Social inequalities in women exposed to obstetric and gyneco-obstetric violence in Ecuador: a cross-sectional study.

BACKGROUND: Obstetric and gyneco-obstetric violence (OV, GOV) is a concerning public health problem, particularly in Latin America. This study aimed to determine the prevalence of OV and GOV and to assess its socio-geographical distribution in Ecuador. METHODS: This cross-sectional study used data from a national survey conducted in 2019 (n = 17,211) among women aged 15 years and over. Independent variables included age, marital status, education, ethnicity, place of residence and region. The chosen outcomes were lifetime experience of OV and GOV. Frequency tables were calculated and crude and adjusted regression models estimating prevalence ratios and their 95% confidence intervals were computed. RESULTS: Nearly one-third (32.8%) of the participants had experienced OV and two-fifths (41.86%) GOV at least once in their lifetime. Prevalence of OV were particularly common in women 26-35 and 46-55 years old, with primary or middle education and in urban regions. In comparison, GOV had a higher prevalence in women aged > 65 years and with no formal education. Both subtypes of violence were more common among women with current or earlier partners compared with the single ones. Also the two outcomes were more prevalent in the non-white population, OV among the populations of colour (POC), while GOV both, in the POC and Indigenous group. Additionally, women from the Highlands and Amazon reported higher OV and GOV than the Coastal group. CONCLUSION: Our study showed that OV and GOV are common in Ecuador and identified an unequal distribution of their prevalence across different socio-geographical groups. Further studies including more social factors and a continuous monitoring of OV and GOV are recommended. Current policies, laws to protect women and guidelines regarding the treatment of women, particularly in health care settings, need to be constantly advocated for and effectively implemented in the country.

Concepts of race and ethnicity among health researchers: patterns and implications.

OBJECTIVES: This study adds to the discussion of appropriate categories of analysis in health research. We contribute data based on actual interviews about the concepts of race and ethnicity, conducted among a broad range of US health researchers. DESIGN: In-person qualitative interviews were conducted with 73 scientists at two health research institutions, one that focused on public health research, and one that focused on research about a specific disease. This represents a larger and more interdisciplinary sample of health researchers than has been previously interviewed about these topics. RESULTS: We identify a core model of how race and ethnicity are understood. The respondents were confused about the concepts of race and ethnicity and their link to genetic differences between populations; many treated these concepts as interchangeable and genetically based. Although ethnicity was considered somewhat more socially constructed, it was often felt to cause unhealthy behavior. In addition, the situation is not improving; the younger health researchers tended to put a stronger emphasis on the genetic aspects of race than did the older health researchers. CONCLUSION: Unlike reviews of how these concepts are used in scientific publications in which race and ethnicity are often undefined, our face-to-face interviews with these researchers allowed an understanding of their concepts of race and ethnicity. Building on their actual perspectives, these data suggest alternative approaches to formal and continuing educational training for health researchers. We recommend beginning with discussions of human diversity, and then moving on to what race and ethnicity are - and are not.

Sorter de citometría de flujo: repercusiones en los indicadores clave de rendimiento de un laboratorio de reproducción asistida / Flow cytometry sorter: results in the key performance indicators of an assisted reproductive technology

Resumen OBJETIVO: Evaluar si la manipulación de gametos con sorter de citometría de flujo repercute negativamente en los indicadores clave de rendimiento de un laboratorio de reproducción asistida. MATERIALES Y MÉTODOS: Estudio descriptivo y retrospectivo, llevado a cabo en parejas a quienes se efectuó fecundación in vitro mediante inyección intracitoplasmática de espermatozoides (ICSI), con selección espermática, mediante un sorter de citometría de flujo, para selección de sexo. El estudio se efectuó en el New Hope Fertility Center de Guadalajara y Ciudad de México, de junio de 2014 a agosto de 2017. Los resultados se compararon con un grupo control seleccionado al azar. Se evaluaron los indicadores decisivos de rendimiento (KPI´s); tasa de fecundación normal, anormal (1PN, ≥ 3 PN) y fallida; tasa de degeneración posterior a ICSI; tasas de segmentación o división, blastocisto, implantación (segmentación y blastocisto) y recién nacido. Se utilizó la prueba t de Student para dos muestras y se consideró estadísticamente significativo el valor de p < 0.05. RESULTADOS: Se evaluaron 150 ciclos. Grupo 1: ICSI con selección espermática y sorter de citometría de flujo (n = 40); Grupo 2: ICSI sin sorter de citometría de flujo (n = 110). Los indicadores clave de rendimiento del grupo 1 disminuyeron; se reportaron tasas de fecundación fallida de 1.6%, blastocisto 17.4%, implantación en la segmentación 10%, implantación en blastocisto 14.2% y de recién nacido 14.5%. CONCLUSIONES: La manipulación de gametos con sorter de citometría de flujo reportó un efecto negativo en los indicadores clave de rendimiento del laboratorio de reproducción asistida, específicamente en las tasas de blastocisto, implantación de blastocisto y de recién nacido.

Abstract OBJECTIVE: To evaluate if the manipulation of gametes with a flow cytometry sorter has a negative effect on the key performance indicators (KPI´s). MATERIALS AND METHOD: Descriptive and retrospective analysis, in couples undergoing In a Vitro Fertilization (IVF) by ICSI, with sperm selection, using a flow cytometry sorter for sex selection. The study was conducted at the New Hope Fertility Center in Guadalajara and Mexico City, from June 2014 to August 2017. The results were compared with a randomly group without a flow cytometry sorter. KPI´s were evaluated; normal fertilization rate, abnormal (1PN, ≥3 PN), failed fertilization, ICSI damage rate, cleavage rate, blastocyst development rate, implantation rate (cleavage and blastocyst-stage) and live birth rate. A Student's t-test was made for two samples considering significant differences with p < 0.05. RESULTS: 150 cycles were evaluated. Group 1: ICSI with sperm selection by a flow cytometry sorter (n = 40); Group 2: ICSI without sperm selection (n = 110). Observing with statistical significance a decreased of the KPI´s of Group 1: failed fertilization rate (1.6%), blastocyst development rate (17.4%), implantation rate (cleavage-stage) (10%), implantation rate (blastocyst-stage) (14.2%) and live birth rate (14.5%). CONCLUSIONS: The manipulation of gametes with the flow cytometry sorter, has a negative effect on the assisted reproductive technology KPI´s; specifically, in the blastocyst rate, blastocyst implantation rate and live birth rate.

Estudio de las conductas prosociales en niños de San Juan de Pasto / Prosocial Behaviors Study in Children San Juan de Pasto

Resumen Objetivo: El presente artículo es el resultado de una investigación finalizada desarrollada en tres escuelas públicas de San Juan de Pasto. El objetivo general se dirigió a develar las manifestaciones de las conductas prosociales de los niños para el diseño e implementación de una estrategia psico-pedagógica. Método: La metodología se abordó desde el paradigma cualitativo, con un enfoque crítico social, de tipo investigación-acción. El presente artículo corresponde a la fase hermenéu tica de la investigación en donde se emplearon como técnicas de recolección de información: narrativas, entrevistas focalizadas, observaciones participantes y sociodramas. Resultados: Los re sultados indicaron que la empatía puede ser vista como una señal de debilidad o como una cons tante necesaria de interacción; en las conductas de ayuda hay manifestaciones principalmente no altruistas y la cooperación se presenta de manera intermitente según los estímulos ambientales.

Abstract Objective: This paper is the result of a completed research, developed in three public schools in San Juan de Pasto. The general objective aimed to reveal the manifestations of children's proso cial behavior towards the design and implementation of a psycho-pedagogical strategy. Method: The methodology was addressed from the qualitative paradigm, with a critical social approach, action-research type. This article refers to the research hermeneutical stage, in which, as data col lection techniques like narrative, focused interviews, participant observations and social drama were used. Results: The results indicated that empathy can be seen as a sign of weakness or as a necessary constant of interaction; in helpful behaviors, there are mainly no altruist manifesta tions and cooperation occurs intermittently according to environmental stimulation.

Documenting the current state of the healthy municipalities, cities and communities initiative in the americas.

The objective of this study was to document the challenges, achievements, and lessons learned in municipalities where the Healthy Municipalities, Cities and Communities (HMC) strategy has been implemented in the Americas. A general survey was distributed through the HMC online network and through the Pan American Health Organization country offices. Municipalities answered questions regarding the planning, implementation, and evaluation phases of the strategy. Fifty-seven municipalities answered the survey. Ninety-three percent of the municipalities had signed a written agreement of political commitment to the HMC strategy. While 60% of the surveyed municipalities reported having a local health and well being situational analysis, 70% had an HMC Action Plan and only 58% had a follow-up and evaluation plan. The activities in which municipalities are engaged under the banner of the HMC strategy vary greatly in the Americas Region with varying degrees of success. Intersectorial collaboration and evaluation continues to be a challenge for the HMC initiative.

Construcción participativa de indicadores de la implementación del modelo de salud intercultural del cantón Loreto, Ecuador / Participatory construction of indicators of an intercultural health model in Loreto county, Ecuador

Desarrollar indicadores para medir la implementación de un modelo de salud intercultural con la participación de usuarios indígenas y proveedores de salud indígenas y no indígenas. Métodos: Investigación con acción participativa. Estudio de caso del modelo de salud intercultural del cantón Loreto, provincia Orellana, en Ecuador. Resultados: Fueron identificados 32 indicadores agrupados en cuatro dimensiones: comunicación y lenguaje; provisión de servicios; servicios integrados con la cultura local y intercambio de conocimientos y experiencias. Conclusiones: El estudio incorporó puntos de vista indígenas no considerados en la estrategia de salud intercultural nacional y que, en muchos casos, son relacionados con la calidad del servicio más que con un tema de diferencia cultural.

To develop indicators for measuring the implementation of an intercultural health model, with indigenous users and indigenous and non-indigenous health providers. Methods: Participatory action research. A case study of the intercultural health model was conducted in Loreto county, Orellana province, Ecuador. Results: Thirty-two indicators were identified, and divided into four dimensions: communication and language; health services provision; health services integrated with the community's culture and knowledge, and exchange of experiences. Conclusions: This study incorporated point of views of indigenous users and providers that have not been previously considered in the national intercultural health strategy. In many cases, they are related to the quality of service rather than being a matter of cultural difference.