A preliminary model of case management for pregnancy-associated breast cancer / 中华护理杂志

To explore the model of case management for patients with pregnancy-associated breast cancer in accordance with China's national conditions,and to improve the patients' compliance and satisfaction with the treatment.Case managers for patients with pregnancy-associated breast cancer were trained,and posts of case managers were established.Case managers,with the aid of multidisciplinary treatment teams and multi-specialized nursing groups,provided comprehensive,sustainable and coordinated care for patients with pregnancy-associated brcast cancer from diagnosis to 6 months after surgery.The model of case management for pregnancy-associated breast cancer could promote the treatment effectively,serving as important guarantee for multidisciplinary cooperation and providing patients with comprehensive,sustainable and coordinated care through mobilization of available resources.

Barreras de acceso y calidad en el control prenatal / Obstacles and quality of prenatal care

Resumen Introducción. El control prenatal (CPN) es una estrategia de costo eficaz en la prevención de mortalidad y morbilidad materna y perinatal. Aunque Colombia tiene una inscripción de gestantes al CPN del 94%, este logro no afecta el descenso de la mortalidad materno perinatal. Objetivo. Describir las barreras de acceso al CPN y la calidad de atención a gestantes en Meta. Materiales y métodos. Se diseñó un estudio observacional descriptivo de corte transversal y se realizó una encuesta que abordó aspectos como percepción de calidad de atención, barreras de acceso e integridad de la atención. Resultados. Se trabajó con 306 gestantes, cuya edad promedio fue de 24 años. El 66% tuvo una o dos gestaciones, el 15% ha tenido aborto y el 25% cesárea. El 74.17% tuvo cuatro o más controles. Existieron factores de riesgo asociados a menos de cuatro controles, percepción de la calidad del control con Odds ratio (OR, por su sigla en inglés) 22.7, inicio del CPN en segundo trimestre con OR 5.64, nivel de ingreso bajo con OR 5.12 y baja escolaridad de la madre con OR 3.62. Conclusión. Es necesario mejorar la calidad e integridad del CPN por los prestadores de salud como estrategia complementaria para asegurar su efecto en la reducción de la morbimortalidad materno y perinatal.

Abstract Introduction: Prenatal care (PC) is a cost-effective strategy that prevents maternal and perinatal mortality and morbidity. Although PC in Colombian pregnant women shows an enrollment rate of 94%, this condition does not impact the decline of maternal perinatal mortality. Objective: To describe the obstacles to access to PC and the perceived quality of care for pregnant women in Meta. Materials and methods: A cross-sectional, observational and descriptive study was designed and a survey was applied to inquire about aspects such as perception of quality of care, obstacles to access and comprehensiveness of care. Results: 306 pregnant women were included in the study, whose average age was 24 years. 66% had one or two pregnancies, 15% had abortions and 25% had a cesarean section. 74.17% of them had four or more prenatal controls. Risk factors were associated with attending less than four controls, while perception of quality had an odds ratio (OR) of 22.7; additionally, beginning PC during the second trimester had an OR of 5.64, low income level an OR of 5.12, and low maternal schooling an OR of 3.62. Conclusion: Improving the quality and integrity of PC by health providers is a complementary strategy to ensure its effect on the reduction of maternal and perinatal morbidity and mortality.

El proceso salud-enfermedad-atención bucal de la gestante: una visión de las mujeres con base en la determinación social de la salud / Health-disease process oral-care of the pregnant: an overview of women in the determination based social health

Resumen Antecedentes. La atención en salud durante el embarazo y el acceso a la atención odontológica de las gestantes en Bogotá registra profundas inequidades. Las patologías orales y las complicaciones que representan para el binomio madre-niño incentivan la necesidad de identificar el proceso salud-enfermedad-atención bucal de las gestantes sustentadas en los postulados de la determinación social de Breilh y los planteamientos de Menéndez. Objetivos. Caracterizar el proceso salud-enfermedad-atención bucal de la mujer gestante. Materiales y métodos. Se efectuó una investigación con abordaje cualitativo interpretativo con base en los fundamentos de Jodelet. El proceso involucró a mujeres que acudieron a su control prenatal y postparto a los hospitales Suba, Engativá y Simón Bolívar. El procedimiento involucró estructurar las entrevistas, concertar la entrada a las instituciones, recolectar y sistematizar la información, para efectuar su procesamiento y análisis. Resultados. Se caracterizaron 18 mujeres entrevistadas. Se establecieron categorías de análisis y se describió el proceso salud-enfermedad-atención bucal de la mujer gestante en los ámbitos económico, político y cultural, en los niveles singular, particular y general, en el marco del perfil epidemiológico de la determinación social. Conclusión. El proceso salud-enfermedad-atención bucal de las gestantes de los hospitales estudiados está influenciado por determinantes del nivel individual, singular y general en los ámbitos político, económico y cultural. Se evidencian procesos que promueven su atención, aunque más los que desincentivan la asistencia de la gestante a la consulta odontológica. Se plantea la necesidad de intervenir en los diferentes niveles para transformar el proceso a corto, mediano y largo plazo, promoviendo una buena salud bucal y una mejor calidad de vida en las mujeres durante su embarazo.

Summary Background. Health care during pregnancy and the access to dental care for pregnant women in Bogotá registers deep inequities. The oral pathologies and its complications to mothers and their children has stimulated the need for identifying the health-illness-oral care process of pregnant women based on the postulates of the social determination of Breilh and approaches of Menendez. Objective. Characterize the health-disease-care oral pregnant women. Materials and methods. An investigation with interpretative qualitative approach based on the Jodelet theoretical bases was performed. The process involved women who assist to their control antenatal and postpartum to Suba, Engativá and Simón Bolívar Hospitals. The procedure involved nterviews, arrange the entry to the institutions, collect and synthesize information, to carry out its processing and analysis. Results. The study involved the characterization of 18 women. The study involved the constitution of analysis categories and the description of the health-disease-oral care process of pregnant women in the economic, political and cultural levels in the singular, particular and general grade in the framework of the epidemiological profile of the social determination. Conclusion. The health-illness-oral care process of the pregnant women in the hospitals involved in the study was influenced by determinants in the individual, particular and general level in the political, economic and cultural issues. It can be concluded that some aspects of promoting process are present, but also there are several difficulties in oral care. It is necessary the intervention at different levels for transforming in the short, middle and long time in order to promote the oral health and quality of life in the pregnant women.

Correlação entre a dor lombar e as alterações posturais em gestantes / Correlation between low back pain and postural alterations during pregnancy

INTRODUÇÃO: A dor lombar é uma queixa comum na população em geral e é sintoma frequentemente relatado durante a gestação. OBJETIVO: Verificar a correlação entre a dor lombar e as alterações posturais em gestantes. MÉTODO: A amostra constituiu-se de 54 voluntárias, com faixa etária variando entre 20 e 30 anos, sendo 27 gestantes. As gestantes foram divididas em três grupos de acordo com o período gestacional: sete no primeiro trimestre (GI), 11 no segundo trimestre (GII), nove no terceiro trimestre (GIII); para ser analisada a incidência de dor ou desconforto relacionada a alterações posturais apresentadas no período gestacional. O grupo controle (GC) foi constituído por 27 voluntárias não grávidas. A análise das fotos foi realizada com o software de Análise Postural (SAPO), e a análise estatística foi feita através dos testes ANOVA e Regressão Linear Simples com nível de significância de 5%. RESULTADOS: Em relação à idade gestacional, a prevalência de dor lombar foi maior nas gestantes com até 13 semanas. Referente à intensidade da dor na região lombar, o GII foi o grupo que apresentou a maior média, com dor moderada, seguido dos grupos GIII, GC e GI, com uma dor leve. Com relação às modificações da curvatura da coluna lombar, não foi possível estabelecer correlação estatisticamente significativa das alterações posturais apresentadas com a presença da dor lombar durante a gestação por meio da análise postural de todas as mulheres. CONCLUSÃO: Não houve correlação entre a sintomatologia de dor lombar e as alterações posturais no período gestacional.

INTRODUCTION: Low back pain is a common complaint in the population as a whole and is a symptom frequently reported during pregnancy. OBJECTIVE: To verify the correlation between low back pain and postural changes during pregnancy. METHOD: The sample consisted of 54 female volunteers, ages from 20 to 30 years, 27 pregnant. Women were sub-divided into three groups according to pregnancy age: seven in first quarter (GI), 11 in the second quarter (GII), nine in third trimester (GIII); to analyze the incidence of pain or discomfort related to abnormal postural alterations during pregnancy. The control group (GC) consisted of 27 non-pregnant volunteers. The image analysis was performed with the Postural Analysis Software (SAPO) and statistical analysis through ANOVA tests and regression analysis with significance level at 5%. RESULTS: Regarding the gestational age, the prevalence of lumbar pain was higher among those with up to 13 weeks. Referring to the intensity of pain in the lumbar region, the GII was the group that had the highest average, with moderate pain, followed by GIII, GC and GI with mild pain. Regarding changes in the curvature of the spine, it was not possible to establish a statistically significant relationship of postural alterations with the presence of lumbar back pain during pregnancy based postural analysis of all women. CONCLUSION: There was no association between low back pain postural changes during pregnancy.

O papel do complexo principal de histocompatibilidade na fisiologia da gravidez e na patogênese de complicações obstétricas / Major histocompatibility complex: its role in the physiology of pregnancy and in the pathogenic mechanisms of obstetric complications

Este trabalho tem por objetivo discutir a estrutura e função dos Antígenos Leucocitários Humanos (HLA), seus métodos de detecção, nomenclatura e os mecanismos imunopatológicos que o associam com a fisiologia da gestação e morbidades obstétricas. Sabe-se que o equilíbrio imunológico entre mãe e concepto é imprescindível na manutenção da gravidez. Moléculas do HLA - notadamente o HLA-G expresso na interface materno-fetal - exercem função importante na tolerância imunológica materna, evitando rejeição fetal e algumas complicações obstétricas. Além disso, o HLA permeia diversas etapas do desenvolvimento conceptual como clivagem, formação do trofoblasto e implantação. Para revisão, foram pesquisados os bancos de dados MEDLINE e LILACS, utilizando os descritores: "HLA antigens"; "pregnancy"; "embryonic development"; "pregnancy complication"; "abortion, habitual"; "pre-eclampsia". O conhecimento sobre a influência do HLA na gravidez é necessário para melhor manejo da gestação e patologias obstétricas auto-imunes, favorecendo intervenções precoces e terapêutica específica, reduzindo a morbimortalidade materna e perinatal.

The aim of this paper is to review Human Histocompatibility Antigens (HLA) structure and function, its detection methods, nomenclature and pathogenic mechanisms associated with pregnancy physiology and obstetrics diseases. Immunological equilibrium between mother and conceptus is indispensable for the maintenance of pregnancy. Molecules from the HLA - mainly HLA-G expressed in the mother-fetus interface - fulfill an important function in maternal immune tolerance, contributing to avoid fetal rejection and obstetrical complications. In addition, HLA influences different stages of fetal development, such as embryonic cleavage, trophoblast, formation and implantation. For this review, were surveyed in the MEDLINE and LILACS databases, using the following keywords: "HLA antigens", "pregnancy", "embryonic development", "pregnancy complication", "abortion, habitual", "pre-eclampsia". Knowledge of the HLA role in pregnancy is necessary to improve pregnancy management and autoimmune obstetrical illnesses, by allowing early interventions and specific therapeutics to reduce maternal and perinatal morbidity and mortality.

Clinical obserration of premature labor complicated with premature rupture of membranes in 110 cases / 中国基层医药

Objective To study the clincal characters of premature labor compicated with premature rupter of membrance, and how to prevent and treat the complications. Methods Among the 110 cases, according to the nursing routine treatment,we treat 50 of them with 10mg im bid. The rest are treated with 4. 8mg q6h of oral salbu-tamoulum,30-60ml of intravenous drip of 25% of magnesii sulfas per day. lOmg of muscle injection of dexametha-soni acetas. Mean while, observe body temperature, the number of white blood cells, the foetus heartbeat and the shape and property of amniotic fluid. Results The 49 cases are successful.11 of which failure. The death rate of less than 34 weeks is much higher than that of more than 34 weeks. The difference is rery obvious(P