Carmen Álvarez Nieto

Motivaciones para el embarazo adolescente

OBJECTIVES To identify the motivations (beliefs, values) for adolescent pregnancy among girls aged less than 17 years old. METHOD We performed a phenomenological qualitative study with audio recording of in-depth interviews with 12 pregnant adolescents between March and September 2008. Purposive sampling of pregnant adolescents (14-16 years) in the high-risk obstetric unit of the Hospital of Jaen (Spain) was performed, using education, voluntariness of pregnancy, urban-rural setting of the family residence and family socioeconomic status as heterogeneity criteria. A content analysis was performed with coding, triangulation of categories, and extraction and verification of results. RESULTS The adolescents sociocultural context was of considerable weight in sexual and reproductive decisions. Adolescents with unplanned pregnancies felt that their responsibility was relative, showing an attitude of acceptance and resignation, which later became a tendency to rationalize the events and claim that the child was wanted or even planned. Girls with a wanted pregnancy did not have a clear idea of the consequences of having a child. Previous ideas about pregnancy were mainly related to physical changes without taking into account other changes that occur during and after pregnancy. CONCLUSIONS The family context and socialization of girls are based on a traditional division of gender roles in which the traditional role of the female caregiver is strongly internalized. The reasons for teenage pregnancy are unclear; pregnant adolescents lacked a sense of self-determination and felt that their lives were determined by circumstances.

Motivations for tobacco consumption among adolescents in an urban high school

Objective: To determine the motivations (attitudes, beliefs and experiences) for tobacco consumption among adolescents. Methods: This study was based on qualitative methodology using six 50-minute discussion groups with 6-8 adolescents per group during the 2008/09 school year. Purposive sampling was performed of 12-18 year-old adolescents attending a middle-class urban school (Jaen, Spain). The sample was stratified by educational level as the homogeneity criterion and gender and tobacco consumption as the heterogeneity criterion. Content analysis consisted of coding, triangulation of categories and obtaining and verifying the results. Results: There were 44 adolescents (54% male). The participants reported that smoking relaxed and improved self-image, providing security (boys) and improving relations with the opposite sex, as well as weight control (girls). The family encouraged smoking by providing a model to imitate, although many adolescents hid their smoking from their families. Friends constituted a pressure group to start or continue smoking. Starting secondary school marked the beginning of experimental use. Society tended to accept consumption and buying tobacco was easy for minors. University students were a role model and were free to smoke. The adolescents looked to their parents and educators/health workers to provide a model of abstinence and reported that they were well informed but only remembered powerful messages. Participants unanimously indicated that tobacco causes addiction, but in proportion to the duration ofOBJECTIVE To determine the motivations (attitudes, beliefs and experiences) for tobacco consumption among adolescents. METHODS This study was based on qualitative methodology using six 50-minute discussion groups with 6-8 adolescents per group during the 2008/09 school year. Purposive sampling was performed of 12-18 year-old adolescents attending a middle-class urban school (Jaén, Spain). The sample was stratified by educational level as the homogeneity criterion and gender and tobacco consumption as the heterogeneity criterion. Content analysis consisted of coding, triangulation of categories and obtaining and verifying the results. RESULTS There were 44 adolescents (54% male). The participants reported that smoking relaxed and improved self-image, providing security (boys) and improving relations with the opposite sex, as well as weight control (girls). The family encouraged smoking by providing a model to imitate, although many adolescents hid their smoking from their families. Friends constituted a pressure group to start or continue smoking. Starting secondary school marked the beginning of experimental use. Society tended to accept consumption and buying tobacco was easy for minors. University students were a role model and were free to smoke. The adolescents looked to their parents and educators/health workers to provide a model of abstinence and reported that they were well informed but only remembered powerful messages. Participants unanimously indicated that tobacco causes addiction, but in proportion to the duration of consumption, and were concerned only with the immediate symptoms caused by smoking. Teenage smokers associated multiple drug use with leisure time. CONCLUSIONS This study provides useful data on motivation that could be used to improve smoking prevention interventions among adolescents. The most important factors seem to be peer influence, parental attitudes, easy access to tobacco and symptoms of dependence.

Motivations for adolescent pregnancy

OBJECTIVES To identify the motivations (beliefs, values) for adolescent pregnancy among girls aged less than 17 years old. METHOD We performed a phenomenological qualitative study with audio recording of in-depth interviews with 12 pregnant adolescents between March and September 2008. Purposive sampling of pregnant adolescents (14-16 years) in the high-risk obstetric unit of the Hospital of Jaen (Spain) was performed, using education, voluntariness of pregnancy, urban-rural setting of the family residence and family socioeconomic status as heterogeneity criteria. A content analysis was performed with coding, triangulation of categories, and extraction and verification of results. RESULTS The adolescents sociocultural context was of considerable weight in sexual and reproductive decisions. Adolescents with unplanned pregnancies felt that their responsibility was relative, showing an attitude of acceptance and resignation, which later became a tendency to rationalize the events and claim that the child was wanted or even planned. Girls with a wanted pregnancy did not have a clear idea of the consequences of having a child. Previous ideas about pregnancy were mainly related to physical changes without taking into account other changes that occur during and after pregnancy. CONCLUSIONS The family context and socialization of girls are based on a traditional division of gender roles in which the traditional role of the female caregiver is strongly internalized. The reasons for teenage pregnancy are unclear; pregnant adolescents lacked a sense of self-determination and felt that their lives were determined by circumstances.

Diagnóstico comunitario mediante técnicas cualitativas de las expectativas y vivencias en salud de una zona necesitada de transformación social

OBJECTIVE To know the views, experiences and expectations of care provided by the Andalusian Public Health System (SSPA) of users of an urban area in need of social transformation (ZNTS). DESIGN Qualitative methodology (exploratory study). LOCATION Urban basic health zone (16,000 inhabitants, 40% ZNTS). PARTICIPANTS Purposive sampling of users of SSPA and community leaders. Homogeneity criteria: age. Heterogeneity criteria: sex, frequency, active/pensioner, level cultural/economic. MAIN INTERVENTIONS Conversational techniques recorded by videotape and moderated by a sociologist (user dicussion groups and in-depth interviews for community leaders). ANALYSIS transcription of speeches, coding, categories triangulation and final outcome. RESULTS Seven groups (43 participants, 58% ZNTS) and 6 leaders. They want continuity of care and choice of professionals, but not the medical change without information and attentions discontinuity primary care/hospital. Theres bad physical accesibility by the urban environment in the ZNTS and is criticized admission services and paperwork; the programmed appointment and the electronic prescriptions are improvements but asking more hospital referrals and reviews. Theres good appreciation of the professionals (primary care-closer, hospital-greater technical capacity). It needs to improve nursing education and speed of emergency assistance. Theres a lack of leadership in the system organization, very fragmented. They know a range of services focusing on the demand for care; other health activities not spread to the users. CONCLUSION The SSPA should incorporate the views and expectations of communities in social risk to a real improvement in the quality of care.Resumen Objetivo Conocer las opiniones, vivencias y expectativas sobre la atención prestada por el Sistema Sanitario Público Andaluz (SSPA) de los usuarios de una zona urbana necesitada de transformación social (ZNTS). Diseño Metodología cualitativa, estudio exploratorio. Emplazamiento Zona básica de salud urbana (16.000 habitantes; 40% ZNTS). Participantes Usuarios del SSPA mediante muestreo intencional de usuarios y líderes de la comunidad. Criterios de homogeneidad: edad. Criterios de heterogeneidad: sexo, frecuentación, activo/pensionista, nivel cultural/económico. Intervenciones principales Técnicas conversacionales registradas mediante videograbación y moderadas por una socióloga (grupos de discusión para usuarios y entrevistas en profundidad para líderes sociales). Análisis con transcripción literal de los discursos, codificación, triangulación de categorías y obtención de resultados. Resultados Siete grupos (43 participantes; 58% ZNTS) y 6 líderes sociales. Se desea continuidad en la atención y libre elección de profesionales, criticando cambios sin información previa y la discontinuidad atención primaria/hospitalaria. Hay mala accesibilidad física por el entorno urbano y críticas a los servicios de admisión y los trámites burocráticos; la cita previa y la receta electrónica son mejoras pero solicitan más derivaciones y revisiones hospitalarias. Hay buena valoración de los profesionales (atención primaria-mayor cercanía, hospital-mayor capacidad técnica). Se precisa mejorar la formación de enfermería y la rapidez de la asistencia urgente. Hay falta de liderazgo en la organización del SSPA, muy fragmentada. Se conoce una oferta de servicios centrada en la demanda asistencial, siendo poco difundidas otras actividades. Conclusión El SSPA debe incorporar las opiniones y expectativas de las comunidades en riesgo social para una mejora real de la calidad asistencial.

Motivaciones para el consumo de tabaco entre los adolescentes de un instituto urbano

Objective: To determine the motivations (attitudes, beliefs and experiences) for tobacco consumption among adolescents. Methods: This study was based on qualitative methodology using six 50-minute discussion groups with 6-8 adolescents per group during the 2008/09 school year. Purposive sampling was performed of 12-18 year-old adolescents attending a middle-class urban school (Jaen, Spain). The sample was stratified by educational level as the homogeneity criterion and gender and tobacco consumption as the heterogeneity criterion. Content analysis consisted of coding, triangulation of categories and obtaining and verifying the results. Results: There were 44 adolescents (54% male). The participants reported that smoking relaxed and improved self-image, providing security (boys) and improving relations with the opposite sex, as well as weight control (girls). The family encouraged smoking by providing a model to imitate, although many adolescents hid their smoking from their families. Friends constituted a pressure group to start or continue smoking. Starting secondary school marked the beginning of experimental use. Society tended to accept consumption and buying tobacco was easy for minors. University students were a role model and were free to smoke. The adolescents looked to their parents and educators/health workers to provide a model of abstinence and reported that they were well informed but only remembered powerful messages. Participants unanimously indicated that tobacco causes addiction, but in proportion to the duration ofOBJECTIVE To determine the motivations (attitudes, beliefs and experiences) for tobacco consumption among adolescents. METHODS This study was based on qualitative methodology using six 50-minute discussion groups with 6-8 adolescents per group during the 2008/09 school year. Purposive sampling was performed of 12-18 year-old adolescents attending a middle-class urban school (Jaén, Spain). The sample was stratified by educational level as the homogeneity criterion and gender and tobacco consumption as the heterogeneity criterion. Content analysis consisted of coding, triangulation of categories and obtaining and verifying the results. RESULTS There were 44 adolescents (54% male). The participants reported that smoking relaxed and improved self-image, providing security (boys) and improving relations with the opposite sex, as well as weight control (girls). The family encouraged smoking by providing a model to imitate, although many adolescents hid their smoking from their families. Friends constituted a pressure group to start or continue smoking. Starting secondary school marked the beginning of experimental use. Society tended to accept consumption and buying tobacco was easy for minors. University students were a role model and were free to smoke. The adolescents looked to their parents and educators/health workers to provide a model of abstinence and reported that they were well informed but only remembered powerful messages. Participants unanimously indicated that tobacco causes addiction, but in proportion to the duration of consumption, and were concerned only with the immediate symptoms caused by smoking. Teenage smokers associated multiple drug use with leisure time. CONCLUSIONS This study provides useful data on motivation that could be used to improve smoking prevention interventions among adolescents. The most important factors seem to be peer influence, parental attitudes, easy access to tobacco and symptoms of dependence.

El discurso médico sobre las matronas a mediados del siglo XX

Objetivo. Contribuir a la historia mas reciente de la profesion de matrona a traves de los textos escritos por medicos. Metodos. Analisis cualitativo, historico, de contenido y de discurso, a traves de fuentes secundarias escritas hace mas de medio siglo. Las fuentes analizadas son ocho articulos escritos por medicos en la revista Matronas de la Escuela Oficial de Matronas de la Casa de Salud de Santa Cristina de Madrid (Espana). Resultados. El denominador comun de los articulos analizados es inculcar a las matronas las competencias y habilidades fisicas y morales que deben tener, justificado en lo importante de la practica de su profesion, pero subyace un discurso de adoctrinamiento para la sumision del colectivo de matronas. Conclusiones. En el periodo estudiado las matronas estaban sometidas al control y jerarquia de genero en favor del prestigio de los medicos. Como vehiculo de adoctrinamiento, entre otros, utilizaron las revistas profesionales de matronas. Estas perdieron espacios de poder y control sobre su profesion con relacion a epocas anteriores en las que tuvieron gran autonomia. El regimen politico, la moral catolica y la vision androcentrica de los anos centrales del siglo XX, ejercieron como elementos negativos de los intereses de un colectivo profesionalizado pero femenino.

Actitud y adaptación maternal en el embarazo

The aim of our study is to evaluate the influence of several factors such as age, wanted pregnancy, education level, etc, on final stages pregnant women’s attitude and perception of pregnancy. A cross-sectional descriptive study was carried out with over 36 weeks pregnant women undergoing routine cardiotocographic check-ups in the Foetal Welfare outpatients unit at the Maternity-Children’s hospital (Ciudad de Jaen Hospital). Kumar et al’s attitude and maternal adaptation questionnaire (1984) was used. The results obtained suggest that a wanted pregnancy is closely linked to a high degree of satisfaction throughout pregnancy, that marital status has a determinant influence on wanted pregnancies, and that affection showed by pregnant women’s partners increases proportionally to the number of pregnancies.