Subject(s)
Humans , Outcome and Process Assessment, Health Care , Patients , Health Personnel , Telemedicine , COVID-19 , Uruguay , Qualitative ResearchABSTRACT
INTRODUCTION: A collaborative (midwife-obstetrician) model of intrapartum care (CMIC) is associated with lower caesarean section (CS) rates than physician-led models. In 2019, the largest private maternity hospital in Latin America (14.000 deliveries/year, 89% CS) created a quality improvement initiative to optimise intrapartum care and safely reduce CS in low-risk women managed by its internal team of healthcare providers (HCP). We conducted formative research to identify potential barriers and facilitators to the implementation of a CMIC. METHODS: Three groups of stakeholders participated in focus groups and interviews: hospital managers and clinical coordinators, HCP working in labour/delivery wards and pregnant women intending to give birth in the hospital. We explored participants' views about the acceptability of implementing a CMIC where a nurse-midwife (NM) on shift would be the main intrapartum HCP, with continuous support/supervision of a dedicated, in-house, obstetrician-gynaecologist (OB-GYN). A thematic analysis approach was used. RESULTS: 12 HCPs, 5 clinical coordinators, 2 hospital managers and 7 women participated. OB-GYNs, coordinators and managers highlighted health system, organisational and structural factors (NMs' limited experience/skills, professional roles, financial reimbursement) as potential barriers. NMs identified logistical and human resources as additional barriers. Women viewed the CMIC with perplexity and insecurity because of cultural beliefs about the dominant role of OB-GYNs, and limited information about NM's capabilities. All professionals agreed that women's acceptance of a CMIC will require educational interventions and communication strategies to inform potential users about the advantages and safety of this model. CONCLUSION: There are important barriers and facilitators to implement a CMIC in a private Brazilian maternity hospital. Factors related to health system structure and organisation may have the greatest impact. A CMIC is more likely to succeed if stakeholders' concerns about responsibilities, power and financial revenues are addressed, and educational interventions targeted at users are deployed prior to its implementation.
Subject(s)
Cesarean Section , Midwifery , Female , Hospitals, Private , Humans , Parturition , Pregnancy , Qualitative ResearchABSTRACT
Este artículo es un análisis de la composición por grado y sexo del plantel docente de la Facultad de Medicina. Se espera contribuir a la discusión sobre los factores estructurales que determinan y condicionan las trayectorias docentes en la facultad. Estos factores generan y reproducen desigualdades de género, que podrían ser anuladas modificando los esquemas explícitos e implícitos que habilitan su existencia. Se relevó y procesó información (de grado y sexo) proveniente de las páginas web actualizadas de 36 servicios de la Facultad que incluyó a 887 docentes. Luego del análisis de los datos analizados en el artículo, enfatizamos que es necesario romper con los esquemas que producen y reproducen los modelos hegemónicos, dando lugar a nuevas formas de relacionamiento entre los géneros, a deconstruir el formato tradicional de la carrera docente. Es una discusión que debería involucrar a todos los órdenes universitarios y a todos los individuos que los componen, independientemente del género.
This article is an analysis of the composition by grade and sex of the teaching staff of the Faculty of Medicine. It is expected to contribute to the discussion on the structural factors that determine and condition the teaching paths in the faculty. These factors generate and reproduce gender inequalities, which could be annulled by modifying the explicit and implicit schemes that enable their existence. Information (of grade and gender) was collected and processed from the updated web pages of 36 services of the Faculty, which included 887 teachers. After analyzing the data analyzed in the article, we emphasize that it is necessary to break with the schemes that produce and reproduce the hegemonic models, giving rise to new forms of relationship between genders, to deconstruct the traditional format of the teaching career. It is a discussion that should involve all university orders and all the individuals that compose them, regardless of gender.
Este artigo é uma análise da composição por série e sexo do corpo docente da Faculdade de Medicina. Espera-se contribuir para a discussão sobre os fatores estruturais que determinam e condicionam os percursos pedagógicos na faculdade. Esses fatores geram e reproduzem as desigualdades de gênero, que poderiam ser anuladas modificando os esquemas explícitos e implícitos que possibilitam sua existência. As informações (de série e gênero) foram coletadas e processadas nas páginas atualizadas da web de 36 serviços da Faculdade, que incluíram 887 professores. Após a análise dos dados analisados no artigo, destacamos que é necessário romper com os esquemas que produzem e reproduzem os modelos hegemônicos, dando origem a novas formas de relação entre os gêneros, para desconstruir o formato tradicional da carreira docente. É uma discussão que deve envolver todas as ordens universitárias e todos os indivíduos que as compõem, independentemente do gênero.
Subject(s)
Humans , Male , Female , Faculty, Medical/statistics & numerical data , Students, Medical/statistics & numerical data , Uruguay , Sex DistributionABSTRACT
El consentimiento informado como deber del médico y derecho de los pacientes está expresamente reconocido en la legislación nacional con especial énfasis a partir de la aprobación de la Ley N° 18.335 en el año 2008. Sin embargo, se han evidenciado dificultades en el proceso de información y obtención del consentimiento. Mediante un cuestionario cerrado, anónimo y autoadministrado se consultó a pacientes operados sobre qué aspectos de la información consideraban relevantes conocer y qué conocimiento tenían sobre el derecho a ser informados. Más del 80% de los entrevistados manifestó el interés en contar con información sobre alternativas terapéuticas y sobre las complicaciones más frecuentes de la intervención. Asimismo, creyeron pertinente contar con la descripción del procedimiento al que serán sometidos y las opciones de modificar el tipo de cirugía durante la operación. Menos del 10% explicitó el interés en ser informado sobre el riesgo de muerte, la posibilidad de reintervenciones y en recibir información mediante figuras e imágenes ilustrativas del procedimiento. Se destaca que nueve de cada diez entrevistados admitieron conocer su derecho a ser informados sobre diferentes aspectos del acto quirúrgico y que casi la mitad (48%) consideró que debe confiar en las decisiones del médico sin importar la cantidad de información recibida.
Informed consent as the physician´s obligation and the patient's right is expressly recognized by the national law, mainly as from 2008, when Act Number 18335 was passed. However, certain difficulties have been seen in the information process and in connection with obtaining consent. Patients who underwent surgery were consulted by means of a closed, anonymous and self-administered survey as to the specific aspects they considered relevant to know and how familiar they were with their right to be informed. Over 80% of the patients in the survey stated they were interested in learning about treatment alternatives and the most frequent complications arising from treatment. Likewise, they thought it would be appropriate to know about the procedure they would undergo and the options available to modify the kind of surgery once it had started. Under 105 of patients stated they were interested in learning about life-threatening risks, the chance of a needing to operate again and receiving information through pictures and illustrations showing the procedure. The study points out 9 out of ten patients admitted they knew about their right to be informed about different aspect of the surgery and that almost half of them (48%) stated they needed to trust the decisions made by physicians, regardless of the quality of the information received.
Ele informou o dever do médico e paciente lei consentimento é expressamente reconhecido pela legislação nacional, com ênfase especial a partir da adoção da Lei nº 18.335, em 2008. No entanto, eles têm demonstrado dificuldades no processo de informação e obter consentimento. Através de um questionário fechado, anônimo e autoadministrado, os pacientes operavam quais aspectos da informação que consideravam relevantes para conhecer e quais os conhecimentos que tinham sobre o direito de serem informados. Mais de 80% dos entrevistados manifestaram interesse em ter informações sobre alternativas terapêuticas e sobre as complicações mais frequentes da intervenção. Da mesma forma, consideraram pertinente a descrição do procedimento a que serão submetidas e as opções para modificar o tipo de cirurgia durante a operação. Menos de 10% manifestaram interesse em ser informado sobre o risco de morte, possibilidade de reintervenções e recebimento de informações através de figuras e imagens que ilustram o procedimento. Ele destaca que nove em cada dez inquiridos admitiram a conhecer o seu direito de ser informado sobre os diferentes aspectos da cirurgia e quase metade (48%) considerou deve confiar nas decisões do médico, independentemente da quantidade de informações recebidas.
Subject(s)
Access to Information , General Surgery/standards , Informed Consent , Patient RightsABSTRACT
Cuarenta años después de Alma Ata, el mundo está reforzando la consciencia sobre la importancia de los atributos y funciones del primer nivel de atención, pero aún queda mucho por hacer para implementarlos, medirlos y aprender de las experiencias exitosas de algunos países. El conjunto de instrumentos Primary Care Assessment Tools (PCAT), desarrollados en los años 90 en Estados Unidos de América por Starfield y Shi (1), se ha mostrado como la herramienta más completa para el análisis de la atención primaria de la salud (APS) y su utilidad fue reconocida en numerosos países y regiones del mundo. El objetivo de esta carta es comunicar preliminarmente el proceso de armonización de las versiones PCAT ya adaptadas en diversos países de Iberoamérica y subrayar la importancia de estas herramientas para evaluar y comparar el primer nivel de atención, particularmente en sistemas de salud fundados en la estrategia de APS.
Subject(s)
Primary Health Care , Health Systems , Latin America , Spain , EpidemiologyABSTRACT
BACKGROUND: In 2005, Uruguay initiated a series of comprehensive anti-smoking measures. We aimed to assess the effect of Uruguay's anti-tobacco campaign. METHODS: We did a population-based trend analysis, using neighbouring Argentina, which has not instituted such extensive anti-tobacco measures, as a control. We assessed three key endpoints in both countries: per-person consumption of cigarettes, as measured by tax records; the prevalence of tobacco use in adolescents, as measured by school-based surveys; and the prevalence of tobacco use in adults, as measured by nationwide household-based surveys. FINDINGS: During 2005-11, per-person consumption of cigarettes in Uruguay decreased by 4·3% per year (95% CI 2·4 to 6·2), whereas per-person consumption in Argentina increased by 0·6% per year (-1·2 to 2·5; p=0·002 for difference in trends). During 2003-09, the 30-day prevalence of tobacco use in Uruguayan students aged 13 years, 15 years, and 17 years decreased by an estimated 8·0% per year (4·5 to 11·6), compared with a decrease of 2·5% annually (0·5 to 4·5) in Argentinian students during 2001-09 (p=0·02 for difference in trends). From 2005 to 2011, the prevalence of current tobacco use in Uruguay decreased annually by an estimated 3·3% (2·4 to 4·1), compared with an annual decrease in Argentina of 1·7% (0·8 to 2·6; p=0·02 for difference in trends). INTERPRETATION: Uruguay's comprehensive tobacco-control campaign has been associated with a substantial, unprecedented decrease in tobacco use. Decreases in tobacco use in other low-income and middle-income countries of the magnitude seen in Uruguay would have a substantial effect on the future global burden of tobacco-related diseases. FUNDING: J William Fulbright Foreign Scholarship Board and the US Department of State.
