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.

Influence of antiretroviral treatment on quality of life in seropositive inmates.

The aim of the study is to evaluate the influence of antiretroviral treatment on health-related quality of life (HRQOL) of three groups of HIV-positive inmates: those who are taking antiretroviral treatment, those who are not on treatment as it has not yet been indicated, and those who refuse to take treatment even though it has been recommended. A cross-sectional study was conducted on 585 HIV+ inmates in three prisons. The response variable was HRQOL. Independent variables were: sociodemographic variables, psychosocial and drug-related variables. Two multivariate linear regression models were constructed in order to determine the HRQOL, physical health score (PHS) and mental health score (MHS), for each of the three groups identified, using patients who refused treatment as the reference category. Patients who refused therapy had a lower MHS compared with patients in whom treatment was not indicated (P = 0.038). With regard to PHS, patients refusing therapy had a lower score than patients who were not indicated therapy (P = 0.005), and than patients receiving therapy (P = 0.010).

Human immunodeficiency virus (HIV) infection in parenteral drug users: evolution of the epidemic over 10 years. Valencian Epidemiology and Prevention of HIV Disease Study Group.

BACKGROUND: Evaluation of acquired immunodeficiency syndrome (AIDS) prevention strategies requires an on-going follow up of the frequency of human immunodeficiency virus (HIV-1) infection. The aim of this study was to examine the trends in prevalence and incidence of HIV-1 infection among injecting drug users (IDU) during the period 1987-1996. METHODS: Transversal and cohort studies were designed which included a consecutive sample of 7132 IDU who attended three AIDS Prevention and Information Centres in the Region of Valencia (Spain) and voluntarily asked to be tested for HIV antibodies. The prevalence was estimated for each year based on the serological status of HIV-1 when the patient first visited the centre. The annual incidence rates were calculated based on the seronegative patients in which a new determination of HIV-1 was done. In order to control the possible effects on the estimations of age, sex and duration of addiction of the people studied, Poisson and logistic regression models were adjusted. RESULTS: Prevalence and incidence rates of HIV-1 infection showed parallel trends over time. The overall prevalence found was 43.6% (95% confidence intervals [CI]: 42.4-44.7%). Of the 4023 seronegative individuals, 1746 were followed up over the whole of the study period. The incidence rate observed was 6.85 x 100 persons/year (95% CI : 6.04-7.66). The prevalence figures show a decrease, which is most marked from 1990 onwards and then they tend to stabilize over the past few years. The incidence rates increase slightly up to 1991 (9.8 x 100 persons/year), and then begin to decrease. CONCLUSION: Trends of prevalence of HIV-1 infection approximate trends of subjacent incidence rate. Despite decrease in HIV-1 infection frequency observed over 10 years, both the prevalence and incidence figures continue to be high in absolute terms. It is necessary to intensify and adapt preventive measures to each subgroup at risk of infection and in the case of heterosexual transmission ensure that the failure observed in the case of IDU is not repeated.

Associated factors to psychiatric morbidity in postmenopausal phases.

BACKGROUND: The greatest risk of psychiatric morbidity during the climacteric years is linked to a greater exposure to stressful life experiences, women's dissatisfaction with their role in society and to an absence of social backup. The question to be posed now is the extent to which the longitudinal surveys can confirm, refute or complement the results of the cross-sectional analyses. METHODS: A study involving population-based cohorts was carried out on a sample of 120 women who had been previously identified as being premenopausal or menopausal during a cross-sectional examination conducted between 1987 and 1988 within the city of Valencia (Spain). The aims were to analyze the movements of specific psychosocial factors (role satisfaction, level of social support) making a comparison between the premenopausal and postmenopausal phases. RESULTS: An increase in the frequency of psychiatric episodes was detected in the later stages of the climacteric. The absence of global social support, being a possible psychiatric case and experiencing severe life events during the initial phases of the climacteric all emerge as being the most reliable factors for predicting the psychiatric morbidity during the postmenopausal phase. CONCLUSIONS: The results lend weight to the hypothesis of psychiatric morbidity being linked to social changes. A discussion of the clinical implications is presented.

[Variation in the prevention of cardiovascular risk factors. A population-based study]. / Variaciones en la prevención del riesgo cardiovascular: estudio poblacional.

BACKGROUND: Published studies on clinical practice variability have mainly focussed on variability in the rates of hospitalization and surgical procedures. The objective of this study was to evaluate variability in the measurement of cholesterolemia and blood pressure in four professional groups and in the general population. METHODS: A cross-sectional survey was performed by mail in the city of Valencia (Spain). Five population groups were selected: physicians, nurses, lawyers, architects and the general population. The sample was obtained by random sampling of each group. RESULTS: Of all the questionnaires returned, only those returned by individuals surveyed (1,755) and their partners (1,296) were used (total: 3,050). The frequency of preventive cholesterolemia measurement was greater among nurses (55.7%) and physicians (54.1%) than among architects (38.9%), lawyers (38.2%) and the general population (35.1%). The frequency of preventive blood pressure measurement was also greater among physicians (47.7%) and nurses (42.2%) followed by architects (39.4%) and lawyers (38.8%) and was lower among the general population (32.2%). After adjusting by sex, age group, marital status, level of education, and employment, only lawyers (RR = 0.79; 95% CI, 0.6-0.9) and architects (RR = 0.77; 95% CI, 0.68-0.88) showed a significantly lower probability of determining cholesterol levels than physicians (basal category) and nurses (RR = 1.05; 95% CI, 0.93-1.18). The general population showed the lowest probability of measuring blood pressure (RR = 0.8; 95% CI, 0.65-0.97), although the differences were statistically significant only when compared with physicians. CONCLUSIONS: Preventive practices should be increased among groups in which they are less frequently performed until they are performed with the same frequency as among physicians and nurses. Efforts should be directed to increasing cardiovascular prevention programs in health centers.

[The users of centers for AIDS information and prevention in the Comunidad Valenciana, Spain: a study based on cluster analysis]. / Usuarios de centros de información y prevención de SIDA en la Comunidad Valenciana: un estudio basado en el análisis de conglomerados.

OBJECTIVE: To measure the usefulness of multiple correspondence analysis (MCA) and cluster analysis applied to the epidemiological research of HIV infection. The specific are to explore the relationships between the different variables that characterize the users of the AIDS Information and Prevention Center (CIPS) and to identify clusters of characteristics which in terms of the attendance to these centers, could be considered similar. METHODS: The clinical history the CIPS in the Valencian region in Spain was used as data source. The target population target were intravenous drug users (IDUSs) attending these centers between 1987 and 1994 (n = 6211). Information about socio-demographic and HIV type I infection-related variables (drug use and sexual behaviour) was collected by means of a semistructured questionnaire. A MCA was carried out to obtain a group of quantitative factors that were used in a cluster analysis. RESULTS: A 44.8% HIV type I prevalence was found. Five factors were detected by MCA that explain 51.14% of the total variability, of which sex, age and the usual sexual partner were the variables best explained. Cluster analysis allowed to describe 5 different subgroups of CIPS users according to their socio-demographics characteristics, risk behaviours and serologic status. It is necessary to highlight the categories 1 and 2, which collect the serologic status and the most relevant characteristics of HIV infection. Category I contains users with a negative serology and characterized by being mainly single adolescent men, with a low educational level; they stated that they have no steady sexual partner, do not share syringes and have been intravenous drug users between 3 and 10 years. They mainly come from the city of Alicante. Category 2 contains mainly people that are HIV positive and older. They also share syringes and have been intravenous drug users for a longer time; they have a higher education level and most of them come from the city of Valencia. CONCLUSIONS: The proposed method of analysis was able to characterise the CIPS users, identifying those socio-demographic variables and risk behaviours that are more related to the serologic status. The applicability of these techniques to epidemiologic studies of HIV type I infection is discussed.

[The work situation and mental health. The results of a cross-sectional study]. / Situación laboral y salud mental. Resultados de un estudio transversal.

The aim of the study is to assess the relationship between employment situation and mental health in the city of Valencia. Between May and July of 1992, a cross sectional study by means of personal interviews was carried out. The total sample was 411 people of these 101 were selected through a random sampling of the working population, the rest (310) consisted of people registered with INEM selected through a predetermined sampling according to age and sex. The variable dependent (psychological morbidity) was measured through the General Health Questionnaire (GHQ) consisting of 28 items. The results obtained show that 36.4% of the unemployed sample displayed psychological morbidity as opposed to 23.3% of those is employment (p = 0.01). The prevalence Odds Ratio (OR) was calculated by means of a logistic regression model. Those in causal employment had a OR of 8.62 (95% CI = 2.66-27.9) as opposed to those in regular employment after adjusting for age, sex and professional status. Those that had been unemployed for more than a year had a OR of 16.02 (95% CI = 4.60-55.75) as opposed to those employment after adjusting for the same variables. These results seem to confirm a greater psychological morbidity among those with casual employment and the unemployed as opposed to those in regular employment although the transversal design of the study does not highlight any relation of casualty that might exist among the variables.

[The mortality trend in suicides in Andalucía from 1976 to 1995]. / Tendencia de la mortalidad por suicidios en Andalucía desde 1976 a 1995.

OBJECTIVE: To describe trends in mortality from suicide among people older then 14 years of age in Andalucía, Spain, from 1976 to 1995, with reference to age, sex, marital status and method of suicide. METHODS: With deaths from suicide and the populations of Andalucía, the following indicators were computed: crude and age-adjusted rates by gender, year of death and marital status; age-adjusted rates of years of potential life lost by year of death and marital status. Poisson regression models were obtained to analyze time trends. RESULTS: Mortality from suicide has experienced an important increase, mainly in men, changing from rates of 13,66 to 18,19 deaths per 100,000 person-years. In women, the increase has been much slighter, from 3,81 to 4,36 deaths per 100,000 person-years. The largest increase has occurred among young males and, to a lesser extent, in the oldest groups, both in males and females, although the rates increase with age. The two main methods of suicide, both in males and females, were hanging and jumping, with the highest frequency occurring among widowers, followed by single and divorced persons, while married people were in the last position. CONCLUSIONS: In a situation of generalized increase in mortality from suicide in Andalucía in the study period, important differences were found by sex, age and marital status.

A systematic review of evidence on the association between cocaine use and seizures.

BACKGROUND: Institutional monographs/medical textbooks mention seizures as a neurological complication of cocaine, but no systematic reviews (SRs) have been published on this issue. We aimed to conduct a SR of the literature on the relationship between cocaine use and seizures and to summarize the biological plausibility of that relationship. METHODS: The pathophysiological mechanisms that may underlie an association between cocaine and seizures were summarized; a SR was then performed using three databases (EMBASE, Medline, PsycINFO) and the Cochrane-library to search for published papers (1980-2012) aimed at quantifying the associations between cocaine use and seizures. The inclusion criteria for selection were: articles based on clinical trials, cohort, case-control (CC) or cross-sectional (CS) studies, participants ≥ 14 years old and not pregnant, and use of cocaine in the last 72 h. Information was extracted, evaluated and cross-checked independently by two researchers. RESULTS: Of the 1243 potentially relevant articles initially identified; one CC and 22 CS studies were finally selected. The CC study did not find cocaine use to be a risk-factor for seizures. In addition to the limitations of the CS design, these studies had important methodological weaknesses and biases. CONCLUSIONS: Despite its biological plausibility, no rigorous scientific evidence supports a causal relationship between cocaine use and seizures. The misinterpretation of the role of cocaine may have important implications in medical services. Well-conducted studies are urgently needed.

Do social inequalities exist in terms of the prevention, diagnosis, treatment, control and monitoring of diabetes? A systematic review.

The major increase in the prevalence of diabetes mellitus (DM) has led to the study of social inequalities in health-care. The aim of this study is to establish the possible existence of social inequalities in the prevention, diagnosis, treatment, control and monitoring of diabetes in Organisation for Economic Co-operation and Development (OECD) countries which have universal healthcare systems. We searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews for all relevant articles published up to 15 December 2007. We included observational studies carried out in OECD countries with universal healthcare systems in place that investigate social inequalities in the provision of health-care to diabetes patients. Two independent reviewers carried out the critical assessment using the STROBE tool items considered most adequate for the evaluation of the methodological quality. We selected 41 articles from which we critically assessed 25 (18 cross-sectional, 6 cohorts, 1 case-control). Consistency among the article results was found regarding the existence of ethnic inequalities in treatment, metabolic control and use of healthcare services. Socioeconomic inequalities were also found in the diagnosis and control of the disease, but no evidence of any gender inequalities was found. In general, the methodological quality of the articles was moderate with insufficient information in the majority of cases to rule out bias. This review shows that even in countries with a significant level of economic development and which have universal healthcare systems in place which endeavour to provide medical care to the entire population, socioeconomic and ethnic inequalities can be identified in the provision of health-care to DM sufferers. However, higher quality and follow-up articles are needed to confirm these results.

[Patients who refuse antiretroviral treatment in prison]. / Pacientes que rehúsan el tratamiento antirretroviral en el medio penitenciario.

INTRODUCTION: Current studies of HIV+ patients in the prison population have been carried out without considering differences that might exist between patients who accept retroviral treatment and those who do not. One possible reason for this may be the difficulty in gaining access to patients who refuse antiretroviral treatment. However, the prison environment makes it possible to locate and study this type of patient, who up till now has not been the subject of study. The aim of this article is to describe the clinical and psychosocial state of HIV+ inmates who refuse ARVT and compare this data with patients receiving treatment and others for whom treatment has not been indicated. METHODS: Cross-sectional study using 585 HIV+ inmates in three prisons in Andalusia from May to June 2004. Refusal, acceptance and non-indication of ARVT treatment was the grouping variable used. The independent variables were socio-demographic, psychosocial, clinical and other variables relating to the prison environment. RESULTS: 16.8% of patients refused ARVT, while 56.3% were receiving treatment and another 26.8 were not indicated for any medication. Amongst the patients that refused ARVT there was a greater prevalence of HIV co-infection, higher inprison consumption of opiates and methadone treatment, more cases pending and higher rates of recidivism. CONCLUSIONS: these results highlight the existence of a group with unique characteristics that is accessible thanks to the special conditions within the prison environment. It is a group that chooses not to follow therapeutic indications and which represents a risk factor not only for its own health, but also for the community at large.

[Differences in sociodemographic, clinical, psychosocial and health care characteristics between men and women diagnosed with fibromyalgia]. / Diferencias en características sociodemográficas, clínicas y psicológicas entre hombres y mujeres diagnosticados de fibromialgia.

INTRODUCTION: Health differences between men and women are determined by biological differences although health services often contribute to gender inequalities. Very few studies that analyze gender differences have been made up to date in these patients. This study aims to analyze sociodemographic, clinical and psychosocial differences between men and women diagnosed with FM and to examine the differential impact of their symptoms on their usual activities, including work environment, and the response these patients obtain from the health care system. MATERIAL AND METHODS: A descriptive cross-sectional survey was carried out with all the patients diagnosed with FM in 2003 in three clinics rheumatology units of a university hospital in Spain. RESULTS: The sociodemographic characteristics were very similar in men and women. However, there was a greater proportion of men diagnosed with FM on sick leave, compared to women with the same diagnosis. Men had a worse perception of their health, a higher percentage of psychiatric history and current mental illness and more impact of the disease. DISCUSSION: This is one of the first studies in Spain examining the differences between men and women diagnosed with FM. The results obtained in this study corroborate that, as in other diseases, there are gender differences in the clinical and psychosocial characteristics of men and women diagnosed with FM.

[Progress of clinical parameters amongst prison inmates receiving antiretroviral treatment]. / Evolución de los parámetros clínicos en reclusos en tratamiento antirretroviral.

INTRODUCTION: Among HIV positive patients the CD4 lymphocyte count, especially the viral load, are the best predictors for progress to full blown AIDS or death. OBJECTIVE: To analyze the factors associated with progress of the CD4 lymphocyte count and viral load in prison inmates in antiretroviral treatment. METHODS: A fixed cohort study was conducted with HIV positive inmates receiving antiretroviral therapy in three Spanish prisons. Adherence to antiretroviral treatment was assessed with the SMAQ questionnaire. To analyze the progress of CD4 and viral load clinical parameters, two fixed effect multilevel linear regression models were utilised. RESULTS: 10% of the sample were women, 42% referred for anxiety or symptoms of depression in the final week, and 46.6% reported having social support inside the prison. CD4 and viral load clinical parameter means were 2.48 and 2.89 respectively, and 38.6% had an undetectable viral load. A negative correlation between viral load and CD4 lymphocyte count (p<0.001) was found. Those inmates who did not present psychological morbidity showed a significant reduction in plasma viral load (p=0.017). CONCLUSIONS: The results of this study show the relevance of psychosocial factors in the immune system.

Women's autonomy and the evaluation of the information available on the Internet on hormone therapy after menopause.

This study was designed to examine the information in Spanish, provided by different Web sites, related to hormone therapy and climacteric symptoms. Web sites evaluated included those belonging to government and scientific institutions and to a miscellaneous group. In Web sites in Spanish, there was more extensive information on the benefits of hormone therapy than there were on other items. The Web sites of governmental institutions provided significantly more information on the risks (P < .01) and benefits (P = .02) of hormone therapy than did the other sites. Governmental institutions from the United States, unlike those from Spain, did not make recommendations regarding when hormone therapy should be considered and instead emphasized the woman's decision. The variability of information in Spanish on hormone therapy and postmenopausal symptoms presented on the Internet is related to the organization responsible for the Web site. Besides, cultural differences in the concept of patient autonomy could partly explain the differences in emphasis made on women's role in the decision-making process.

[Mental morbidity and social support in prisoners in treatment with antiretrovirals]. / Morbilidad psíquica y apoyo social en reclusos en tratamiento con antirretrovirales.

OBJECTIVE: To define the incidence of depressive disorders and anxiety disorders in prisoners of three prisons of CCAA in treatment with antiretrovirals, and moreover the associated variables and the intensity of social support within the prison. METHODS: Through a cross-sectional design 281 prisoners were studied. RESULTS: 42% showed mental morbidity and 53.4% lacked social support. To be imprisoned in the Granada prison, to be a woman, poor health state, to describe difficulties for compliance with antiretrovirals drug, a history greater than 13 years for drugs consumption, and usual residence with the couple of family, all were factors associated with mental morbidity. Factors associated with social support non-existence were history of more than one imprisonment, lack of familiarity with the medical equipment, to be more than 35 years old, and to suffer mental morbidity.

Health-related quality of life of patients with HIV: impact of sociodemographic, clinical and psychosocial factors.

OBJECTIVES: This study aims to analyse how a wide group of clinical, social, demographic and psychological factors are related to both physical and mental quality of life in HIV + patients. DESIGN: A cross-sectional study was carried out of 320 HIV + patients in antiretroviral treatment who attended infectious diseases units in four hospitals in the region of Andalusia (Spain). METHODS: Health-Related Quality of Life was measured by the MOS-HIV. Included as independent variables were: sociodemographic variables, variables related to antiretroviral therapy, psychosocial variables like social support (Duke-UNC-11) and psychological morbidity (GHQ-28), variables related to main risk behaviours and clinical variables. RESULTS: In the multiple linear regression analysis, a better PHS quality of life was found to be associated with the absence of mental illness, social support, not being an intravenous drug user and using more than one type of non-injectable drug. A better quality of life, in mental terms, was found to be associated with fewer years as a non-intravenous drug user, having social support, absence of mental illness, not being an intravenous drug user taking only one additional pill, not having any difficulty in taking the medication, and being female. CONCLUSIONS: The study of other non-biological factors that may be related to quality of life has been limited practically to social support and the emotional state. This study highlights the importance of these factors independently from the clinical state, as well as the existence of other psychological and behavioural factors that are also related.

Social adjustment in schizophrenia: factors predictive of short-term social adjustment in a sample of schizophrenic patients.

A sample of 60 Spanish schizophrenic patients was studied in order to ascertain the relationship between their relatives' expressed emotion (EE) and social adjustment after 2 years of follow-up. The average extent of the disability did not increase over time, and differences in dysfunction rates between the various specific social roles were identified. No differences in social outcome were detected between patients with high EE and low EE families. Three factors which predict social adjustment outcome were obtained using logistic regression analysis, namely clinical conditions, baseline social adjustment and the occurrence of a psychotic relapse during the follow-up period.