Descripción del nivel de conocimiento de los signos y síntomas de alarma obstétrica en mujeres embarazadas / Description of the level of knowledge about the signs and symptoms of obstetric alarm in pregnant women

Resumen OBJETIVO: Describir el nivel de conocimiento de los signos y síntomas de alarma obstétrica en mujeres embarazadas. MATERIALES Y MÉTODOS: Estudio de serie de casos prolectivo y descriptivo efectuado en la Unidad de Medicina Familiar 16, Instituto Mexicano del Seguro Social, Mexicali, Baja California, entre los meses de enero a junio de 2022. Variables de estudio: edad, sexo, escolaridad y nivel de conocimiento de signos y síntomas de alarma a través de una encuesta elaborada conforme a los criterios de la guía de práctica clínica. Se utilizó estadística descriptiva con el programa SPSSv24. RESULTADOS: Se estudiaron 150 pacientes embarazadas. El bajo nivel de conocimiento de los signos y síntomas de alarma se observó en 15 casos, el nivel medio en 47 casos y el nivel alto en 88 casos (58.7%). En cuanto a las características de la población, los límites de edad fueron 20 y 34 años, la escolaridad secundaria ocupó el 47.3% seguido de la preparatoria con el 35.3% y en cuanto a la ocupación el 80.7% refirió ser empleada. El 34% cursaba el primer trimestre del embarazo y el 48.7% el segundo trimestre. CONCLUSIONES: El nivel de conocimiento de las pacientes embarazadas atendidas en la unidad es alto y medio porque pueden reconocer los signos y síntomas de alarma durante el embarazo, sobre todo quienes cursan el segundo embarazo, en coincidencia con estudios nacionales e internacionales. El grupo predominante fue el de 20 a 34 años, con escolaridad media y superior.

Abstract OBJECTIVE: To describe the level of knowledge of obstetric alarm signs and symptoms in pregnant women. MATERIALS AND METHODS: Selective and descriptive case series study carried out in the Family Medicine Unit 16, Mexican Institute of Social Security, Mexicali, Baja California, between January and June 2022. Study variables: age, sex, education and level of knowledge of warning signs and symptoms through a survey prepared according to the criteria of the Clinical Practice Guide. Descriptive statistics were performed using SPSSv24. RESULTS: 150 pregnant patients were screened. A low level of knowledge of warning signs and symptoms was observed in 15 cases, a medium level in 47 cases and a high level in 88 cases (58.7%). Regarding the characteristics of the population, the age range was 20-34 years, 47.3% had secondary education, followed by high school with 35.3%, and 80.7% reported being employed. Thirty-four per cent were in the first trimester of pregnancy and 48.7 per cent in the second trimester. CONCLUSIONS: The level of knowledge of pregnant patients attending the unit is high and medium in terms of being able to recognize the warning signs and symptoms of pregnancy, particularly in the second trimester, in line with national and international studies. The predominant age group was 20-34 years, with secondary and higher education.

Why do graphic health warnings fail: An explanatory case study on the persistence of smoking behavior among male adult smokers in a rural and low-income setting in the Philippines

BACKGROUND@#The Philippines enacted in 2014 Republic Act No. 10643 that mandated the printing of Graphic Health Warnings on tobacco packages. However, smoking behavior among male smokers in the country, particularly in rural and low-income areas, persists even if the Graphic Health Warnings are according to the guidelines set by the World Health Organization. Hence, this explanatory case study aims to examine why and how most male adult smokers in a rural and low-income setting in the Philippines fail to quit smoking despite the presence of Graphic Health Warnings on tobacco packages.@*METHODS@#Forty-four male adult smokers from Barangay Urdaneta in Magallanes, Cavite, were recruited to participate in this study through snowball sampling. They underwent semi-structured interviews about their history of smoking, experiences as a smoker, and perspectives on Graphic Health Warnings. Thematic analysis of verbatim transcripts was then carried out to identify emerging themes.@*RESULTS@#Findings showed Graphic Health Warnings fail to persuade against smoking because fear was not aroused enough for smoking cessation. Specifically, the perception of risk from smoking was low due to lack of literacy on its harmful effects, and self-efficacy needed for smoking cessation was low because of self-doubt and denial. Other factors, such as the subjective and social benefits of smoking, were likewise contributory to the persistence of smoking behavior.@*CONCLUSION@#All these concerns must be considered for an effective campaign against tobacco use and consumption since Graphic Health Warnings on tobacco packages is only one strategy to address the burden of tobacco smoking.

Factores asociados con el cumplimiento de las precauciones de contacto en un hospital de alto nivel de complejidad / Factors related to contact-warnings compliance in a high complexity hospital / Fatores associados à adesão às precauções de contato em um hospital de alto nível de complexidade

Introducción: La prevención de infecciones intrahospitalarias es uno de los aspectos más inquietantes en enfermería en los últimos años. Para esto, se han establecido diversas estrategias, entre ellas, los aislamientos hospitalarios. Sin embargo, se encuentra gran diAcultad para el cumplimiento de las medidas de aislamiento. Objetivo: Determinar los factores sociodemográAcos y de la atención en salud relacionados con el cumplimiento de las precauciones de contacto por parte de los visitantes en un hospital de alta complejidad de la ciudad de Medellín. Método: Se realizó un estudio descriptivo de corte trasversal a un total de 126 visitantes de pacientes aislados por contacto. Se identiAcaron factores asociados al cumplimiento del aislamiento mediante una encuesta, se analizó la información en el programa SPSS mediante una regresión logística y se asumió signiAcancia estadística si valor P menor a 0,05. Resultados: La adherencia total al aislamiento fue de un 40,5% y está asociada principalmente con dos factores: disponibilidad de los elementos de protección y estar de acuerdo con el uso de estos. Conclusiones: Los factores mejor asociados con el cumplimiento del aislamiento hacen necesario que las instituciones garanticen suAcientes insumos para los visitantes y que tanto el personal de salud como los visitantes reciban una mayor sensibilización en este tema.

Introduction: Preventing the intra-hospital infections is one of the major concerns in the last year. To that end, different strategies have been set such as hospital isolation. However, there is a grate default in order to comply with the isolation measures Objective: To determine the sociodemographic and healthcare factors related to how to comply with the contact warnings by the visitors coming into a high complexity hospital in Medellín. Methods: It is a cross-sectional descriptive study including in total 126 visitors who were isolated aÆer a contact. Factors associated with the isolation compliance were identiAed based on a survey. Information was analyzed with SPSS soÆware by doing a logistic regression and statistical signiAcance was assumed as P<0.05. Results: Total adherence to isolation was 40.5%, which is mainly associated with two factors: availability of protective garments and to agree with their use. Conclusions: Ǽe factors deemed as best associated with the isolation compliance required that the institutions provided enough protective garments to the visitors and that both the visitors and the hospital staff can receive a better awareness-rising communication on this topic.

Introdução: A prevenção de infeções intrahospitalares é um dos aspectos mais preocupantes nos últimos anos. Para isso, tem se estabelecido várias estratégias, entre elas, o isolamento hospitalar. No entanto, há grande diAculdade para a adesão as medidas de isolamento. Objetivo: Determinar os fatores sociodemográAcos e da atenção em saúde relacionados com o cumprimento das precauções de contato por parte dos visitantes em um hospital de alta complexidade na cidade de Medellín. Método: Foi realizado um estudo descritivo transversal com um total de 126 visitantes de pacientes isolados por contato. IdentiAcaram-se fatores associado ao cumprimento do isolamento mediante inquérito, analisou-se a informação no programa SPSS mediante regressão logística e foi assumida signiAcância estatística se o valor P fosse menor a 0,05. Resultados: A adesão total ao isolamento foi de 40,5% e está associada principalmente com dois fatores: disponibilidade dos elementos de proteção e concordância com seu uso. Conclusões: Os fatores mais bem associados ao cumprimento do isolamento tornam necessário que as instituições garantam suprimentos suAcientes para os visitantes e que tanto o pessoal de saúde quanto os visitantes recebam maior conscientização sobre essa questão.

Awareness about cigarettes and other tobacco products act and impact of health warnings on smokers in a North Indian city

Background: Tobacco use is a major preventable cause of morbidity as well as mortality worldwide. To combat the increasing trend of this problem, Government of India formulated the COTPA (Cigarettes and Other Tobacco Products Act) in 2003. The study aimed to assess the awareness about COTPA and impact of pictorial warnings among smokers attending outpatient services in a tertiary care hospital in Jammu.Method: The present study was conducted among 320 patients attending the outpatient department of Internal Medicine, Government Medical College, Jammu who happened to be cigarette smokers. The questionnaire was developed by authors with the help of literature review and pilot tested before its final use. Information was elicited about demographic details, awareness about COTPA and impact of pictorial warnings on quitting of smoking.Results: More than half of the respondents were in 30-50-year age group and were urban residents. Awareness about COTPA was good on some parameters but was relatively low on other parameters. Despite all, the respondents noticing pictorial warnings on tobacco packages, only 69.37% of them were contemplating to quit. About half of them were of the view that warning statements preferably be written in local languages.Conclusion: Health and pictorial warnings on tobacco packages remain an important pillar in filling the gap of knowledge and communicating the health risks of tobacco use to the consumers. Only 69.3% of the respondents were planning to quit and awareness levels about COTPA were mixed.

Impact of targeted education on managing warning and error signals by children and adolescents with type 1 diabetes using the Accu-Chek Combo Insulin Pump System

PURPOSE: Insulin pumps are widely used in diabetes. They are equipped with safety alarms to alert users. Pump manuals contain alarm codes and how to troubleshoot them. However, these manuals are lengthy and difficult to use, particularly in emergencies. We aim to assess the impact of targeted education on warnings and errors in improving competency to troubleshoot the alarms. METHODS: Twenty-one patients, with a median age of 13, were recruited over a 5-month period. Each patient had 2 study visits. The frequencies and types of alarms were recorded, and patients were given a summary sheet that outlined common alarms encountered and troubleshooting tips. In visit 2, the frequencies and types of alarms were compared to those of visit 1. The patients were asked to fill a questionnaire and to rate the education session given in visit 1, their level of competency in decrypting alarm codes, and their promptness in responding to alarms. RESULTS: Low cartridge (W1), low battery (W2), and bolus cancelled (W8) were the commonest warnings. The most noted errors were occlusion (E4), power interruption (E8), empty battery (E2), set not primed (E11), and cartridge empty (E1). The numbers of warning and error signals markedly decreased after targeted education (P < 0.05). The ability in decrypting warning signals significantly improved (P=0.02), and the frequency of response to pump alarms significantly increased (P=0.001). CONCLUSION: Certain warnings and errors are more common than others in insulin pumps. Targeted education is useful in improving competency and response of patients in managing pump alarms.

Análise da interferência da indústria do tabaco na implementação das advertências sanitárias nos derivados de tabaco no Brasil / Analysis of the interference of the tobacco industry in the implementation of health warnings on tobacco products in Brazil

O propósito desta dissertação de mestrado é entender a relação que se estabelece entre a adoção de uma medida reguladora pelo governo, com forte impacto na população, e a reação por ela gerada em grupos de interesse.O embasamento teórico do estudo proposto se fundamenta na teoria de políticas sociais, que estuda a ação de grupos de interesse contra a implantação de medidas reguladoras, neste caso específico, a influência da indústria fumageira e seus aliados, na implementação das advertências sanitárias em produtos de tabaco no Brasil.Esta dissertação é dividida em quatro partes, incluindo introdução, percurso teórico metodológico, resultados e discussão e conclusão e recomendações.A metodologia utilizada envolve o estudo de documentos relacionados à implementação e avaliação das advertências sanitárias nos produtos de tabaco comercializados no Brasil, assim como do arcabouço legislativo que amparou a introdução dessas advertências. Em paralelo, foi realizada uma busca dos documentos internos da indústria do tabaco, liberados em 1999 durante ações de litígio nos Estados Unidos, com o objetivo de identificar as reações do setor, no processo de introdução e adoção das advertências sanitárias no mundo e no Brasil. Este trabalho também apresenta a evolução histórica desta medida no Brasil, com o foco na reação da indústria do tabaco.Os resultados deste estudo sugerem que várias ações do governo foram permeadas pela interferência da indústria do tabaco. Em alguns casos as intervenções eram explícitas e em outros momentos eram indiretas ou obscuras.À luz do marco referencial adotado, concluiu-se que houve a interferência da indústria fumageira como um grupo de interesse, de pressão e de lobby nas políticas de advertências sanitárias adotadas. Esta dissertação trouxe informações inovadoras e originais no cenário nacional que poderão ser úteis aos gestores da saúde pública e tomadores de decisão, na promoção de políticas de controle do tabaco, com foco nas advertências sanitárias. Recomendações para a melhoria da condução estratégica da Política Nacional de Controle do Tabaco foram também desenvolvidas.

The purpose of this monograph is to understand the relationship between the adoption of a regulatory measure by the government, with strong impact over the population, and the reaction of interest groups. The theoretical framework of this study is the theory of social policies, which addresses the influence of interest groups against the adoption of regulatory measures, in this specific case, the interference of the tobacco industry and its allies in the regulatory framework of health warnings used on tobacco products in Brazil. The methodology involves the study of documents related to the implementation and evaluation of health warnings on tobacco products sold in Brazil, as well as on the legislative framework that based the introduction of these warnings in the country. In parallel, we conducted a search on tobacco industry’s internal documents, released in 1999 during a litigation process in the United States, aiming to identify the reactions of this sector in the process of introduction and implementation of health warnings globally and specifically in Brazil. This paper presents the historical evolution of this measure, with focus on tobacco industry’s reaction. The text of this monograph has four parts, comprising the introduction, theoretical and methodological aspects, results and discussion and conclusion and recommendations. The results of this study suggest that several governmental actions were targeted by tobacco industry’s interference. In some cases the influence was explicit and in other situations their presence was indirect and obscure. The study concludes that, following the theoretical referential, there is evidence that the industry has interfered on the health warnings regulatory and implementation framework in Brazil acting as an interest/pressure/lobby group. The results of this monograph shadow a new light on this area with useful and innovative information that might be relevant to decision makers and public health managers when 9 furthering tobacco control policies targeting health warnings measures. Recommendations for improvement in the strategic guidance of the Tobacco Control National Policy were made in this regard.

Ineffective pictorial health warnings on tobacco products: Lessons learnt from India.

Pictorial warnings are effective in promoting smoking cessation as shown by research in the developed countries. This study aims to determine perceptions of Indians about the effectiveness of pictorial health warnings on tobacco packs which existed from May 31, 2009, to December 1, 2011. A cross-sectional survey was undertaken in five states of India with 1897 participants (56% males; 54% tobacco users). More tobacco users expressed that the pictorial warnings are inadequate to convey the health impact of tobacco use when compared with nonusers (71.50% vs. 62.75%; P < 0.001). More illiterates when compared with literates expressed their concern that the current pictorial warnings will not motivate them to quit (61.17% vs. 51.01%; P < 0.001). The new warnings implemented from December 1, 2011, in India are also not field-tested. Field testing and assessment of effectiveness of health warnings should be a mandatory requirement for Parties reporting on Article 11 of Framework Convention on Tobacco Control (FCTC).

Tobacco industry interference for pictorial warnings.

Aim : A study was carried out to understand the process of interference by the tobacco industry, to measure the compliance of the industry for displaying pictorial warnings on a tobacco product as per the packaging and labeling rules post 31 st May, 2009, and to understand the public opinion on the messages conveyed through such warnings. Materials and Methods : A total of 60 samples of tobacco products were purchased after 31 May, 2009, from the retail vendors of tobacco sellers across the country. Results : The government of India has from time to time, taken measures, including legislations, to control tobacco consumption. The actual implementation of these rules has been postponed repeatedly, apparently because of constant pressure exerted by the tobacco industry. The skull and bone sign hurting religious sentiments as stated by the group of ministers proved to be misleading. Later the Group of Ministers (GOM) proposed three very weak and poorly communicative pictorial health warnings to replace those recommended by the Union Health Ministry based on the inputs of the Department of Audio Visual Publicity (DAVP). The industry tried to use strategic means by displaying a dull, diluted, and watered down pictorial warning. The focus group study conducted showed that a scorpion gets associated with the product in a non-scientific manner. X-ray of the lung was hardly understood by anybody. Conclusion : Overall the tobacco industry has constantly flouted with the law right from the policy level to its implementation by displaying dull, diluted, and poorly informed pictorial warnings.

Neurociências, artes gráficas e saúde pública: as novas advertências sanitárias para maços de cigarros / Neurosciences, graphic arts, and public health: new health warnings on cigarette packaging

A exposição a produtos derivados do tabaco é considerada a mais importante causa de morte evitável no mundo. Ações de controle do tabagismo envolvem uma gama de intervenções para ajudar pessoas a parar de fumar e prevenir que jovens não se tornem dependentes. Advertências sanitárias com imagens mostradas em embalagens de cigarro são uma das formas mais efetivas de informar acerca das consequências do tabagismo. Pesquisas em neurobiologia da emoção demonstram que estímulos visuais afetam atitudes e comportamentos; estímulos agradáveis promovem predisposições para aproximação e os aversivos, afastamento. Os apelos positivos que o marketing da indústria tabagista induz em suas embalagens devem ser neutralizados por advertências que mostrem os riscos de fumar, desconstruindo o apelo prazeroso e induzindo predisposições de afastamento em relação ao produto.

Exposure to tobacco products is considered the leading cause of avoidable death in the world. Tobacco control initiatives encompass a gamut of ways of helping people to quit smoking and keeping young people from ever becoming addicted. Pictorial health warnings on cigarette packaging constitute one of the most effective means of conveying information about the consequences of smoking. Research on the neurobiology of emotions shows that visual stimuli affect attitudes and behavior: pleasant stimuli prompt a tendency to approach while unpleasant stimuli prompt a tendency to avoid. The positive appeals placed on packaging by the tobacco industry's marketing departments should be neutralized by warnings that indicate the risks of smoking, thereby deconstructing any pleasurable appeal and prompting a tendency to avoid the product.