ABSTRACT
Resumen: Objetivo: Evaluar la cobertura de atención del parto eutócico en Unidad Centinela (UC), de primer nivel de atención. Verificar el cumplimento de lo establecido en el modelo e identificar los factores que impiden o favorecen su uso, desde la perspectiva de los prestadores de salud y de las usuarias. Materiales y métodos: Estudio con un componente cuantitativo y uno cualitativo, retrospectivo, con información de bases primarias y secundarias. Variable principal: Atención del parto eutócico, Análisis: Descriptivo, porcentajes para variables categóricas y promedios δ para variables continuas, diferencias estadísticas entre dos variables categóricas, Chi2 de Pearson. Multivariado: Regresión logística de factores asociados a la atención del parto. Se realizaron 12 entrevistas semiestructuradas a usuarias y 8 prestadores de servicios, el análisis se realizó con base en la Teoría Fundamentada a través de Ethnograph v.5. Resultados: Muestra: 218 usuarias, edad promedio fue 24.7 años. La UC proporcionó control prenatal, el 61% más de 5 consultas; sin embargo, la atención de partos eutócicos solamente fue de 17 partos (33.4%). Las barreras más importantes referidas por las usuarias y prestadores de salud fueron: falta de personal, capacitación, insumos, apoyo insuficiente y protección legal institucional en caso de complicaciones. Conclusiones: La UC es una estrategia para regresar la atención de partos al primer nivel de atención, pero es necesario implementar un plan de mejora y fortalecimiento de los proveedores.
Abstract: Objective: Evaluate the coverage of eutocic delivery care in the Sentinel Unit (UC), of the first level of care, verify compliance with what is established in the model and identify the factors that prevent or favor its use, from the perspective of the providers of health and users. Materials and methods: Qualitative and quantitative study, retrospective with information on the primary and secondary bases. Main variable: care of eutocic delivery. Analysis: Descriptive, percentages for categorical variables and δ means for continuous variables, statistical differences between two categorical variables, Pearson Chi2. Multivariate: logistic regression of factors associated with delivery care. Twelve semi-structured interviews were conducted with users and 8 service providers, the analysis was carried out based on Grounded Theory through Ethnograph v.5. Results: Sample: 218 users, average age was 24.7 years. The UC provided prenatal control, 61% more than 5 consultations; however, the care of eutocic deliveries was only 17 deliveries (33.4%). The most important barriers referred to by the users and health providers were: lack of personnel, training, supplies and insufficient support and institutional legal protection in case of complications. Conclusions: UC is a strategy to return delivery care to the first level of care, but it is necessary to implement a plan to improve and strengthen providers.
ABSTRACT
OBJECTIVE: To explore the use of birth care in a Sentinel Unit. MATERIALS AND METHODS: We interviewed eight health providers and 12 female users of health services to explore the main reasons to use birth care in a Sentinel Unit. RESULTS: Findings indicate that the reasons for which health providers do not attend births were fear of legal claims by users, lack of institutional support if complications arise, lack of training, not feeling confident in obstetric care, and the lack of necessary supplies. Female users mentioned the perception of a lack of trained physicians and a lack of necessary materials and medicines. CONCLUSIONS: Despite the strengthening of the infrastructure and human resources, as well as a 24/365 model attention and the increase of health personnel in the sentinel units, there are still significant barriers in certain units to achieve compliance with coverage of quality obstetric care focused on the needs of women.
Subject(s)
Maternal Health Services , Physicians , Pregnancy , Female , Humans , Mexico , Quality of Health Care , Health Facilities , Health Personnel , Qualitative ResearchABSTRACT
BACKGROUND: Information about the clinical and epidemiological characteristics of atopic dermatitis (AD) is essential to generate knowledge of the disease and its socioeconomic impact. OBJECTIVE: To describe the clinical characteristics of the patients of an atopic dermatitis clinic. METHODS: An observational, retrospective, and cross-sectional study. Demographic data, severity of the AD (according to the Eczema Area Severity Index), clinical phenotype, total serum IgE, the presence of allergic and non-allergic comorbidities, as well as of anxiety and depression, were recorded by means of targeted questionnaire and Hamilton Scale. Descriptive and inferential statistics were obtained, considering a statistical significance associated with a value of p <0.05. RESULTS: 187 patients were included; the median age was 12 years with a range of 1-87 years. Differences were found regarding sex and severity (p < 0.05). Mild forms of AD were presented in 57.8% of the patients, moderate forms in 20.9%, and severe forms in 21.4%. The severity was associated with allergic comorbidities such as asthma (p = 0.001) and allergic conjunctivitis (p <0.001). Severe AD was associated with a state of anxiety and depression (p <0.05), as well as with ocular affectation (p<0.001). CONCLUSION: The pediatric population is the most affected by AD; however, in the adult population, the severe form associated with allergic comorbidities is observed.
Antecedentes: Los datos sobre características clínicas y epidemiológicas de la dermatitis atópica son fundamentales para generar conocimiento sobre la enfermedad y su impacto socioeconómico. Objetivo: Describir las características clínicas de los pacientes de una clínica de dermatitis atópica. Métodos: Estudio observacional, retrospectivo y transversal. Se registraron datos demográficos, gravedad de la dermatitis atópica (según el Eczema Area Severity Index), fenotipo clínico, IgE sérica total, presencia de comorbilidades alérgicas y no alérgicas, así como de ansiedad y depresión mediante interrogatorio dirigido y escala de Hamilton. Se realizó estadística descriptiva e inferencial, considerando una significación estadística con p < 0.05. Resultados: Se incluyeron 187 pacientes, la edad tuvo una mediana de 12 años, con un rango de uno a 87 años. Se encontraron diferencias respecto al sexo y gravedad (p < 0.05). La dermatitis atópica leve se presentó en 57.8 %, la moderada en 20.9 % y la grave en 21.4 %. La gravedad estuvo asociada a comorbilidades alérgicas como asma (p = 0.001) y conjuntivitis alérgica (p < 0.001). La dermatitis atópica grave se asoció a ansiedad y depresión (p < 0.05), así como afectación ocular (p < 0.001). Conclusión: Lo población pediátrica es la más afectada por dermatitis atópica, pero en los adultos se observa la forma grave asociada a comorbilidades alérgicas.
