La atención al parto en diferentes países de la Organización para la Cooperación y el Desarrollo Económico (OCDE) / Childbirth care in different countries of the Organization for Economic Co-operation and Development (OECD)

El desarrollo científico-tecnológico ha comportado una progresiva medicalización del proceso de embarazo, parto y puerperio y la institucionalización de la atención al parto en los hospitales en la mayoría de países industrializados. Existen diferentes modelos organizativos y de atención al parto y se pueden encontrar diferencias en cuanto a los resultados de esta atención. OBJETIVO: Describir diferentes modelos organizativos y de atención al parto en países seleccionados de la Organización para la Cooperación y el Desarrollo Económico (OCDE) e identificar variaciones en la estructura organizativa de los modelos observados. METODOLOGÍA: Búsqueda bibliográfica y cuestionario a informantes clave de diferentes países para identificar los aspectos relevantes sobre financiación de los servicios, lugar en que se presta la atención y distribución de competencias. RESULTADOS: Se describe la organización y el modelo de atención al parto, en el contexto de los sistemas de salud de cada país. Países incluidos: Reino Unido, Australia, Holanda, Irlanda, Francia, España y Canadá. Se presentan indicadores de la OCDE sobre la actividad sanitaria, el comportamiento del sistema de salud y el estado de salud de la población. CONCLUSIONES: Se observan diferentes formas de organizar la atención a la maternidad entre los países seleccionados y se evidencian diferencias en los resultados de la atención. Existen varios tipos de localización para la atención a las mujeres con bajo riesgo obstétrico durante el proceso de maternidad. En los sistemas de salud observados, la atención a las muje-res durante el embarazo se suele realizar en un entorno no hospitalario, mientras que para la atención al parto existen diferentes opciones sobre los tipos de localización y de atención que, en algunos casos, pueden ser elegidos por las mujeres. Los indicadores seleccionados muestran un am-plio rango de resultados entre los países elegidos, y parece conveniente investigar la posible relación de esta variabilidad con el tipo de organiza-ción y de atención durante el proceso de maternidad, así como identificar criterios comunes sobre los aspectos específicos para la atención a las mujeres que no presentan riesgos obstétricos

Scientific and technological advances have entailed an increased influence of medicine in the process of pregnancy, childbirth and post-partum with the institutionalisation this entails for childbirth care in the hospitals of most industrialised countries. Several organisational and childbirth care models are in place and differences can be observed between them with regard to the outcomes of such care. AIM: To describe differing organisational and childbirth care models in the chosen countries of the Organization for Economic Co-operation and Development (OECD) and identify variations in the organisational structure of the models observed. METHODOLOGY: To conduct a bibliographical search and questionnaire on key informers from various countries to identify relevant aspects concerning service funding, care settings and distribution of authority in this sphere. RESULTS: A description is given of the organisation and childbirth care model on the context of the health systems of each country. The countries studed are: Australia, Canada, France, Ireland, the Netherlands, Spain and the United Kingdom. OECD indicators are presented on healthcare activity, the operation of the health system and the state of health of thepopulation. CONCLUSIONS: Several forms of organising maternity care have been observed from the countries chosen and differences have been identified in the outcomes of care. There are numerous kinds of settings for providing care to women with a low obstetric risk during the maternity process. In the healthcare systems analysed, care for women during pregnancy is often provided in a non-hospital setting; however, when it comes to childbirth care, several options are available in terms of the setting and care which can even be chosen by women themselves in certain cases. The indicators selected point to a broad range of results among the chosen countries and it would be appropriate to research the possible link between this variation in terms of the kind of organisation and care provided during maternity and, accordingly, to identify common criteria relating to specific aspects in care for women with low obstetric risks

Fatigue in knee and hip osteoarthritis: the role of pain and physical function.

OBJECTIVES: It is suggested that serious levels of fatigue are present in nearly half of patients with OA. However, it is unclear which dimensions of fatigue are involved, if fatigue is related to pain and physical function, and if fatigue is influenced by therapy. The aims of this study were to measure levels of different dimensions of fatigue before and after evidenced-based conservative treatment and to investigate the association between fatigue and pain and physical function in patients with knee or hip OA. METHODS: In this observational cohort study, levels of different dimensions of fatigue were measured in knee and/or hip OA patients before and after 12 weeks of conservative treatment. Cross-sectional and longitudinal relations between (change in) fatigue dimensions and (change in) pain or physical function were studied using association models, controlling for predefined possible confounders. RESULTS: A total of 231 patients was included, with 47% experiencing severe fatigue. A small decrease in levels of fatigue was seen after standardized treatment. The level of fatigue severity was cross-sectionally and longitudinally associated with physical function, whereas the level of physical fatigue was cross-sectionally and longitudinally associated with pain and physical function. No confounders were identified. CONCLUSIONS: Important levels of fatigue are common in knee and hip OA patients. After evidence-based tailored conservative treatment targeted to improve pain and physical function, a small decrease in fatigue levels was found. Reduction in levels of different fatigue dimensions were related to the change in physical function and pain.