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Objective: To evaluate the acceptability, feasibility, rating, and potential impact of PRONTO, a low-tech and high-fidelity simulation-based training for obstetric and neonatal emergencies and teamwork using the PartoPants low-cost birth simulator., Methods: A pilot project was conducted from September 21, 2009, to April 9, 2010, to train interprofessional teams from 5 community hospitals in the states of Mexico and Chiapas. Module I (teamwork, neonatal resuscitation, and obstetric hemorrhage) was followed 3 months later by module II (dystocia and pre-eclampsia/eclampsia) and an evaluation. Four elements were assessed: acceptability; feasibility and rating; institutional goal achievement; teamwork improvement; and knowledge and self-efficacy., Results: The program was rated highly both by trainees and by non-trainees who completed a survey and interview. Hospital goals identified by participants in the module I strategic-planning sessions were achieved for 65% of goals in 3 months. Teamwork, knowledge, and self-efficacy scores improved., Conclusion: PRONTO brings simulation training to low-resource settings and can empower interprofessional teams to respond more effectively within their institutional limitations to emergencies involving women and newborns. Further study is warranted to evaluate the potential impact of the program on obstetric and neonatal outcome., (Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

Objectives: Parent-adolescent communication about sexuality has been shown to influence adolescents' sexual behaviour. This study aims to describe communication about sex between Mexican parents and adolescents, and its relation to age at first intercourse and condom use., Methods: Cross-sectional study with self-administered questionnaires of first year students at 23 high schools. Communication was divided into three themes: biological aspects, risks associated with sexual behaviour, and prevention. For sexually active adolescents, discussion timing was determined to have occurred prior to, or after sexual initiation. Analysis included logistic regression models stratifying by discussion timing., Results: Overall 5,461 questionnaires were analysed. Among male respondents 24.3% and among females 10.6% stated that they were sexually active. As many as 83.1% reported having spoken with parents about sexual relations. Communication was more common with mothers. Discussions about risk and prevention prior to sexual initiation was associated with condom use at first intercourse (Odds ratio [OR] = 2.05); late discussion was associated with younger age (<15) at first intercourse (OR = 3.51)., Conclusions: Communication before onset of sexual activity about risk and prevention is associated with safe sex practices. Improving parent-adolescent communication is a poorly studied strategy to influence adolescents' behaviour. Interventions should promote early parent-adolescent communication.

Although the majority of births in Mexico are attended by skilled birth attendants, maternal mortality remains moderately high, raising questions about the quality of training and delivery care. We conducted an exhaustive review of the curricula of three representative schools for the education and clinical preparation of three types of birth attendant - obstetric nurses, professional midwives and general physicians - National Autonomous University of Mexico (UNAM) School of Obstetric Nursing; CASA Professional Midwifery School; and UNAM School of Medicine, Iztacala Campus. All curricular materials were measured against the 214 indicators of knowledge and ability in the International Confederation of Midwives (ICM) skilled attendant training guidelines. The CASA curriculum covered 83% of the competencies, 93% of basic knowledge and 86% of basic abilities, compared with 54%, 59% and 64% for UNAM Obstetric Nursing School and 43%, 60% and 36% for UNAM School of Medicine, respectively. Neither the Obstetric Nursing School nor the School of Medicine documented the quantity or types of clinical experience required for graduation. General physicians attend the most births in Mexico, yet based on our analysis, professional midwives had the most complete education and training as measured against the ICM competencies. We recommend that professional midwives and obstetric nurses should be formally integrated into the public health system to attend deliveries.