¿Queremos ser madres? Vivencias y significados del embarazo en la adolescencia en una comunidad nativa de la Amazonía peruana

El embarazo en la adolescencia es un fenómeno que ha sido ampliamente pensado y discutido en el Perú en las últimas décadas. Sin embargo, son escasas las investigaciones antropológicas en contextos indígenas, donde la tasa de fecundidad de las mujeres de 15 a 19 años se mantiene alta a pesar de los esfuerzos del Estado y de organismos no gubernamentales para su reducción. Este artículo, desde un enfoque cualitativo etnográfico, explora y analiza cómo las adolescentes embarazadas de la comunidad nativa Nuevo Paraíso, ubicada en la Amazonía peruana, conciben el embarazo dentro de sus proyectos de vida. Los resultados obtenidos evidencian que los/as adolescentes generan pautas específicas de interacción y vivencias de la sexualidad en contextos socioeconómicos cambiantes y de mayor movilidad de la población. En este escenario, las vivencias de las adolescentes embarazadas son diversas y distan de ser negativas en su totalidad. Por un lado, la presencia familiar, las nociones de género, los ciclos de vida y la formalización con la pareja fomentan un ambiente favorable para una maternidad deseada, en la que el embarazo genera valoraciones positivas como el reconocimiento social y la adquisición del estatus de adultez. Por otro lado, los embarazos no deseados se producen en contextos donde los padres han estado ausentes y las parejas han sido inestables, lo cual conlleva a situaciones desfavorables y de especial vulnerabilidad para las adolescentes.La grossesse à l’adolescence est un phénomène qui a été largement abordé et discuté au Pérou ces dernières décennies. Cependant, les recherches anthropologiques étudiant les contextes indigènes, où les taux de fécondité des femmes entre 15 et 19 ans demeurent élevés malgré les différents efforts de l’État et des organismes non gouvernementaux pour les réduire, restent peu nombreuses. Cet article explore et analyse la façon dont les adolescentes enceintes de la communauté native Nuevo Paraíso, en Amazonie péruvienne, conçoivent la grossesse dans le cadre de leurs projets de vie. Les résultats obtenus montrent que les adolescent.e.s suivent des schémas spécifiques d’interaction et de vécus de la sexualité dans des contextes socio-économiques en mutation et marqués par une plus grande mobilité sociale. Dans ce contexte, les vécus des adolescentes enceintes sont très divers et ne sont pas forcément des expériences considérées comme négatives. D’un côté, la présence familiale, la notion de genre, les cycles de vie et la mise en couple créent des conditions favorables au développement d’une maternité désirée. Ainsi, la grossesse entraîne une série de valorisations positives telles que la reconnaissance sociale et l’acquisition du statut d’adulte. De l’autre côté, les grossesses non désirées ont lieu dans des situations marquées par l’absence des parents et par l’instabilité dans la vie de couple. Cela engendre donc des situations défavorables et de forte vulnérabilité pour les adolescentes.Adolescent pregnancy is a phenomenon that has been extensively thought about and discussed in Peru over the last decades. However, there are few anthropological investigations in indigenous contexts where the fertility rate of women from 15 to 19 years remains high in spite of the efforts made by government and non-governmental organizations for its reduction. This article utilizing a qualitative ethnographic approach explores and analyzes how pregnant adolescents of the native community of Nuevo Paraíso in the Peruvian Amazon conceive of pregnancy within their life projects. The results obtained demonstrate that adolescents generate specific patterns of interaction and experiences of sexuality in changing socioeconomic contexts and with higher population mobility levels. In this scenario, the experiences of pregnant adolescents are diverse and far from being all negative. On the one hand, family presence, gender notions, life cycles and relationship formalization foster a favorable scenario for a desired motherhood where pregnancy generates positive assessments such as social recognition and the acquisition of adulthood status. On the other hand, unwanted pregnancies occur in contexts where parents have been absent and couples have been unstable, leading to unfavorable situations and special vulnerability for adolescents

¿Queremos ser madres? : vivencias y significados del embarazo adolescente en la comunidad nativa Nuevo Paraíso, Ucayali

El embarazo adolescente es un fenómeno que ha sido pensado y discutido en nuestro país, de manera amplia, en las últimas décadas. Sin embargo, son escasas las investigaciones antropológicas sobre este en contextos indígenas donde la tasa de fecundidad se mantiene alta a pesar de los esfuerzos estatales y organismos no gubernamentales para su reducción. La presente investigación, desde un enfoque cualitativo etnográfico, explora los significados y las experiencias del embarazo adolescente. En ese sentido, se indaga y analiza cómo las adolescentes embarazadas conciben el embarazo dentro de sus proyectos de vida, así como, se busca comprender las representaciones culturales que elaboran los actores relevantes (padres de familia, personal de las instituciones estatales, adolescentes) sobre la adolescencia y el embarazo en la comunidad nativa Nuevo Paraíso, Ucayali, región que ocupa el tercer lugar en la tasa más alta de embarazo adolescente en el país (23, 1%) (INEI 2018: 99). Los resultados obtenidos evidencian que los y las adolescentes shipibas generan pautas específicas de interacción y vivencias de la sexualidad en contextos socioeconómicos cambiantes y de mayor movilidad de la población. En este escenario, las vivencias de las adolescentes embarazadas son diversas y distan de ser todas negativas. Por un lado, la presencia familiar, la estabilidad con la pareja y la asistencia casi completa a la escuela fomentan un escenario favorable para un embarazo y una maternidad deseada, donde este adquiere valoraciones positivas que posibilitan la adquisición del estatus de adultez y el reconocimiento como comuneras activas, desplegando agencia y autonomía en sus decisiones. Por otro lado, los embarazos no deseados se producen en contextos donde los padres han estado ausentes y las parejas han sido inestables lo cual conlleva a situacionesTesi

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

Background: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. Methods: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions: Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death

The value of open-source clinical science in pandemic response: lessons from ISARIC

International audienc

ISARIC-COVID-19 dataset: A Prospective, Standardized, Global Dataset of Patients Hospitalized with COVID-19

The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use

Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry

Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs). Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality. Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions. Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51). Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings