Intimate partner violence and perinatal health: a systematic review.

BACKGROUND: Physical, psychological and sexual intimate partner violence (IPV) has been described in the literature as different types of IPV experienced by women during pregnancy all over the world. OBJECTIVES: To review and summarise systematically the empirical evidence on the links between IPV during pregnancy and the perinatal health of mothers and fetuses/neonates. SEARCH STRATEGY: MEDLINE (Ovid), CINAHL, Embase, Nursing@ovid (Ovid) and LILACS were searched (2008-2018). SELECTION CRITERIA: Observational studies that examined perinatal health outcomes (i.e. pre-term birth, low birthweight, miscarriage, perinatal death and premature rupture of membranes) in pregnant women exposed to IPV. DATA COLLECTION AND ANALYSIS: Information on study characteristics, type of IPV measured, study design, methodological quality and outcome variable extracted. RESULTS: Fifty studies were included. Twenty-nine analysed undifferentiated IPV (n = 25 489), 34 included physical IPV (n = 7333), 22 analysed psychological IPV (n = 7833) and 18 examined sexual IPV (n = 2388). Fifteen studies were from Asia, 12 from North America and Oceania, and 12 from Central and South America. The studies examined the association between IPV and 39 different perinatal health outcomes. The most frequent outcomes reported were pre-term birth (50%), low birthweight (46%), miscarriage (30%), perinatal death (20%) and premature rupture of membranes (20%). A significant association with perinatal health outcomes was reported by 12 of the studies analysing undifferentiated IPV, 18 physical IPV, six psychological IPV and two sexual IPV. CONCLUSIONS: The relation between IPV and perinatal health outcomes can be seen in different epidemiological designs and countries. In all, 39 different outcomes were identified and 29 were associated with IPV. TWEETABLE ABSTRACT: A variety of poor perinatal health outcomes are associated with psychological, physical and sexual IPV.

Personal and psychosocial predictors of psychological abuse by partners during and after pregnancy: a longitudinal cohort study in a community sample.

OBJECTIVE: To describe the incidence and risk factors of psychological intimate partner violence (IPV) during pregnancy and the first year after childbirth. DESIGN: Longitudinal cohort study. SETTING: Nine primary care centers in the Valencia Region (Spain). POPULATION: A consecutive sample of 1400 women in the first trimester of pregnancy, attending the prenatal programme in the Valencia Region of Spain in 2008, with follow-up in the third trimester of pregnancy, and at 5 and 12 months postpartum. A total of 888 women (66.5%) participated in all four phases. METHODS: A logistic regression model was fitted using generalised estimating equations to assess the effects of previous partner violence, consumption of alcohol or illicit drugs and social support on subsequent psychological partner violence. MAIN OUTCOME MEASURE: Psychological IPV during follow-up. RESULTS: We observed an increase in the incidence of psychological IPV after birth, particularly at 5 months postpartum. The strongest predictor of psychological IPV was having experienced abuse 12 months before pregnancy (OR 10.46, 95%CI 2.40-45.61). Other predictors were consumption of alcohol or illicit drugs by the partner or a family member (OR3.50, 95%CI 1.38-8.85) and lack of affective social support (OR2.83, 95%CI 1.31-6.11). CONCLUSIONS: Previous abuse and psychosocial risk factors predict partner psychological abuse after birth. Monitoring psychological IPV and effective interventions are needed not only during pregnancy but also during the postpartum period.

[Job stress perceived by hospital medical staff]. / Exigencias laborales psicológicas percibidas por médicos especialistas hospitalarios.

OBJECTIVE: To identify the psychosocial risk factors related to psychological demands perceived by specialist physicians from six public hospitals in the province of Valencia in Spain. METHODS: A qualitative study was carried out. The population studied comprised the hospitals' specialist medical staff (Oncology, Internal Medicine, Traumatology, Radiology and Intensive Care). A trained interviewer performed 47 individual, face-to-face, semi-structured interviews. To select the participants, the following structural variables were taken into account: gender, age, family responsibilities, medical specialty, professional standing, length of service, and type of contract. Interviews were tape recorded and subsequently transcribed. Finally, the content of the interviews was analyzed. RESULTS: The main psychosocial risk factors mentioned by the participants were workload and lack of staff, mainly due to the characteristics of work organization in the hospital. Another job stressor was daily contact with suffering and death, and feeling responsible for human life. Other significant job stressors were interpersonal relations in the work environment, in the case of patients' relatives, uncertainty about diagnosis and treatment, the possibility of being sued for malpractice, and communicating bad news. CONCLUSIONS: Hospital physicians report a large number of psychosocial risk factors. Some involve the characteristics of the medical profession (contact with suffering and death, responsibility for human life, uncertainty about diagnosis and treatment) and others concern work organization (workload and staffing shortages).

[Validation of the Job Content Questionnaire in hospital nursing staff]. / Validación del Job Content Questionnaire en personal de enfermería hospitalario.

OBJECTIVE: The aim of this study was to determine the reliability and construct validity of the three dimensions of the Job Content Questionnaire (JCQ): demand, control and job support among hospital nursing staff. METHODS: The minimun reduced version of the JCQ was used, which include three dimensions: psychological demands (9 items), job control (9 items) and job support (11 items). Validity was assessed in a random sample of 330 nursing staff from two general hospitals in the province of Alicante (Spain). The reliability of the questionnaire was evaluated after re-interviewing a subsample of 50 nurses 15 days after the first interview. Construct validity was evaluated by calculating correlations between the three dimensions of the JCQ obtained after factorial analysis with the burnout scale and six dimensions of the 36-item short-form health survey (SF-36) questionnaire. RESULTS: Factorial analysis revealed that the version of the JCQ validated in this study had the same factorial structure as the original questionnaire. The intraclass correlation between the first and second interview was high for each of the three dimensions (between 0.83 and 0.87). Cronbach's alpha was also high (between 0.74 and 0.88). A moderate but significant correlation was found between the three JCQ dimensions and the burnout scale: (-0,27 for job support, 0.31 for psychological demands and -0.12 for job control). A moderate correlation was also found for some SF-36 dimensions. CONCLUSION: The factorial structure of the JCQ was similar to that proposed by the author in the context of Spanish culture. The reliability and internal consistency of each of the three dimensions was high while construct validity was moderate.

[The rejoining of the workforce of mothers during the first year of life of their child]. / Reincorporación al trabajo de las madres durante el primer año de vida de su hijo.

OBJECTIVES: To study the return to paid work between the 5th and 12th month after the birth of a child depending on socioeconomic and occupational characteristics of employed mothers. Furthermore, to analyse the differences at the time of returning to work (5th or 12th month) according to these characteristics. METHODS: Longitudinal study carried out on a sample of 528 primiparous or secundiparous women who have had a child in a public hospital in the city of Valencia and who have carried out a professional activity during pregnancy. Three cross-sectional cut off points were made; the first two days after childbirth, the second five months later and the third a year after the child was born. The information collection was conducted by means of a questionnaire. Uni and multivariate statistical analysis techniques have been used. RESULTS: Five months after childbirth the probability of returning to work was greater in women who worked with permanent contracts in the private sector (ORadjusted: 7.4) or public sector (ORadjusted: 7.8). Likewise it is higher in service workers (ORadjusted: 2.0), administrative staff (ORadjusted: 2.5) and professionals or technical workers (ORadjusted: 2.9). The probability of returning to paid work a year after childbirth is higher in the mother who works in the public sector with permanent or temporary contracts (ORadjusted: 21.0 and 5.1 respectively) and in the private sector with permanent contracts (ORadjusted: 5.1). It is also higher in service workers (ORadjusted: 2.2), in administrative staff (ORadjusted: 2.7) and professionals or technical workers (ORadjusted: 4.7). CONCLUSIONS: Childbirth may lead to a break in the working career of the woman. The socio-demographic and professional factors which might explain this break are low professional qualifications and unstable employment in private sector companies.

[Validity of the occupational history assessed by interview]. / Validez de la historia professional obtenida por entrevista.

The study was carried out on 114 workers of a large firm in the city of Barcelona. Its objectives were to measure the validity of a questionnaire on professional history, achieved by telephone interviews, using the firm's employee register and to identify the socio-professional characteristics associated with the firm. The validity of the main and secondary occupation (name and length of the occupation) was assessed by company reported information with that in the firm's registry, which was considered as a reference criterion. The validity of the name of the main and secondary occupation was 88% and 74% respectively and the validity of their length was 57% and 64.4% respectively. The validity of professional history, in as much as the name of the main and secondary occupation was high. The validity of their length was low.

[Occupational risk factors in the sectors of economic activity of Barcelona]. / Factores de riesgo laboral en las ramas de actividad económica de Barcelona.

The aim of the present study is to identify and prioritize the most important five occupational risk factors perceived by representatives of workers in each one of the economical activity branches (EAB) in Barcelona, by the Delphi Method. A Delphi survey was carried out for each EAB of Barcelona. 273 trade union delegates (from 21 to 28 by EAB) were consulted the three successive postal interviews. The typical risk factors (noise, toxics, and infections agents) appeared in the first and second place in the printing, food, textile, chemical and health branches of activity. However, risk factors related to work organization were pointed out in the first place in the rest of branches. The use of the Delphi method by the occupational health managers of a geographical area could let, in an easy and fast way, identify and prioritize the risk factors of this area in order to introduce effectiveness prevention measures.

[The expectations of a woman's return to work after childbirth]. / Las expectativas de reincorporación de la mujer al trabajo tras el nacimiento de un hijo.

The objective of this study is to assess the relationship between the decision to return to work during the first year after delivery and socio-demographic and professional factors, as well as the reasons why the decision is made. Data collection was carried out by a personal interview in the hospital, two days after childbirth. 597 primiparous or secundiparous women who had developed a professional activity during pregnancy were interviewed. Uni and multivariate statistical analysis techniques were used. Blue collar workers (ORadjusted = 0.13), administrative staff (ORadjusted = 0.16), women who give up work more than a month before the birth (ORadjusted = 0.33 and 0.28), women without a contract (ORadjusted = 0.19) and temporary workers (ORadjusted = 0.30) were less likely to make the decision of returning to work. According to these results, the continuity of the women in the labour market after maternity is determined to a great extent by the social and employment context where she works; a fact which must be taken into account when putting into practice maternal and child health promotion programmes.

[The mortality of a retrospective cohort of workers in a Spanish iron and steel plant. The methodological problems in defining the cohort]. / Mortalidad de una cohorte retrospectiva de trabajadores de una siderúrgica española. Problemas metodológicos en la definición de la cohorte.

The work environment of an iron foundry involved a large number of exposures related to several health problems, mainly lung cancer. "Altos Hornos del Mediterráneo (AHM)" fron Sagunto is an iron industry that stopped its foundry plant production in 1984. The present paper shows the methodological problems merged during the reconstruction of AHM workers' cohort. From personnel files a male cohort was defined for 7,018 males who worked at least one year and started work between 1950 and 1970, following them through 1991. The cause of death was obtained from de Civil register, Life insurance and reference hospitals. By means of experts the work areas were rated in three exposure levels. 6% of cohort members were lost during the follow-up. 2786 deaths were reported and 88% causes of death were retrieved. The enterprise data files let us to reconstruct the cohort, but the availability of a National Death Index, as there is in other countries would have made easier the job and would have improved the data quality.

[The Spanish version of the "Nursing Stress Scale". A cross-cultural adaptation process]. / La versión castellana de la escala "The Nursing Stress Scale". Proceso de adaptación transcultural.

BACKGROUND: The cross-cultural adaptation of "The Nursing Stress Scale" used to gauge job stressors stress in hospital nursing staff members. METHODS: The translation-back translation method of translating this scale into Spanish and then back into English has been employed, rounded out with qualitative means and methods (focus groups). The original scale was translated in Spanish independently by two bilingual nurses born in Spain who had lived in the United States. In following, the text in question was translated back into English by two U.S.-born translators living in Spain. Two focus groups were formed, one comprised of male and female nurses and other of nurses aides from different units and hospitals. Lastly, a pilot survey was made of 20 professional nurses. RESULTS: The items were ranked by how difficult it was to come up with a phrase in Spanish which would be equivalent in concept to the original one. Fifteen (15) items entailed no problem, 13 entailing an average degree of difficulty and 6 a high degree. Following another translation of the problematical items and the inquiries made to one of the individuals who had written the original scale, a Spanish version was drafted in which 12 items showed two or more alternative versions, which were then assessed in the pilot survey. As a result of the groups, the conclusion was drawn that the types of job stressor perceived by nursing staff are comparable to those included on the original scale, with the exception of the "Break Down of computer" item, which is not applicable to our environment. CONCLUSION: An adapted Spanish version of The Nursing Stress Scale has been drafted, the subsequent assessment of its validity and reliability being required.

[Evolution of fecundity in the Valencian community during the 1975-1990 period]. / Evolución de la fecundidad en la Comunidad Valenciana durante el período 1975-1990.

BACKGROUND: To study the evolution of specific cases of fertility by age groups in the Autonomous Region of Valencia, between 1975 and 1990, and compare this development with the evolution on a national level. METHODS: The specific fertility rates were calculated for seven 5-year age groups within the female fertility period (15-49 years). The number of births per age of mother (Natural Movement of the Spanish Population) has been used and the denominator is the female population calculated be geometrical interpolation from the figures provided by different censuses and electoral roles for each one of the age groups. The study period is 1975 to 1990. RESULTS: The evolution of the fertility rate in the Autonomous Region of Valencia is declining in all age groups except the 30-34 year age group, where fertility showed a slight increase at the end of the eighties, the same as in the rest of the country. Worthy of mentioned is the 15-19 year old group, with figures below the national level, and the 25-29 year old group, where the figures are greater than for the rest of the country as a whole. On a province (county) level, the development is similar to what has been described above. Alicante has the highest figure out of the three provinces (counties) for women in the 15-19 and 35-39 year age ranges. CONCLUSION: The evolution of the fertility rate in the Autonomous Community of Valencia is similar to the development in the rest of the country, a slight increase being detected in women in the 30 to 40 year group, which is similar to what has happened in other European countries.

[Work-related stress factors and the psychological well-being of hospital nurses]. / Estresores laborales y bienestar psicológico impacto en la enfermería hospitalaria.

OBJECTIVE: To analyze the factors which cause stress at work among hospital nursing staff according to their socio-demographic and professional characteristics and their affects on psychological welfare. METHODS: A cross study carried out on a randomly chosen group of 201 nursing professionals composed of nurses and nurses aides from a general public hospital in the city of Valencia. The data was gathered by means of a self-administered questionnaire. To measure the variable response, psychological welfare, The Goldberg General Health 28 item version questionnaire, GHQ-28, was used. Work stress factors were evaluated by means of a scale valid for our cultural environment, Spain,: the Nursing Stress Scale, NSS, which consists of 34 items having a range from 0 to 102. In addition, information about diverse socio-demographic and professional variables were gathered. The authors carried out a simple analysis on all the data obtained. RESULTS: The scores registered on the work stress factors scale were lower for nursing professionals older than 55 and for those who have more than 20 years experience in their service, with a medium of 23.28 (IC 95% = 9.87-54.84) and 25.29 (IC 95% = 11.80-54.22) respectively. On the other hand, the medium was higher for nurses with a medium of 34.16 (IC: 15.29-76.29) in comparison to the score for nurses aides. The total score on the work stress factors scale was higher in the "probable situations" of psychological stress with a medium of 42.40 (IC 95% = 21.35-84.21). CONCLUSIONS: The results of this study demonstrate that a higher level exposure to work stress factors lowers the psychological welfare among nursing staff.

Understanding the relationship of long working hours with health status and health-related behaviours.

BACKGROUND: The objectives of this study are to identify family and job characteristics associated with long work hours, to analyse the relationship between long work hours and several health indicators, and to examine whether gender differences for both objectives exist. METHODS: The sample was composed of all salaried workers aged 16-64 years (3950 men and 3153 women) interviewed in the 2006 Catalonian Health Survey. Weekly work hours were categorised as less than 30 h (part-time), 30-40 (reference category), 41-50 and 51-60 h. Multiple logistic regression models separated by sex were fitted. RESULTS: Factors associated with long working hours differed by gender. Among men, extended work hours were related with being married or cohabiting and with being separated or divorced. In men, working 51-60 h a week was consistently associated with poor mental health status (aOR 2.06, 95% CI 1.31 to 3.24), self-reported hypertension (aOR 1.60, 95% CI 1.12 to 2.29), job dissatisfaction (aOR 2.05, 95% CI 1.49 to 2.82), smoking (aOR 1.33, 95% CI 1.03 to 1.72), shortage of sleep (aOR 1.42, 95% CI 1.09 to 1.85) and no leisure-time physical activity (aOR 2.43, 95% CI 1.64 to 3.60). Moreover, a gradient from standard working hours to 51-60 h a week was found for these six outcomes. Among women it was only related to smoking and to shortage of sleep. CONCLUSION: The association of overtime with different health indicators among men could be explained by their role as the family breadwinner: in situations of family financial stress men work overtime in order to increase the income and/or accept poor working conditions for fear of job loss, one of them being long working hours.

Psychosocial work environment and burnout among emergency medical and nursing staff.

OBJECTIVES: The prevalence of burnout syndrome is increasing among doctors and nurses. The aim of this study was to analyse the relationship between the psychosocial work environment and burnout syndrome among emergency medical and nursing staff in Spain. A secondary aim was to determine if the effect of this psychosocial work environment on burnout was different for doctors and nurses. METHODS: A cross-sectional survey was carried out by means of a mail questionnaire among 945 emergency doctors and nursing staff of Spain. The outcome variable was three dimensions of burnout syndrome [emotional exhaustion (EE), personal accomplishment (PA), depersonalisation (DP)]. The explanatory variable was that psychosocial work environment evaluated according to Karasek and Johnson's demand-control model. The adjusted odds ratios (OR) and their 95% confidence intervals were calculated by logistical regression. RESULTS: The probability of high EE was greater among those exposed to high psychological demands, OR 4.66 (2.75-7.90), low job control, OR 1.65 (1.04-2.63), and low supervisors' social support, OR 1.64 (1.01-2.59). Emotional exhaustion dimension was negatively influenced by low control only among doctors. Those exposed to low job control had a higher risk of low PA, OR 2.55 (1.66-3.94). There was no evidence of negative effect of psychosocial risk factors on the DP. Prevalence of EE and PA was higher among doctors and nurses. CONCLUSIONS: The presence of risk factors derived from work organisation within the work place (psychosocial risk factors) increases the probability of presenting burnout syndrome and, above all, EE.

Nurses' attitudes towards shiftwork and quality of life.

The repercussions on the social and family life of shiftworkers are important. The objectives of this work are to compare the attitudes to permanent and rotating shiftwork, and the impact of shiftwork on social and family life. A cross-sectional epidemiological study was carried out in 606 female and 367 male nurses chosen at random from public hospitals in the Valencian region. Information was gathered by means of a questionnaire, and descriptive analysis was carried out. It can be concluded that workers on rotating shifts who are dissatisfied with their working hours give incompatibility with social and family life as the main reason. Furthermore, working nights (permanently or rotating) disturbs harmony between working hours and days off of the spouse.

Psychological well-being among hospital personnel: the role of family demands and psychosocial work environment.

BACKGROUND: This study investigates the effect of gender role and the psychosocial work environment on the psychological well-being of hospital staff in two general hospitals in the province of Valencia (Spain). METHOD: A cross-sectional survey was carried out among 313 workers by means of a self-answered questionnaire. The outcome variable (psychological well-being) was evaluated with four dimensions of the "SF-36 Health Survey" (mental health, vitality, limitations in the emotional role and limitations in the social function). The explanatory variables were: characteristics related to gender role, professional characteristics and the psychosocial working environment evaluated according to Karasek and Johnson's demand-control-support model. The adjusted odds ratios (ORs) and their 95% confidence intervals were calculated by logistical regression. RESULTS: Those who have very good marital relationship have less risk of presenting bad mental health, OR 0.43 (0.24-0.78), and limitation in the social function, OR 0.43 (0.24-0.77), and in the emotional role, OR 0.35 (0.16-0.74). Those who dedicate more than 30 h a week to domestic chores have a higher risk of limitation of social function, OR 2.48 (1.16-5.31). Those exposed to high psychological demands present a higher probability of having bad mental health, OR 1.77 (1.04-3.00). Those exposed to low job social support have a higher risk of bad mental health, OR 1.86 (1.09-3.19), low vitality, OR 2.21 (1.30-3.77), and limitation in the social function, OR 1.88 (1.10-3.22). CONCLUSION: Gender role and psychosocial work environment have a negative influence on the psychological well-being of hospital staff.