Structural and gender violence in Mexico take on various forms, obstetric violence among them. The objective of our study consisted in analyzing experiences of structural and gender discrimination ...against women during childbirth care at two public hospitals in Mexico.
We conducted a cross-sectional mixed methods study including a survey of closed questions administered to all women who received health care for vaginal or cesarean childbirth at two public hospitals from May 7 to June 7, 2012 (N = 512). Those who reported some form of abuse on the part of health-care professionals were then invited to complete a semi-structured interview (20 women agreed to participate). In addition, three focus groups were organized with health-care professionals from both institutions (31 participants): two were composed of nurses and one of obstetrician-gynecologists (OB-GYNs). This work deals with the qualitative component of the study.
The narratives of the health-care professionals interviewed contained expressions of health discrimination relating to certain characteristics of their clients, namely poverty, ignorance, failure to understand instructions and being women. The women, on the other hand, perceived themselves as belonging to a low social class and, as a result, behaved passively with staff throughout their hospital stay. They reported both physical and psychological abuse during care. The first included having their legs manipulated roughly, being strapped to the bed, and being subjected to multiple and careless pelvic examinations. Psychological abuse included reprimands, insults, disrespectful remarks, neglect and scowling gestures when requesting assistance.
The results of our study bear implications for the doctor-client relationship and for the health system in general. They suggest a need to dismantle medical practice - particularly with regard to obstetrics and gynecology - as it has been historically learned and internalized in Mexico. It is imperative to design public policies and strategies based on targeted interventions for dismantling the multiple forms of structural and gender violence replicated daily by actors in the health system.
Suicide in adolescents constitutes a public health problem throughout the world. The objective of this study was to identify the prevalence of suicidal behaviour in a public middle school in Mexico ...and to implement appropriate educational interventions in the school and community contexts. Our work took place from September 2017 to July 2018. We conducted a quasi‐experimental, mixed‐methodology study with 12‐year‐old students in first year of middle school (n = 29), using an educational intervention approach within the frame of the Life Skills Education methodology. We included family members and academic staff in the study with the view of sensitising them to suicidal behaviour. At the community level, we worked with the adolescent and adult populations to form ‘gatekeepers’ (guardians). We administered a questionnaire on psychosocial indicators of depression and suicide risk to 383 students in their first‐to‐third years of middle school. Other questionnaires were applied, and life skills focus groups (FGs) were organised with the educational intervention participants. The questionnaires addressed suicidal behaviour in adolescents, alcohol consumption, life skills and prosociality. Prevalence of attempted suicide cases came to 14.1% (95 CI% 10.7–17.9), the average age of those who reported having hurt themselves with the purpose of taking their lives was 12.9 years, 75% of those who had attempted suicide were female and 64.8% had consumed alcohol. The educational intervention with students achieved a statistically significant increase in the life skills of participants, specifically as regards self‐awareness and overall scores. The family members in the FGs developed greater awareness of suicidal behaviour, and the adolescents engaged at the community level significantly broadened (p < .05) their knowledge of depression. In developing countries such as Mexico, it is essential not only to increase the number of interventions for preventing suicidal behaviour in adolescents, but also to improve instruments for measuring the extent of the problem.
Objetivo. Analizar la interpretación e implementación de las políticas para la vigilancia de la salud de los trabajadores del programa para el control de vectores en México. Material y métodos. Se ...realizó un estudio transversal con métodos mixtos en cuatro estados de México; se incluyen entrevistas semiestructuradas, recolección de datos sobre los plaguicidas aplicados y los resultados del biomonitoreo realizado a los trabajadores y obtenidos de los registros estatales. Resultados. En todos los estados participantes se identificó un uso extensivo y variado de plaguicidas altamente peligrosos. Los procesos para monitorear la exposición ocupacional a inhibidores de acetilcolinesterasa son diferentes en cada uno de ellos y en ninguno se calculan los índices biológicos de exposición. Conclusiones. El conocimiento sobre las políticas para vigilar la salud de los trabajadores debe fortalecerse y es necesario mejorar el contenido de las políticas vigentes de modo que abarquen los múltiples plaguicidas que aplican los trabajadores, así como sus posibles efectos combinados y a largo plazo.
•Using an Intervention Mapping design favored consumption of fruits, vegetables and simple water.•Consumption of fruits, vegetables and water increased as a result of our intervention.•Mothers and ...teachers learned how to prepare easy and healthy dishes for breakfast.•Informed mothers became interested in sharing their new knowledge.•Understanding the harm caused by sugary drinks discouraged teachers from consuming them.
For preschool children, mothers and teachers are the principal models and promoters of fruit, vegetable and simple water consumption at home and school, respectively. However, the daily intake of these food and drink items falls below recommended standards among Mexican adults, posing a high risk of non-communicable diseases such as overweight and obesity across all age groups in the country. The objective of this article is to describe the design, implementation and evaluation of an educational initiative conducted in a Mexican locality with the aim of promoting the consumption of fruits, vegetables (FVs) and simple water (SW) among preschoolers through the influence of their mothers and teachers. We used the Intervention Mapping methodology with qualitative and quantitative components. Mothers attended eight theoretical and practical sessions and two school meetings, while teachers were offered two workshops. Our results revealed positive changes among both groups: participants took greater interest in healthy nutrition, increased their purchase, preparation and intake of FVs and SW and promoted their consumption. This confirms that it is possible to achieve favorable changes in eating habits among those who participate in educational initiatives in Mexico.
Objetivo: Identificar las barreras que existen para la atención de las conductas suicidas, desde la perspectiva de las/los profesionales de la salud mental del primer nivel de atención de la Ciudad ...de México.
Metodología: Estudio cualitativo exploratorio, basado en 35 entrevistas semiestructuradas, dirigidas a personal de salud de dos unidades de salud mental de referencia nacional. El análisis de la información se hizo mediante el Framework Analysis.
Resultados: Las/los participantes consideraron que las conductas suicidas no han sido definidas como una prioridad dentro de los trastornos de salud mental. La ausencia de políticas públicas, la sobrecarga de trabajo, la falta de seguimiento a las/los pacientes, entre otras, fueron identificadas como barreras para una atención adecuada y oportuna.
Conclusiones: Los programas de prevención de las conductas suicidas deben tomar en cuenta el contexto socioeconómico de la población y las características de los servicios de salud, así como las necesidades de las personas prestadoras de servicios de salud. Se requiere ampliar el entrenamiento profesional y mejorar el sistema de referencia y contrarreferencia entre los distintos niveles de atención.
To explore the pillars of community resilience in a region where Chagas disease is endemic, with the aim of promoting participatory processes to deal with this condition from the resilience of the ...population.
Qualitative study using ethnographic record and six interviews of focus groups with young people, women and men. The research was carried out in a rural area of the state of Morelos, Mexico, between 2006 and 2007. We carried out educational sessions with the population in general, so that residents could identify the relationship between the vector Triatoma pallidipennis, the parasite (Trypanosoma cruzi), symptoms, and preventive actions for Chagas disease. The ethnographic record and groups were analyzed based on Taylor and Bogdan's modification, and the focus was to understand the socio-cultural meanings that guide the speeches and activities of residents in relation to the pillars of community resilience.
The population felt proud of belonging to that location and three pillars of community resilience were clearly identified: collective self-esteem, cultural identity, and social honesty. Having these pillars as bases, we promoted the participation of the population concerning Chagas disease, and a Community Action Group was formed with young people, adult men and women, and social leaders. This Group initiated actions of epidemiological and entomological surveillance in the community to deal with this problem.
It is necessary to create more experiences that deepen the understanding of the pillars of community resilience, and how they contribute to enhance participation in health to deal with Chagas disease.
Explorar los pilares de la resiliencia comunitaria en una región en la que la enfermedad de Chagas es endémica, con la finalidad de partir de la resiliencia de la población para impulsar procesos participativos para enfrentar este padecimiento.
Estudio cualitativo que utilizó registro etnográfico y seis entrevistas de grupos focales con jóvenes, mujeres y hombres adultos. La investigación se efectúo en una localidad rural del Estado de Morelos, México, entre 2006 y 2007. Se efectuaron sesiones educativas con la población en general, para que los habitantes identificaran la relación entre el vector Triatoma pallidipennis, el parásito (Trypanosoma cruzi), la sintomatología y acciones preventivas para la enfermedad de Chagas. El registro etnográfico y los grupos fueron analizados con base en una modificación de Taylor y Bogdan, y el foco fue comprender los significados socioculturales que guían los discursos y actividades de los pobladores en relación a los pilares de la resiliencia comunitaria.
La población se sentía orgullosa de pertenecer a esa localidad y se identificaron con claridad tres pilares de la resiliencia comunitaria: autoestima colectiva, identidad cultural y honestidad social. Tomando como base estos pilares, se impulsó la participación de la población en torno a la enfermedad de Chagas, y se formó un Grupo de Acción Comunitaria con jóvenes, hombres y mujeres adultos, y líderes sociales. Este Grupo inició acciones de vigilancia epidemiológica y entomológica en la comunidad para hacer frente a esta problemática.
Es necesario generar más experiencias que profundicen en la comprensión de los pilares de resiliencia comunitaria, y en la manera en que estos contribuyen a potenciar la participación en salud para enfrentar la enfermedad de Chagas.
Objetivo. Determinar la prevalencia de abuso sexual infantil(ASI) por sexo en adolescentes a partir de la Encuesta Nacionalde Salud y Nutrición 2018-19 y analizar las asociacionescon características ...sociodemográficas, conductas de riesgoe indicadores de salud mental. Material y métodos. Seanalizó el cuestionario para población adolescente (10-19años), se estimaron prevalencias de ASI y se realizó un modelode regresión logística ajustado por variables de interés.Resultados. La prevalencia nacional de ASI es de 2.5% (3.8%mujeres y 1.2% hombres). Entre las mujeres se encontróasociación con la edad, el estado conyugal, el tipo de localidad,el consumo excesivo de alcohol, la sintomatología depresivay los pensamientos suicidas. Entre los hombres, se encontróasociación con el nivel socioeconómico, la sintomatologíadepresiva y los pensamientos suicidas. Conclusiones. Esurgente realizar estudios con mayor precisión y periodicidady garantizar el acceso a los servicios de salud y de justiciaposevento.
Objective. To analyze the prevalence of domestic violence in adult women during confinement derived from the Covid-19 pandemic and individual, familiar and communitarian associated factors. ...Materials and methods. A secondary analysis was carried out the 2020 National Health and Nutrition Survey on Covid-19, with national representation. A logistic regression model adjusted for the variables of interest was performed. Results. The prevalence was 5.8%. The most reported acts were shouting, insults or threats (4.3%). Most of the women who reported some type of violence in the home had already experienced it before the confinement. Low levels of well-being (OR= 1.96, 95%CI: 1.28,2.99), and living in a home where job was lost due to contingency (OR= 1.96, 95%CI: 1.41,2.73) were associated factors. Conclusions. In care interventions, it is necessary to take into account factors that deepen the vulnerability of women, such as pre-existing violence and loss of employment.
Objetivo.
Esta revisión sintetiza la evidencia cuantitativa, general y desglosada por categorías tipológicas de la falta de respeto y maltrato en la atención institucional del parto y el aborto en ...América Latina y el Caribe.
Métodos.
Mediante búsquedas sistemáticas se identificaron 18 estudios primarios. Se calcularon Q e I
2
y se realizaron metaanálisis, metarregresiones y análisis de subgrupos con la aplicación de un modelo de Der Simonian-Laird de efectos aleatorios agrupados con varianza inversa y la transformación arco-seno doble de Freeman-Tukey.
Resultados.
Se identificaron estudios realizados en cinco países de América Latina. No se identificaron estudios del Caribe. La prevalencia agregada de falta de respeto y maltrato durante el parto y el aborto fue de 39%. La medida agregada para este fenómeno durante el parto fue de 43% y la medida agregada en los casos de aborto fue de 29%. La heterogeneidad elevada no permitió generar medidas agregadas según categorías tipológicas. No obstante, se presentan las frecuencias de formas específicas del fenómeno agrupadas tipológicamente.
Conclusiones.
La evidencia sugiere que la falta de respeto y maltrato durante la atención del parto y el aborto son problemas de derechos humanos y salud pública prevalentes en algunos países de la Región. Es necesario lograr consenso internacional sobre la definición y operacionalización de este problema y desarrollar métodos estandarizados para su medición. Lo anterior es imprescindible para el alcance de las metas de la Agenda 2030 relacionadas con la reducción de la morbimortalidad maternoperinatal y la eliminación de todas las formas de violencia y discriminación contra la mujer.
The aim of this study was to identify the prevalence and severity of intimate partner violence (IPV) in eight indigenous regions of Mexico, as well as the socioeconomic and demographic variables that ...are associated with this phenomenon. A cross-sectional study was conducted in indigenous regions that have a greater availability of government medical services than other indigenous regions. Interviews were conducted with female patients (n = 3287) seeking medical care in either of the two public health institutions in these regions. The severity of intimate partner violence (SIPV) during the previous 12 months was measured using a 33-item scale. Multinomial logistic regression analyses were performed to explore the factors associated with SIPV. Intimate partner violence prevalence was 25.5% (95%CI 24.93–25.26). Female partner variables such as personal history of child abuse (ORA 3.48; 95%CI 2.48–4.89) and work outside the home (ORA 1.74; 95%CI 1.22–2.49) and male partner variables such as unemployment (ORA 2.31; 95%CI 1.34–3.97) and a high frequency of alcohol use (ORA 13.35; 95%CI 7.02–25.39) were the main predictors for IPV. We found a three-fold higher risk of IPV for women living in the Los Altos de Chiapas region (ORA 3.01; 95%CI 1.88–4.79) compared with women in the Mayan region (reference category). Such results should aid decision makers in the development of extended public policies and interventions to address violence against women in the indigenous populations of Mexico.
► Specific indigenous regions were found to have different risks for severe intimate partner violence in Mexico. ► A personal history of child abuse and employment outside the home were strongly associated with IPV. ► High frequency of alcohol use and unemployment were highly associated with IPV among indigenous men.
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