has increased greatly in recent years, creating a public health crisis that affects all types of population. The use of illegal opiates amongst pregnant women has also risen, causing a surge in the frequency in which adverse neonatal outcomes, such as Neonatal Abstinence Syndrome (NAS), are seen in clinical practice. Furthermore, children exposed prenatally to these substances have cognitive, motor and psychiatric adverse outcomes throughout their lifetime. This article's objective is to provide an updated literature review about opioid use during pregnancy and its consequences on children exposed in-utero.

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ABSTRACT OBJECTIVE Explore the use of two abortion care models in Argentina over the period 2016-2019: pro-rights private medical service providers and abortion accompaniment (via self-management and via health institutions); and compare the profile of who accesses these models and when. METHODS We used data from accompaniment collectives in the Socorristas en Red and private service providers. We estimated annual abortion rates via these service models and compared the profile of the populations by type of service and gestational age (2019) using descriptive statistics and chi-square tests. RESULTS In 2016, 37 people per 100,000 women of reproductive age obtained accompanied self-managed abortions, and the number increased to 111 per 100,000 in 2019, a threefold increase. The rate of abortions via care providers was 18 per 100,000 in 2016 and 33 in 2019. Higher proportions of those who obtained abortion via care providers were 30 years or older. A higher proportion of those accompanied were 19 years or younger; 11% of those who obtained accompanied self-managed abortions were more than 12 weeks gestation compared with 7% among those who had accompanied abortions via health institutions and 0.2% among those who had abortions with private providers. A higher proportion of those who accessed accompanied abortions after 12 weeks gestation had lower educational levels, did not work or have social security coverage, had more past pregnancies, and attempted to terminate their pregnancies prior to contacting the Socorristas compared to those who had accompanied abortions at 12 weeks or earlier. CONCLUSIONS In Argentina, prior to Law 27.610 models of care guaranteed access to safe abortion. It is important to continue making visible and legitimizing these models of care so that all those who decide to have an abortion, whether inside or outside health institutions, have safe and positive experiences.

RESUMEN OBJETIVO Explorar la utilización de dos modelos para la atención al aborto en Argentina en el período 2016-2019: abortos con proveedores de servicios médicos privados proderechos y abortos acompañados (vía autogestión y vía instituciones de salud); y comparar el perfil de quiénes acceden a estos modelos y cuándo. MÉTODOS Utilizamos datos de sistematizaciones de colectivas de acompañamiento en Socorristas en Red y de proveedores de servicios privados. Estimamos tasas anuales de abortos mediante estos servicios y comparamos el perfil de las poblaciones por tipo de servicio y edad gestacional (2019) utilizando estadísticas descriptivas y prueba chi-cuadrado. RESULTADOS En el 2016, 37 personas por cada 100,000 mujeres en edad reproductiva obtuvieron abortos acompañados vía autogestión, aumentando a 111 por 100,000 en 2019, es decir, se triplicó. La tasa de abortos con proveedores fue de 18 por 100,000 en 2016 y de 33 en 2019. Mayor proporción de quienes acudieron con proveedores tenía 30 años o más y mayor proporción de personas acompañadas tenía 19 años o menos; el 11% de quienes obtuvieron abortos acompañados vía autogestión tenía más de 12 semanas de gestación en comparación con el 7% entre quienes tuvieron abortos acompañados vía instituciones de salud y el 0.2% entre quienes abortaron con proveedores. Una mayor proporción de quienes accedieron a abortos acompañados después de 12 semanas de gestación tenía menor nivel educativo, no trabajaban ni tenían cobertura de obra social, y habían tenido más embarazos e intentado interrumpir su embarazo comparando con quienes abortaron acompañadas a las 12 semanas o antes. CONCLUSIONES En Argentina existen modelos de atención que han garantizado el acceso a abortos seguros desde antes de la Ley 27.610. Es importante continuar visibilizando y legitimando estos modelos para que todas las personas que deciden abortar, dentro o fuera de instituciones de salud, tengan experiencias seguras y positivas.

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OBJECTIVE: To analyze the extent to which task-sharing to midlevel providers has been implemented as a strategy to increase access to abortion provision in Colombia, and examine the factors that have affected decentralization of services. METHODS: We conducted a case study based on the World Health Organization's 2015 guideline: Health Worker Roles in Providing Safe Abortion Care and Post-abortion Contraception. Documentation was collected on the standard and epidemiological landscape of abortion in Colombia, followed by semistructured discussions with groups and individual stakeholders. RESULTS: Task-sharing as a distinct policy to increase access to abortion services has not been implemented in Colombia. However, role distribution toward nonspecialist physicians has been used as a strategy to ensure access. Other professionals, such as nurses, have limited tasks in abortion care despite evidence to support a more expanded role. CONCLUSION: The implementation of task-sharing as a strategy to increase access to safe abortion services in Colombia is influenced by a wide range of factors and, although it is not policy, nonspecialist and diverse healthcare professionals supervise abortion care. Knowing the evidence-based guidelines to safely and successfully include other healthcare professionals in abortion provision is a fundamental step in implementing this strategy.

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La terapia manual es un área de la fisioterapia que utiliza técnicas con finalidades terapéuticas sobre tejidos musculares, óseos, conjuntivos y nerviosos, para favorecer reacciones fisiológicas que promueven la disminución del dolor. Objetivo: Describir, mediante revisión los efectos reportados en la literatura científica, las técnicas de liberación miofascial y punción seca en pacientes con Fibromialgia y Síndrome de Dolor Miofascial. Método: Se realizó una revisión a de Ensayos Clínicos Controlados en materia de intervención con técnicas de liberación miofascial y punción seca en pacientes con diagnóstico de fibromialgia y síndrome de dolor miofascial. Se excluyeron estudios en participantes con trastornos psiquiátricos y neurológicos, o con participación en otro tipo de tratamiento. La consulta se realizó en diferentes bases de datos: Pubmed, Elsevier, Ebscohost, Proquest, Pedro mediante términos DeCS. Resultados: El análisis de resultados se realizó a partir de la clasificación de los documentos según las técnicas de liberación miofascial (masaje, inducción miofascial, presión manual o isquémica) y la punción seca. Las medidas efecto varían de acuerdo a los diferentes protocolos de intervención, con un valor p< 0.001 y 0.005. Discusión: Se demuestra que tanto las técnicas de liberación miofascial como la punción seca, logran disminuir el dolor, mejorar rangos de movimiento y la funcionalidad principalmente en pacientes con Fibromialgia y Síndrome de Dolor Miofascial

Manual therapy is a physiotherapy area that uses techniques on muscle, bone, conjunctive and nervous tissues with therapeutic purposes, to favor physiological reactions that promote pain reduction. Objective: To describe, by reviewing the effects reported in the scientific literature, the techniques of myofascial release and dry needling in patients with fibromyalgia and myofascial pain syndrome. Method: A review of controlled clinical trials was made in terms of intervention, with myofascial release techniques and dry needling, in patients with a diagnosis of fibromyalgia and myofascial pain syndrome. Studies with participants with psychiatric and neurological disorders, or with participation in another type of treatment, were excluded. The inquiry was made in different databases: Pubmed, Elsevier, Ebscohost, Proquest, Pedro using DeCS terms. Results: The results analysis was made from clasifying the documents according to myofascial release techniques (massage, myofascial induction, manual or ischemic pressure) and dry needling. The effect measures vary according to the different intervention protocols, with a p value of <0.001 and 0.005. Discussion: It is demonstrated that both myofascial release and dry needling techniques, manage to reduce pain, improve range of motion and functionality mainly in patients with fibromyalgia and myofascial pain syndrome.

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PURPOSE: This study focuses on investigating the evolution of nursing studies in order to know how much this transformation has contributed to the development of the nursing profession. METHODS: Literature review with data sources from different national and international databases. These sources provide an update on the ongoing evolution of nursing studies and the progress of this profession as a result of change. CONCLUSIONS: The competencies and skills that add value to the nursing profession are: an evidence-based practice; empathic communication; and other broad-range skills such as critical thinking. All are necessary in order to develop the profession alongside the constant changes in the health systems and the improvement of quality care. These competencies and skills should be evaluated and their achievement is being reached through the "portfolio". Innovations that enable the development of these skills can be found in education, strategies and tools used by educators and institutions.

PROPÓSITO: El propósito de este estudio es indagar en la evolución de los estudios de enfermería y en sus competencias, para conocer el aporte del resultado final de esta transformación al desarrollo de la profesión enfermera. METODOLOGÍA: Revisión bibliográfica de tipo descriptivo, cuyas fuentes han sido recopiladas de diferentes bases de datos nacionales e internacionales. Estas proporcionan al lector una puesta al día sobre la constante evolución de los estudios de enfermería y su progreso como profesión, resultante de ese cambio. CONCLUSIONES: Las competencias y habilidades que aportan valor a la profesión enfermera son: la práctica basada en la evidencia; la comunicación empática; y otras capacidades transversales como el pensamiento crítico. Todas ellas sirven para hacer frente al constante cambio del sistema de salud y mejora de los cuidados de calidad. Estas deben ser evaluadas y su logro se está alcanzando mediante el “portafolio”. La innovación facilitadora del desarrollo de todas estas habilidades se encuentra en la educación, en estrategias y herramientas por parte de educadores e instituciones que asuman riesgos y liderazgo.

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The hormone leptin, by binding to hypothalamic receptors, suppresses food intake and decreases body adiposity. Leptin receptors are also widely expressed in extra-hypothalamic areas such as hippocampus, amygdala and cerebellum, where leptin modulates synaptic transmission. Here we show that a defective leptin receptor affects the electrophysiological properties of cerebellar Purkinje neurons (PNs). PNs from (db/db) mice recorded in cerebellar slices display a higher firing rate of spontaneous action potentials than PNs from wild type (WT) mice. Blockade of GABAergic tonic inhibition with bicuculline in WT mice changes the firing pattern from continuous, uninterrupted spiking into bursting firing, but bicuculline does not produce these alterations in db/db neurons, suggesting that they receive a weaker GABAergic inhibitory input. Our results also show that the intrinsic firing properties (auto-rhythmicity) of WT and db/db PNs are different. Tonic firing of PNs, the only efferent output from the cerebellar cortex, is a persistent signal to downstream cerebellar targets. The significance of leptin modulation of PNs spontaneous firing is not known. Also, it is not clear if the increased excitability of cerebellar PNs in db/db mice results from hyperglycemia or from the lack of leptin signaling, since both conditions coexist in the db/db strain.

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