Análisis etnográfico del intervencionismo en la atención perinatal / Ethnographic analysis of the perinatal care interventionism

Objetivo principal: analizar los factores culturales que determinan el intervencionismo de la atención perinatal en un área de salud de la Región de Murcia. Metodología: se desarrolló una investigación cualitativa con enfoque etnográfico. Se realizaron dos grupos de discusión a profesionales, dieciocho entrevistas etnográficas en profundidad a puérperas y observación participante en atención primaria y hospital de referencia del área de estudio. Resultados principales: los resultados se circunscribieron a las representaciones ideológicas del dolor en la gestante, la incertidumbre del riesgo del proceso perinatal, y el hospital como espacio de seguridad y eje del intervencionismo. Conclusión: la alta demanda de la analgesia epidural por las embarazadas y la oferta sistemática por los profesionales, la incertidumbre del riesgo durante el embarazo, la representación del hospital como espacio de seguridad y control durante el parto, y la endoculturación de la mujer en el circuito asistencial serán factores determinantes en el intervencionismo de la atención perinatal

Objective: To analyse the cultural facts that determine the perinatal interventionism in a Health Area of Murcia Region. Methods: A qualitative research with ethnographic approach was carried out in this research by using both focus group to professionals and eighteen in depth interviews to women who were in postpartum period. These methods were complemented by carrying out a participant observation in both primary health care and hospital. Results: Three central themes emerged from narratives: pregnant women's ideologic representations about pain, the uncertainty of the risk of the perinatal process, the hospital: security environment and axis of the interventionism. Conclusions: the determinant facts about the interventionism of the perinatal care are related to the high demand for epidural analgesia from pregnant women and its systematic offer provided by professionals, the uncertainty of the risk during the pregnancy, the hospital representation as a safe place during childbirth, and the pregnancy women's enculturation that takes place through circuit of care

[Informed Consent in the Humanization of the Cesarean: A Preliminary Study]. / Consentimiento Informado en la Humanización de la Cesárea: Un Estudio Preliminar.

The informed consent (IC) is a process based on dialogue between the professional and the patient in which he freely decides on possible interventions in their health. This is applicable to caesarean delivery and if it meets a number of conditions will help to improve the process of ″humanization″ of birth. The overall objective of this study is to analyze preliminarily in several hospitals in the Region of Murcia the IC in caesarean delivery. To this end, we have revised the documents of IC and we studied who, where, when and how the IC process is done. The results show that all hospitals are based on the same document, and although the documents take into account all the elements of a IC, do not indicate the date of their design or subsequent revisions. It does not contemplate the risks and complications that caesarean section can have on the newborn, mother, and mother-child relationship later. It is noted that the document of IC normally is delivers by gynecologist in the consultation, when intervention is programmed, although it are sometimes nurses, who after admission to the hospital give it to sign the patient. In urgent caesarean sections, there are some hospitals that in life-threatening situation, do not offer the document of IC to women. In others, it is offered hastily by the gynecologist or midwife. In conclusion, the IC is a process which used correctly, favors the relationship between women and health professionals in the intervention of cesarean section. Although this process and the documents of IC examined in our study, have presented many positive aspects, the humanization of caesarean could be increased improving with the preparation and updating of these documents and coordinating the various professionals.

Consentimiento informado en la humanización de la cesárea: un estudio preliminar / Informed consent in the humanization of the cesarean: a preliminary study

El consentimiento informado (CI) es un proceso basado en el diálogo entre el profesional y el paciente en el que éste decide libremente sobre las posibles intervenciones en su salud. Éste es aplicable al nacimiento por cesárea y siempre que cumpla una serie de condiciones ayudará a la mejora del proceso de 'humanización' del nacimiento. El objetivo general de este estudio es analizar de forma preliminar el CI de las cesáreas en varios hospitales de la Región de Murcia. Para ello hemos revisado los documentos de CI y hemos analizado quién, dónde, cuándo y cómo se realiza el proceso del CI. Los resultados muestran que todos los hospitales parten de un mismo documento y, aunque los documentos tienen en cuenta todos los elementos de un CI, no indican la fecha de su diseño ni las revisiones posteriores. Tampoco contemplan los riesgos y complicaciones que la cesárea puede tener en el recién nacido, la madre y la posterior relación madre-hijo. Se observa que el documento de CI normalmente lo ofrece el ginecólogo en la consulta, cuando la intervención es programada, aunque en ocasiones es el personal de enfermería quien después del ingreso en el hospital se lo da a firmar a la paciente. En cesáreas urgentes hay algunos hospitales que se acogen a la situación de riesgo vital y no ofrecen el CI a la mujer. En otros se ofrece haciéndolo el ginecólogo o la matrona de forma apresurada. En conclusión, el CI es un proceso que empleado de forma correcta favorece la relación entre la mujer y los profesionales sanitarios en la intervención de la cesárea. Aunque este proceso y los documentos utilizados en él, presentan en nuestro estudio, muchos aspectos positivos, la humanización de la cesárea podría incrementarse mejorando tanto la confección y actualización de estos documentos como coordinando a los diversos profesionales que participan en este proceso de CI

The informed consent (IC) is a process based on dialogue between the professional and the patient in which he freely decides on possible interventions in their health. This is applicable to caesarean delivery and if it meets a number of conditions will help to improve the process of 'humanization' of birth. The overall objective of this study is to analyze preliminarily in several hospitals in the Region of Murcia the IC in caesarean delivery. To this end, we have revised the documents of IC and we studied who, where, when and how the IC process is done. The results show that all hospitals are based on the same document, and although the documents take into account all the elements of a IC, do not indicate the date of their design or subsequent revisions. It does not contemplate the risks and complications that caesarean section can have on the newborn, mother, and mother-child relationship later. It is noted that the document of IC normally is delivers by gynecologist in the consultation, when intervention is programmed, although it are sometimes nurses, who after admission to the hospital give it to sign the patient. In urgent caesarean sections, there are some hospitals that in life-threatening situation, do not offer the document of IC to women. In others, it is offered hastily by the gynecologist or midwife. In conclusion, the IC is a process which used correctly, favors the relationship between women and health professionals in the intervention of cesarean section. Although this process and the documents of IC examined in our study, have presented many positive aspects, the humanization of caesarean could be increased improving with the preparation and updating of these documents and coordinating the various professionals

Influencia del género en la formación de las matronas en el siglo XX / Influence of gender on midwifery training in the Twentieth Century

Objetivo principal: analizar la influencia del género en la formación de las matronas durante el siglo XX. El punto de inflexión será el Decreto de 18 de enero de 1957. Metodología: este trabajo es un estudio cualitativo con enfoque fenomenológico. Realizamos entrevistas en profundidad a 13 matronas y el análisis de textos legislativos. Resultados principales: el Decreto de 1957 que estableció la especialización de matronas para las Ayudantes Técnicos Sanitarios femeninas supuso un cambio, ampliando las enseñanzas de estas profesionales y exigiéndoles un mayor esfuerzo en sus vidas. La capacitación percibida por las matronas no fue suficiente para que se les reconociera como profesión autónoma hasta el siglo XXI. Conclusión principal: el género será determinante en la formación de las matronas. Como mujeres inmersas en una profesión femenina se les ha exigido una serie de requisitos legislativos desiguales a otros profesionales

Objective: analyze the influence of gender in midwifery training in Twentieth Century. The turning point is the Decree of January 18, 1957. Methods: this work is a qualitative study using a phenomenological approach. Thirteen in-depth interviews were conducted to midwives and some laws were analyzed. Results: the 1957 decree that established the specialization of midwives for female Sanitary Technical Assistant will be a change, will expand the learnings of these professionals and will require more effort in their lives. Although midwives felt themselves well-trained it was not enough to be recognized as an autonomous profession until the XXI century. Conclusion: gender will be decisive in midwives training. Women immersed in a female profession have been demanded unequal legislative requirements to other professionals

La asistencia al parto: del hogar al hospital / Assistência de parto: de casa para o hospital / Assistance for childbirth: home to hospital

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Duración de la lactancia materna en el noroeste murciano / Duration of breastfeeding in the northwest of Murcia

Objetivo. Conocer la duración de la lactancia materna (LM) exclusiva en mujeres pertenecientes al área IV del Servicio Murciano de Salud y estudiar la influencia de algunos factores sociodemográficos y obstétricos en la duración de la misma. Personas y método. La población estudiada fueron 211 mujeres que dieron a luz con parto vaginal durante los meses de mayo a noviembre de 2005 en el Hospital Comarcal del Noroeste (Región de Murcia), que iniciaron LM en paritorio de forma correcta. Se realizó un estudio descriptivo mediante encuesta telefónica, que incluía las siguientes variables: tiempo de LM exclusiva, edad, paridad, actividad laboral remunerada, nivel de estudios, asistencia a educación maternal, lactancia previa y apoyo recibido de su entorno. Resultados. La edad media de las 203 mujeres que participaron en el estudio fue de 31,06 años (DE= 5,39); un 53,6% (109) de ellas tenían entre 30 y 40 años. Eran multíparas un 56,1% (114) y tenían actividad laboral un 39,4% (80). La media del tiempo de duración de la LM exclusiva fue de 4,3 meses (DE= 1,83). Un 66,55% (135) de las mujeres lactaron a sus bebés hasta los 3 meses y la mitad (103) lo hicieron hasta los 5 meses. No se han encontrado diferencias en el tiempo de lactancia entre las mujeres primíparas y multíparas, ni tampoco en relación con si realizan actividad laboral. El grupo de mujeres de entre 30 y 40 años es el que más prolonga la LM hasta los 12 meses (10,09%), así como el de las que tienen estudios universitarios (11%). El 62,5% (127) manifiesta haber recibido un apoyo aceptable o mucha ayuda de su entorno. Conclusiones. La mitad de las mujeres lactaron a sus hijos hasta los 5 meses, y esto no está relacionado ni con la paridad ni con la actividad laboral (AU)

Objective. To know the duration of exclusive breastfeeding (BF) of women from area IV of the Health Care Service of Murcia and to study the influence of certain socio-demographic and obstetric factors on the duration of the said breastfeeding. Subjects and method. The population studied consisted of 211 women who gave birth through a vaginal delivery between the months of May and November 2005 in Hospital Comarcal del Noroeste (Region of Murcia), who started BF in the delivery room in a correct manner. A descriptive study was conducted by means of a telephone survey that included the following variables: duration of exclusive BF, age, parity, paid work activity, level of studies, attendance of Prenatal education, previous breastfeeding, support received from their surroundings. Results. The average age of the 203 women who participated was 31.06 years; SD= 5.39, and 53.6% (109) of the women were between the ages of 30 and 40. Of the total, 56.1% (114) were multiparas and 39.4% (80) had a work activity. The time average of the duration of exclusive BF was 4.3 months; SD= 1.83. Of the total, 66.55% (135) women breastfed their babies until they were 3 months old and half of the women (103) until they were 5 months old. No differences were found in the duration of breastfeeding between primipara and multipara women; nor in relation to whether or not they had a work activity. The group of women between the ages of 30- 40 was the group that most prolonged the BF until 12 months (10.09%) and with university studies (11%). Of the total 62.5% (127) of the women said they had received a reasonable or great amount of support from their surroundings. Conclusions. Half of the women breastfed their babies until they were five months old and the duration is neither related to parity nor to the work activity (AU)

Multiple bone lesions resembling a metastatic origin. An unexpected diagnosis.

Lytic and blastic lesions have been associated to malignant tumours, such as solid cancer (breast cancer, renal cancer, prostate cancer, malignant melanoma or thyroid tumours). Although a mixed pattern with lytic and blastic lesions is due to metastatic tumour, this is not the only possible origin. The following case shows a systematic. This case report shows the number of tests that were made in order to discover the origin of osteolytic and osteoblastic lesions and it is notable that there is not an occult neoplasia on every occasion.