Entorno de mujeres embarazadas mexicanas y sus conocimientos y actitudes sobre la atención prenatal / Mexican pregnant women's environment, knowledge and attitudes on prenatal care / Ambiente de gestantes mexicanas e seus conhecimentos e atitudes sobre o pré-natal

RESUMEN Objetivos Explorar barreras y facilitadores para contar con atención prenatal, conocimientos sobre embarazo saludable y; actitudes frente al embarazo. Métodos Estudio cuali-cuantitativo, en embarazadas con vulnerabilidad socio-económica. Se examinaron barreras y facilitadores para recibir atención prenatal y entrevistas estructuradas y semi-estructuradas para evaluar conocimientos y actitudes frente al embarazo. En el análisis cualitativo se categorizaron datos y en el cuantitativo, se estimaron frecuencias y proporciones y promedio y D.E. Resultados Se entrevistaron 10 mujeres entre 18 y 33 años de edad, 50% acudieron al cuidado prenatal durante el primer trimestre. Los facilitadores para atención prenatal: roles en la pareja y apoyo familiar. Las barreras: entorno inseguro, al interior y el exterior del hogar y falta de recursos para transportarse. La mayoría no recibió información para aumentar de peso durante el embarazo. Casi ninguna conocía sobre depresión ni maltrato. La mitad desconocía riesgos del tabaco, alcohol y otras sustancias adictivas, así como de prevención de enfermedades infecto-contagiosas. Las actitudes en torno al embarazo: con estresores de su entorno; viven en ambientes caóticos; con miedos por el embarazo; e interés por adquirir conocimientos sobre su embarazo. Conclusión Las mujeres tienen disposición para adquirir conocimientos sobre el embarazo y cuentan con apoyo familiar y de pareja. Su atención debe fortalecer temas de salud mental, violencia familiar, ganancia saludable de peso, riesgos de sustancias adictivas y prevención de enfermedades infecto-contagiosas; contemplando afronta-miento de entornos inseguros, manejo del tiempo y de la economía familiar.(AU)

ABSTRACT Objectives To explore the barriers and facilitators to prenatal care, as well as the knowledge about healthy pregnancy and the attitude towards pregnancy. Materials and Methods Mixed-methods study in pregnant women with social and economic vulnerability. Barriers and facilitators for prenatal care were examined using ethnographic methods, while structured and semi-structured interviews were used to assess knowledge and attitudes. Data were categorized during the qualitative analysis, and frequencies, ratios, average and standard deviation were calculated in the quantitative analysis. Results Ten women aged between 18 and 33 years were interviewed; 50% sought prenatal care during their first trimester. Facilitators included partner role and family support, and barriers were unsafe neighborhood and home, and lack of funds to cover transportation to the clinic. Most women did not receive information related to weight gain. Almost none knew about depression or abuse. Half of them did not know about risks of addictive substances, nor did they know about prevention of infectious diseases. Finally, attitudes towards pregnancy were: environmental stressors; chaotic homes; fears about pregnancy; and interest in knowing more about pregnancy. Conclusion The interviewed women were open to learn about their pregnancy and they have family and spouse support. Prenatal care should be strengthened with topics related to mental health, domestic abuse, healthy weight gain, risk of addictive substances, and prevention of infectious diseases. They can be enhanced by including safety in unsafe areas, as well as techniques for better time and family economy management.(AU)

RESUMO: Objetivos Explorar barreiras e facilitadores para ter atendimento pré-natal, conhecimento sobre gravidez saudável e; atitudes em relação à gravidez. Métodos Estudo qualitativo-quantitativo em gestantes com vulnerabilidade socioeconômica. Barreiras e facilitadores para o atendimento pré-natal e entrevistas estruturadas e semiestruturadas foram examinadas para avaliar conhecimentos e atitudes em relação à gravidez. Na análise qualitativa, os dados foram categorizados e, na quantitativa, foram estimadas frequências e proporções e média e DP. Resultados Foram entrevistadas 10 mulheres entre 18 e 33 anos de idade, 50% realizaram pré-natal durante o primeiro trimestre. Facilitadores do pré-natal: papéis no casal e apoio familiar. Barreiras: ambiente inseguro, dentro e fora de casa e falta de recursos para o transporte. A maioria não recebeu informações para ganhar peso durante a gravidez. Quase ninguém sabia sobre depressão ou abuso. Metade desconhecia os riscos do tabaco, álcool e outras substâncias viciantes, bem como a prevenção de doenças infecciosas e contagiosas. Atitudes em torno da gravidez: com estressores em seu ambiente; eles vivem em ambientes caóticos; com medos de gravidez; e interesse em aprender sobre sua gravidez. Conclusão As mulheres estão dispostas a adquirir conhecimento sobre a gravidez e ter apoio da família e do parceiro. Sua atenção deve fortalecer questões de saúde mental, violência familiar, ganho de peso saudável, riscos de substâncias viciantes e prevenção de doenças infecto-contagiosas; contemplando lidar com ambientes inseguros, gerenciamento de tempo e finanças familiares.(AU)

[Mexican pregnant women's environment, knowledge and attitudes on prenatal care]. / Entorno de mujeres embarazadas mexicanas y sus conocimientos y actitudes sobre la atención prenatal.

OBJECTIVES: To explore the barriers and facilitators to prenatal care, as well as the knowledge about healthy pregnancy and the attitude towards pregnancy. MATERIALS AND METHODS: Mixed-methods study in pregnant women with social and economic vulnerability. Barriers and facilitators for prenatal care were examined using ethnographic methods, while structured and semi-structured interviews were used to assess knowledge and attitudes. Data were categorized during the qualitative analysis, and frequencies, ratios, average and standard deviation were calculated in the quantitative analysis. RESULTS: Ten women aged between 18 and 33 years were interviewed; 50% sought prenatal care during their first trimester. Facilitators included partner role and family support, and barriers were unsafe neighborhood and home, and lack of funds to cover transportation to the clinic. Most women did not receive information related to weight gain. Almost none knew about depression or abuse. Half of them did not know about risks of addictive substances, nor did they know about prevention of infectious diseases. Finally, attitudes towards pregnancy were: environmental stressors; chaotic homes; fears about pregnancy; and interest in knowing more about pregnancy. CONCLUSION: The interviewed women were open to learn about their pregnancy and they have family and spouse support. Prenatal care should be strengthened with topics related to mental health, domestic abuse, healthy weight gain, risk of addictive substances, and prevention of infectious diseases. They can be enhanced by including safety in unsafe areas, as well as techniques for better time and family economy management.

OBJETIVOS: Explorar barreras y facilitadores para contar con atención prenatal, conocimientos sobre embarazo saludable y; actitudes frente al embarazo. MÉTODOS: Estudio cuali-cuantitativo, en embarazadas con vulnerabilidad socio-económica. Se examinaron barreras y facilitadores para recibir atención prenatal y entrevistas estructuradas y semi-estructuradas para evaluar conocimientos y actitudes frente al embarazo. En el análisis cualitativo se categorizaron datos y en el cuantitativo, se estimaron frecuencias y proporciones y promedio y D.E. RESULTADOS: Se entrevistaron 10 mujeres entre 18 y 33 años de edad, 50% acudieron al cuidado prenatal durante el primer trimestre. Los facilitadores para atención prenatal: roles en la pareja y apoyo familiar. Las barreras: entorno inseguro, al interior y el exterior del hogar y falta de recursos para transportarse. La mayoría no recibió información para aumentar de peso durante el embarazo. Casi ninguna conocía sobre depresión ni maltrato. La mitad desconocía riesgos del tabaco, alcohol y otras sustancias adictivas, así como de prevención de enfermedades infecto-contagiosas. Las actitudes en torno al embarazo: con estresores de su entorno; viven en ambientes caóticos; con miedos por el embarazo; e interés por adquirir conocimientos sobre su embarazo. CONCLUSIÓN: Las mujeres tienen disposición para adquirir conocimientos sobre el embarazo y cuentan con apoyo familiar y de pareja. Su atención debe fortalecer temas de salud mental, violencia familiar, ganancia saludable de peso, riesgos de sustancias adictivas y prevención de enfermedades infecto-contagiosas; contemplando afronta-miento de entornos inseguros, manejo del tiempo y de la economía familiar.

Attrition of advanced trauma life support (ATLS) skills among ATLS instructors and providers in Mexico.

BACKGROUND: Mexico has had the Advanced Trauma Life Support (ATLS) program since 1986. We assessed the attrition of ATLS skills among ATLS providers and instructors in this country. STUDY DESIGN: Three groups (S, 16 students [new medical graduates enrolled for an ATLS course]; P, 33 providers; and I, 26 instructors [who had completed courses previously]) were evaluated. Group S read the manual before pretesting. Groups P and I were subdivided based on the length of time since the course had been completed: P1, less than 2 years (n = 22); P2, more than 2 years (n = 11); I1, less than 2 years (n = 16); and I2, more than 2 years (n = 10). Multiple-choice and psychomotor testing using ATLS scoring criteria were used. Affect was assessed post-ATLS for motivational factors, interactivity, and attitude toward trauma care. RESULTS: Multiple-choice test scores (means +/- SD) out of a maximum of 40 were as follows: S, 24.3 +/- 2.6; P1, 24.0 +/- 5.7; P2, 21.3 +/- 8.0; I1, 23.2 +/- 8.2; and I2, 24.0 +/- 7.2. Group S all passed the post-ATLS multiple-choice test (with correct answer percentages of 60.3% +/- 6.6% pre-ATLS versus 88.8% +/- 5.6% post-ATLS). An ATLS passing score of 80% correct answers was achieved in 2 of 33 for group P and 8 of 26 for group I (p < 0.05), with no statistically significant differences between groups P1 and P2 or between groups I1 and I2. For the psychomotor skills testing component, 5 of 16 in the S group passed, 15 of 22 in P1 passed, 9 of 11 in P2 passed, 14 of 16 in I1 passed, and 6 of 10 in I2 passed. The pass rate was significantly lower in the S pre-ATLS group than in the P and I groups (p < 0.05, Fisher's exact test). More than 60% preferred interactive components and enrolled for professional improvement, and more than 90% reported improved post-ATLS attitude to trauma care. CONCLUSIONS: Reading the manual alone yields similar cognitive but inferior psychomotor performance compared with subjects who completed the course previously. The majority of previous providers and instructors did not obtain a passing score (80%) in the multiple-choice test, but all the new providers passed the post-ATLS multiple-choice test, suggesting major attrition of cognitive skills but maintenance of psychomotor skills. Instructors had superior cognitive performance versus providers with worsening performance over time, but clinical skills performance was maintained at an equally high level by all groups. A very positive attitude toward ATLS prevailed among all participants.

El programa del Comité de Trauma del Colegio Americano de Cirujanos y la atención a desastres

El Colegio Americano de Cirujanos fue fundado para mejorar el nivel de atención al paciente quirúrgico y su comité de trauma se ha dedicado a establecer las normas para el cuidado del paciente traumatizado. En el año de 1986 se estableció el comité de trauma por México, cuyo beneficio fundamental a sido el de desarrollar los programas señalados por el comité del trauma del Colegio Americano de Cirujanos. Una de las acciones fundamentales del comité ha sido patrocinar y contribuir al desarrollo continuo del curso avanzado de Apoyo Vital en Trauma (ATLS). El trauma es la principal causa de muerte en la población, ya sea por accidentes vitales, violencia humana o como víctimas de un desastre, afecta más a los jovenes con las consecuentes pérdidas en la productividad, sufrimiento humano y gran pérdida de vidas (AU)

Colecistectomía por laparoscopia: experiencia en los primeros noventa casos / Cholecystecomy through laparoscopy: experience of the first 90 cases

De diciembre de 1990 a febrero de 1992, a 60 pacientes se les hizo colecistectomía por vía laparoscópica. En 20 (22.2 por ciento) de ellos la colecistectomía por este método se realizó en fase aguda. Solamente en cuatro (4.4 por ciento) fue necesario terminar el procedimiento efectuando una laparotomía. Fueron dados de alta a las 24 horas de la intervención 70 por ciento y dentro de las primeras 48 horas 97 por ciento. Ningún paciente tuvo que ser intervenido por complicación posoperatoria. No hubo mortalidad y no ocurrió ninguna complicación debida al procedimiento quirúrgico. En esta serie se describe por primera vez la hidrodisección de la vesícula biliar por laparoscopía que facilita la resección de ésta del lecho hepático.