Transitando hacia el ejercicio de autonomía y liderazgo:… «para el posicionamiento hay que luchar¼ / Moving towards the practice of autonomy and leadership:… «Positioning requires striving¼ / Transitar para o exercício de autonomia e liderança:… «Para o posicionamento, tem que lutar¼

Resumen Introducción: En Chile, las enfermeras/os tienen respaldo legal para gestionar el cuidado, esto facilita el desarrollo de competencias para ejercer autonomía y liderazgo. Actualmente persisten barreras para transitar hacia un reconocimiento real de la independencia profesional. Objetivo: Develar la experiencia vivida de enfermeras con cargos en niveles de jefatura respecto al propio desarrollo para lograr el liderazgo y autonomía profesional. Metodología: Estudio cualitativo, descriptivo-interpretativo, desde la trayectoria fenomenológica de Edmund Husserl. Muestreo selectivo de caso homogéneo de tres enfermeras que desempeñaban rol de jefatura en instituciones de salud, región Valparaíso, Chile. Participación consentida. Entrevista no estructurada. Análisis del discurso utilizando el modelo de liderazgo integral de Ken Wilber. Resultados: Categorías: Conciencia del líder «ser inquieta...intelectualmente¼. Construyendo competencias «el liderazgo se aprende¼. Transitando hacia el ejercicio de la autonomía y el liderazgo, "para el posicionamiento hay que luchar". El peso de las estructuras organizacionales «tu rol es parte de un hospital¼. Interpretación: El ejercicio del liderazgo y la autonomía se fundamenta en competencias actitudinales por sobre las cognitivas y técnicas. Existe mayor apoyo y reconocimiento a nivel institucional, que al interior del equipo de salud. Persisten limitaciones para lograr máxima expresión del liderazgo y autonomía, por persistencia de modelos institucionales hegemónicos, centrados en decisiones médicas y desconocimiento del rol integrado. Conclusión: El líder se mueve en un escenario dual, entre un menor reconocimiento del equipo y un creciente empoderamiento del rol autónomo y visibilidad a nivel directivo institucional.

Abstract Introduction: In Chile, nurses have legal support to manage care, a situation which facilitates the development of competencies to perform with autonomy and leadership; however, barriers still persist while moving towards a real acknowledgement of professional independency. Objective: To unveil the lived experience of nurses in executive roles regarding their own development towards leadership and professional autonomy. Methodology: This is a descriptive and interpretative qualitative study framed by the Edmund Husserl phenomenological approach. The sample by homogeneous case included three nurses in executive roles in health institutions in Valparaiso, Chile. The participation was by consent. An unstructured interview was used. For the discourse analysis, the Ken Wilber integral leadership model was followed. Results: Categories: Leadership awareness <being inquiring… intellectually>… Building Competencies <leadership is learned>. Moving towards the practice of autonomy and leadership, "positioning requires striving". Weight of the organizational structures <your role is part of a hospital>. Interpretation: A practice of leadership and autonomy is based on attitude competencies over the cognitive and technical ones. Nevertheless, there still persist limitations to achieve a maximal expression of leadership and autonomy due to hegemonic institutional models which focus on medical decisions and neglect the integrated roles. Conclusion: The leader moves in a dual setting between a lower acknowledgement from the team, and a higher empowerment of the autonomous role and the visibility at the institutional directive level.

Resumo Introdução: No Chile, as enfermeiras/os têm apoio legal para gerenciar o cuidado, isto facilita o desenvolvimento de competências para exercer autonomia e liderança. Atualmente, persistem barreiras para transitar em direção a um reconhecimento real da independência profissional. Objetivo: Desvendar a experiência vivida de enfermeiras com cargos em níveis de chefia ao respeito do próprio desenvolvimento, para atingir a liderança e autonomia profissional. Metodologia: Estudo qualitativo, descritivo-interpretativo, desde a trajetória fenomenológica de Edmund Husserl. Amostragem seletiva de caso homogéneo de três enfermeiras que desempenhavam papel de chefia em instituições de saúde, região Valparaíso, Chile. Participação consentida. Entrevista não estruturada. Análise de discurso, utilizou-se o modelo de liderança integral de Ken Wilber. Resultados: Categorias: Consciência do líder «ser irrequieta...intelectualmente¼. Ir construindo competências «a liderança se aprende¼. Transitar em direção ao exercício da autonomia e a liderança, "para o posicionamento tem que lutar". O peso das estruturas organizacionais «seu rolo é parte de um hospital¼. Interpretação: O Exercício da liderança e a autonomia fundamenta-se em competências atitudinais, sobre as cognitivas e técnicas. Existe maior apoio e reconhecimento a nível institucional, que no interior da equipe de saúde. Persistem limitações para atingir a máxima expressão de liderança e autonomia, por persistência de modelos institucionais hegemónicos, centrados em decisões médicas e desconhecimento do rolo integrado. Conclusão: O líder movimenta-se em um cenário dual, entre um menor reconhecimento da equipe e um empoderamento crescente do rolo autónomo e visibilidade a nível diretivo institucional.

A global reference for caesarean section rates (C-Model): a multicountry cross-sectional study.

OBJECTIVE: To generate a global reference for caesarean section (CS) rates at health facilities. DESIGN: Cross-sectional study. SETTING: Health facilities from 43 countries. POPULATION/SAMPLE: Thirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10,045,875 women giving birth from 43 countries for model testing. METHODS: We hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three-step approach to generate the global benchmark of CS rates at health facilities: creation of a multi-country reference population, building mathematical models, and testing these models. MAIN OUTCOME MEASURES: Area under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate. RESULTS: According to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C-Model, with summary estimates ranging from 0.832 to 0.844. The C-Model was able to generate expected CS rates adjusted for the case-mix of the obstetric population. We have also prepared an e-calculator to facilitate use of C-Model (www.who.int/reproductivehealth/publications/maternal_perinatal_health/c-model/en/). CONCLUSIONS: This article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C-Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS. TWEETABLE ABSTRACT: The C-Model provides a customized benchmark for caesarean section rates in health facilities and systems.

PP138. Human fetal malformations associated with the use of angiotensin II receptor antagonist.

INTRODUCTION: antagonists of angiotensin II receptor (AAR) are commonly used for the treatment of chronic hypertension in the general population. Some of these pharmacological agents are losartan, candesartan, valsartan and tasosartan. Despite the good response achieved with these drugs in the control of hypertension, all medications that act directly on the renin-angiotensin system should be contraindicated during pregnancy. These drugs have been associated with fetal and neonatal injury, including hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure and death.Here we report a case of fetal malformations and death associated with the use of losartan. OBJECTIVES: describing the association of fetal malformations and the use of losartan during first and second trimester of pregnancy. METHODS: this is a case report involving a 37-year-old pregnant woman at 26 gestational weeks. This patient had history of chronic hypertension for more than five years that was being regularly treated with Losartan 50mg/day. After her first consultation losartan was promptly discontinued and substituted for methyldopa. However, scan evaluation demonstrated severe oligohydramnios associated with altered fetal biophysical profile and altered Doppler fluxometry (absent diastolic flow at umbilical arteries). Therefore, a cesarean-section was performed after corticoid administration for fetal lung maturation. At first moment some characteristic alterations as fetal limb contractures and craniofacial deformation were detected at the 1007g new-born. This baby went to death 36h after delivery due to severe lung hypoplasia. RESULTS: the autopsy examination revealed renal tubular dysgenesis associated with changes secondary to nephropathy, probably induced by drug (Fig. 1). Associated findings were underdevelopment of bones of the skull with large fontanelles, thymus atrophy and signs of perinatal hypoxia. CONCLUSION: the difficulty of attending basic health assistance was attributed to be associated with this case, as this patient did not have opportunity and sufficient information about the necessity of changing her medication during pregnancy. Apart from this situation, this case report brings good information about the association between antagonists of angiotensin II receptor and human fetal malformations.