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This paper draws on economic theory, sociology and political science approaches to explain informal payments in the Romanian health care system. It estimates the likelihood of paying a bribe (informal payment) using a reduced health care demand equation in a probit model with sample selection correction. Social capital, as having a relationship with doctors, and the perception of the health care system, as corrupt, are found to influence the probability of making an informal payment. The likelihood of making an informal payment in the Romanian health care system is modelled using a maximum-likelihood probit estimation with sample selection correction. In the selection equation, reduced health care demand, self-perceived health status and being afraid of diseases are used as exclusion restrictions for identifying the parameters of the econometric model.

Objective To assess the effect of a multifaceted intervention among skilled birth attendants on the use of oxytocin during the third stage of labor, the active management of the third stage of labor (AMTSL), and the rate of routine episiotomy during vaginal births in two health districts in Nicaragua. Methods An uncontrolled before-and-after study design was used. The rates of oxytocin use in the third stage of labor, AMTSL, and episiotomy were measured for vaginal births occurring in eight hospitals and health centers during 2011–2012, before and after implementation of a multifaceted facility-based intervention. The intervention involved the use of opinion leaders, interactive workshops to develop and implement evidence-based guidelines, academic detailing, the use of reminders, and feedback on the rates of oxytocin use and episiotomy. Results Oxytocin use during the third stage of labor increased significantly from 95.3% to 97.4% (P = 0.003). The episiotomy rate dropped significantly from 31.2% to 21.2% overall, and from 59.6% to 40.5% in primiparous women (P Conclusion The multifaceted intervention improved the targeted care practices during childbirth. However, a further decrease in the routine use of episiotomy would be desirable.

En este trabajo subrayamos la necesidad de contar las muertes maternas que ocurren como resultado de episodios de violencia domestica, y tambien exponemos algunas de las principales dificultades que se enfrentan al tratar de hacerlo. Examinamos algunos elementos basicos que deben tenerse presentes al contar las muertes maternas de este tipo y explicamos como una definicion de mortalidad materna que de cabida a la violencia domestica como causa de muerte mejorara la vigilancia epidemiologica y las intervenciones de salud. Lograr un acuerdo general acerca de la definicion de "muerte materna por violencia domestica" y un marco estrategico para responder a ese tipo de muerte constituiria un logro de gran importancia para los sectores de la comunidad internacional que velan por la salud de la mujer y la equidad de genero.

Objective To determine the contribution of induced abortion to tubal infertility in Mexico. Design Population- and hospital-based case-control study. Setting Tertiary hospitals in Mexico City. Sample Women between 20 and 40 years with infertility and controls of the same age: 251 cases, 502 hospital controls, 502 neighbourhood controls. Methods A case–control study was conducted in four tertiary hospitals in Mexico City with 251 cases and 1004 controls (two hospital and two neighbourhood controls per case, matched by age [±2 years]). Cases were infertile women, aged 20–40, with tubal occlusion confirmed by laparoscopy. Controls were fertile women, who had carried a pregnancy to term within the last two years. Participants completed a previously validated questionnaire asking about reproductive history and induced abortion. Results Our study did not show an association between induced abortion and tubal infertility among women that did not relate both events (cases vs hospital controls: OR = 1.57, 95% CI: 0.29–8.65; cases vs neighbourhood controls: OR = 0.82, 95% CI: 0.07–8.99) using conditional logistic models adjusting by marital status, number of pregnancies, age at first sexual intercourse and history of pelvic inflammatory disease. In contrast, early age at sexual debut and history of pelvic inflammatory disease significantly increased the risk of tubal infertility. Conclusions In Mexico, the lack of association between induced abortion and tubal damage causing infertility observed in this population might be explained by a shift toward ‘safer’ abortion practices.

To examine physicians' knowledge and attitudes in regard to medication abortion, we conducted focus-group discussions with general practice physicians and obstetrician-gynecologists in Honduras, Mexico, Nicaragua and Puerto Rico. Physicians were familiar with the practice of several types of medication and surgical abortion methods. Medication abortion with misoprostol is most common among women of higher socioeconomic status and is prescribed by physicians, pharmacists or self-administered. Conflicting opinions regarding safety, efficacy, cost, potential for self-medication and acceptability emerged; some participants expressed hope that medical abortion would reduce the risks associated with unsafe abortion, while others contended that drug distribution and self-medication without proper counseling could be problematic. Participants noted a lack of reliable sources of information for both providers and women, and expressed interest in strategic dissemination of information.

Objective. To examine the relationship between family structure and the prevalence of exclusive breastfeeding (EBF) in Nicaragua. Material and Methods. A subset of the Nicaraguan Demographic and Health Survey conducted in 1998 was obtained by selecting all last-born infants less than 4 months old at the time of the survey. Weighted chi-squared and multivariate logistic regression analyses were used to examine the association. Results. Interviewee women heads of household and interviewee women whose husbands were the heads of the household had a significantly lower prevalence of EBF. Exposure to the health care system was not related to EBF. Conclusions. New approaches are needed to promote that men support women’s decisions to breastfeed. Health institutions should effectively communicate the benefits of breastfeeding on both the mother and the child.The English version of this paper is available too at: http://www.insp.mx/salud/index.html

En el presente trabajo se muestra el desarrollo de un modelo predictivo de la combustión de mezclas de gas natural para motores de encendido por chispa. El modelo se basa en la solución de dos zonas: una de mezcla combustible sin quemar y otra de productos de combustión. En cada una de ellas se resuelve para cada ángulo de giro del cigüeñal las ecuaciones de energía y conservación de la materia. Las ecuaciones diferenciales no lineales de la energía para cada una de las fases consideradas: compresión, combustión y expansión, se resuelven por el método de Runge-Kutta de cuarto orden. El modelo, además de permitir estudiar la combustión de diferentes composiciones de los componentes del gas natural, facilita evaluar la combustión en presencia de aire seco y húmedo. Se muestran los resultados de la validación con datos experimentales demostrando precisión y exactitud en los resultados que arroja el programa. Se presentan resultados de presión en el cilindro, temperatura en las zonas de mezcla sin quemar y quemada, fracción de masa quemada y calor de reacción de la combustión para el motor modelado usando una mezcla de gas natural. This study shows the development of a predictive natural gas mixture combustion model for conventional combustion (ignition) engines. The model was based on resolving two areas; one having unburned combustion mixture and another having combustion products. Energy and matter conservation equations were solved for each crankshaft turn angle for each area. Nonlinear differential equations for each phase’s energy (considering compression, combustion and expansion) were solved by applying the fourth-order Runge-Kutta method. The model also enabled studying different natural gas components’ composition and evaluating combustion in the presence of dry and humid air. Validation results are shown with experimental data, demonstrating the software’s precision and accuracy in the results so produced. The results showed cylinder pressure, unburned and burned mixture temperature, burned mass fraction and combustion reaction heat for the engine being modelled using a natural gas mixture.

Documentar el subregistro de muertes violentas relacionadas con el embarazo y la importancia de considerar, dentro de la definición de mortalidad materna, aquellas muertes producidas también por causas relacionadas con violencia. Material y métodos. El estudio se realizó en el estado de Morelos, a partir de 394 certificados de defunción de mujeres entre 12 y 49 años de edad que murieron a lo largo del año 2001. Con base en una lista de diagnósticos de los certificados de defunción, se excluyeron 167 casos que, por las causas de muerte determinadas en el certificado de defunción, no se consideraron que podrían haber sido muertes maternas ni muertes violentas. Posteriormente se realizó el análisis de los 227 certificados restantes a través de la revisión de expedientes clínicos y/o autopsias verbales. Resultados. Se encontraron 51 muertes violentas. Las estadísticas oficiales señalan que en 2001 hubo 18 muertes maternas, mientras que este estudio identificó 23 muertas maternas directas más cuatro muertas violentas durante el embarazo y el posparto. Es decir, se encontró que el evento reproductivo fue el factor que desencadenó el homicidio o suicidio de cuatro mujeres. Excepto en un caso, este hecho no está señalado ni relacionado en los registros oficiales. Conclusiones. Se recomienda la inclusión de la violencia relacionada con la reproducción en los registros oficiales de mortalidad materna como una causa indirecta. Esto permitiría profundizar la comprensión de las causas de la mortalidad materna y orientaría la elaboración de políticas, programas y servicios de prevención y atención. La autopsia verbal (AV) es una técnica que ayuda a la identificación de casos de embarazo y muertes maternas violentas.

This study measured the contribution of abortion-related deaths to overall maternal mortality and calculated the underestimation of maternal mortality using verbal autopsy and clinical record review where available. We reviewed 807 death certificates of women aged 12–50 who died in 2001 in two sites of about 1.5 million inhabitants each in the state of Morelos (primarily rural) and the municipality of Nezahualcoyotl (primarily urban) in the state of Mexico. Deaths were classified as definite, possible or non-maternal deaths. Finally, we identified abortion-related deaths and calculated the underestimation of maternal mortality. Among 326 possible maternal deaths, we encountered five misclassified cases: one spontaneous abortion and four non-abortion maternal deaths. Among 32 registered maternal deaths, we found four misclassified cases that were actually second trimester, abortion-related deaths. There were no officially registered abortion-related deaths in either Morelos or Nezahualcoyotl, making the overall underestimation of abortion mortality 100%. Abortion contributed 13.5% of all maternal deaths. The overall underestimation of maternal mortality was 13.5%, higher in Morelos (21.7%). There were no unregistered maternal deaths in Nezahualcoyotl. Unsafe abortion continues to be an important cause of maternal mortality, though first trimester deaths appear to be decreasing. We identified domestic violence as an important cause of death among pregnant and post-partum women, and two abortion-related suicides, and believe these should be reconsidered as indirect maternal deaths. The misclassification of second trimester abortion deaths as maternal deaths from other causes is an obstacle to preventing them.

Several factors limited HIV transmission during the 1980s, includ-ing a ten-year civil war accompanied by an economic blockade by the United States of America (USA), which isolated the country for several years; a relatively controlled commercial sex industry; low infection rates for injecting drug users; and a ban on the commercial sale of blood. In the late 1990s, however, the spread of HIV rapidly increased.