Background: There is a complex interplay between women's preferences, abortion services availability and the context in which these are provided. Even in countries where it is legal, denial of abortion is common, especially in low and middle income countries, forcing women to look for the service elsewhere and bringing serious consequences to the health and wellbeing of many women and their families. This non-systematic review pretends to answer the question: Which are the barriers to and facilitators for the access to legal abortion services in low and middle income countries? Methods: A non-systematic bibliographical review. Inclusion criteria: all quantitative, qualitative and evidence synthesis studies performed in low and middle income countries according to the World Bank classification for 2015 and published in English, Spanish and Portuguese language, between 2005 and 2017. Exclusion criteria: articles evaluating the efficacy of interventions, addressing the knowledge about abortion procedures among health care students and personnel, as well as those that only included sex workers. Results: The database search yield 199 articles in MEDLINE. 24 in Scopus and 38 in Scielo. A total of 22 articles including 15 countries from Africa (n = 6), Asia (n = 5), Central and South America (n = 3) and Europe (n = 1). The legal status of abortion in each of these countries was studied and described. For the analysis of the information, three categories of deepening were established: Laws and policies, Service delivery and Women's abortion care-seeking behavior. Conclusion: the determinants of access to abortion in low and middle income countries are convoluted as multiple delays and barriers usually overlap. Similarly, stigmatization has a great impact across all the steps of abortion provision.
Objective. This work sought to evaluate the impact of an educational intervention on oral hygiene care aimed at nursing care staff, on the incidence of Ventilator-Associated Pneumonia (VAP) in adults from an ICU in Colombia. Methods. Quasi-experimental study pre- and post-educational intervention aimed at nursing staff in which theoretical-practical sessions were conducted during 12 weeks to explain different oral hygiene techniques according to the oral conditions of patients. The study gathered sociodemographic, clinical, and characteristic variables of the oral and dental care received. The VAP was diagnosed according with international criteria. Results. The educational intervention received participation from 60 individuals (40 nurses and 20 nursing aides), 80% were women. The work collected data from 171 patients, 70 (40.9%) cared for after the educational intervention. Daily oral and dental care by the staff increased from 29.6% to 92.8% after the intervention. Although the accumulated incidence of VAP diminished from 8.9% to 2.8% and the rate of incidence dropped from 9 to 3.5 cases per 1000 days of intubation, these changes were not statistically significant. Conclusion. The educational intervention aimed at the nursing staff in oral care reduced the incidence of VAP in adults connected to ventilator in ICU; although this decrease was not statistically significant, it was a clinically relevant result for the institution, which is why it is necessary to continue the educational strategies on oral health studied in this staff.
General practitioners may have to submit medical reports to the courts on patients who have a suspected alcohol problem, 98% of such requests coming from magistrates courts. When, however, a defendant decides to plead "not guilty" to an offence on the grounds of intoxication general practitioners are often asked to prepare a report to support the plea. We present guidelines on preparing such reports and discuss the implications of the contents.
Introducción. La COVID-19 se manifiesta en el 80% casos de forma leve, sin embargo, en 5% progresa a enfermedad severa con necesidad de manejo en unidad de cuidados intensivos (UCI). Objetivo. Identificar los factores demográficos, clínicos y de tratamiento asociados a la mortalidad en pacientes con COVID-19 atendidos en la UCI de un hospital de cuarto nivel de atención de Medellín, Colombia. Materiales y métodos. Estudio de cohorte retrospectivo. Se analizaron las historias clínicas de 182 pacientes admitidos en UCI por COVID-19 entre marzo y diciembre de 2020. Se realizaron análisis bivariados (pruebas de chi-cuadrado, exacta de Fisher, t de Student no pareada o U de Mann-Whitney) para evaluar la asociación entre, por un lado, características demográficas, presencia de enfermedades coexistentes, resultados de laboratorios, intervenciones terapéuticas, requerimiento de soporte ventilatorio y hemodinámico, y, por otro, mortalidad. Además, se realizó un análisis multivariado en el que se construyeron regresiones logísticas binarias simples y múltiples, calculando RR crudos y ajustados. Se consideró un nivel de significancia de p<0.05. Resultados. La mortalidad fue de 47.80%. En el análisis multivariado, los siguientes factores se comportaron como factores protectores: edad <60 años (RRa: 0.154, IC95%:0.059-0.401; p=0.000), uso de vasopresores (RRa 0.082, IC95%:0.021–0.319; p<0.001) y uso de terapia de remplazo renal (RRa: 0.205, IC95%:0.059–0.716; p=0.013). La no realización de traqueostomía se asoció como factor de riesgo (RRa: 14.959, IC95%:4.865-45.998; p<0.001). El conteo más bajo de plaquetas registrado durante la estancia en UCI tuvo un efecto neutro pero fue una variable cuantitativa significativamente asociada (RRa: 0.999, IC95%:0.990-0.999; p=0.003). Conclusiones. En el presente estudio, tener menos de 60 años, el uso de vasopresores y de terapia de remplazo renal se comportaron como factores protectores, mientras que la no realización de traqueostomía se comportó como factor de riesgo para mortalidad. Además, el conteo más bajo de plaquetas registrado durante la estancia en UCI fue una variable cuantitativa significativamente asociada.
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