Impact of accidental and intentional injuries in Mexico. Findings of the Global Burden of Disease study for 1990 and 2021.

BACKGROUND: Previous analyses on the burden of disease in Mexico identified that injuries differentially affect young people, males and working-age people. OBJECTIVE: To analyze the burden of disease due to intentional and unintentional injuries in Mexico during 1990 and 2021, at the national and state levels. MATERIAL AND METHODS: The results of the Global Burden of Disease study for the 1990-2021 period were used to describe the burden of disease attributed to injuries in Mexico. The life years lost (YLL) due to premature mortality, years lived with disability (YLD) and disability-adjusted life years (DALY) were analyzed. RESULTS: The burden of disease related to intentional injuries has increased, as also have YLDs and DALYs associated with unintentional injuries. Men continue to have higher mortality and DALY rates compared to women. Interpersonal violence and suicide have steadily increased. The analysis by state showed patterns with important variations. CONCLUSIONS: Injuries generate catastrophic consequences in terms of mortality and disability in Mexico. It is necessary to promote and strengthen programs and policies in order to improve the data system and injury prevention.

ANTECEDENTES: Análisis previos sobre la carga de la enfermedad en México identificaron que las lesiones afectan de manera diferenciada a hombres, personas jóvenes y en edad productiva. OBJETIVO: Analizar la carga de la enfermedad por lesiones intencionales y no intencionales en México durante 1990 y 2021 en los ámbitos nacional y estatal. MATERIAL Y MÉTODOS: Se utilizaron los resultados del Global Burden of Disease respecto al período 1990-2021 para describir la carga de la enfermedad por las principales causas de lesiones en México; se analizaron los años perdidos por muerte prematura (APMP), los años vividos con discapacidad (AVD) y los años de vida saludable perdidos (AVISA). RESULTADOS: La carga de la enfermedad relacionada con lesiones intencionales se ha incrementado, al igual que los AVD y AVISA por lesiones no intencionales. Los hombres continúan presentando tasas de mortalidad y AVISA más altas comparados con las mujeres. La violencia interpersonal y el suicidio se han incrementado de manera sostenida El análisis por estados mostró patrones con variaciones importantes. CONCLUSIONES: Las lesiones generan consecuencias catastróficas en términos de mortalidad y discapacidad en México. Es indispensable impulsar y reforzar los programas y políticas para mejorar el sistema de datos y la prevención de lesiones.

Living Conditions of Adolescents Who Have Attempted Suicide in Mexico.

Suicidal behavior represents a complex public health problem, with a rising number of suicide attempts registered among Mexican adolescents. We undertook a qualitative study in order to understand the living conditions of adolescents who had attempted to take their lives in five Mexican states. We interviewed 37 adolescents who had engaged in suicide attempts in the year prior to our study. To code and analyze the information, we defined the following three categories of living conditions as social determinants of health for adolescents: poverty and vulnerability, education, and health care. To this end, we followed the methodology proposed by Taylor and Bogdan, and used Atlas.ti 7.5.18 software for analyses. Among our findings, we noted that poverty, manifested primarily as material deprivation, rendered the daily lives of our interviewees precarious, compromising even their basic needs. All the young people analyzed had either received medical, psychological, and/or psychiatric care as outpatients or had been hospitalized. School played a positive role in referring adolescents with suicidal behavior to health services; however, it also represented a high-risk environment. Our findings highlight the urgent need to implement a national intersectoral strategy as part of comprehensive public policy aimed at improving the health of adolescents in Mexico.

Unintentional injuries in Mexico, 1990-2017: findings from the Global Burden of Disease Study 2017.

BACKGROUND: To date, the burden of injury in Mexico has not been comprehensively assessed using recent advances in population health research, including those in the Global Burden of Disease Study 2017 (GBD 2017). METHODS: We used GBD 2017 for burden of unintentional injury estimates, including transport injuries, for Mexico and each state in Mexico from 1990 to 2017. We examined subnational variation, age patterns, sex differences and time trends for all injury burden metrics. RESULTS: Unintentional injury deaths in Mexico decreased from 45 363 deaths (44 662 to 46 038) in 1990 to 42 702 (41 439 to 43 745) in 2017, while age-standardised mortality rates decreased from 65.2 (64.4 to 66.1) in 1990 to 35.1 (34.1 to 36.0) per 100 000 in 2017. In terms of non-fatal outcomes, there were 3 120 211 (2 879 993 to 3 377 945) new injury cases in 1990, which increased to 5 234 214 (4 812 615 to 5 701 669) new cases of injury in 2017. We estimated 2 761 957 (2 676 267 to 2 859 777) disability-adjusted life years (DALYs) due to injuries in Mexico in 1990 compared with 2 376 952 (2 224 588 to 2 551 004) DALYs in 2017. We found subnational variation in health loss across Mexico's states, including concentrated burden in Tabasco, Chihuahua and Zacatecas. CONCLUSIONS: In Mexico, from 1990 to 2017, mortality due to unintentional injuries has decreased, while non-fatal incident cases have increased. However, unintentional injuries continue to cause considerable mortality and morbidity, with patterns that vary by state, age, sex and year. Future research should focus on targeted interventions to decrease injury burden in high-risk populations.

[Therapeutic adherence to retraining programs for women and men involved in abusive relationships in Mexico]. / Adherencia terapéutica a programas de reeducación para mujeres y hombres en relaciones de pareja violentas.

OBJECTIVE: To analyze the therapeutic adherence among participants in the retraining program operated by the Ministry of Health of Mexico, in eight states in 2010. MATERIALS AND METHODS: This is a cross-sectional and descriptive study that assesses therapeutic adherence in a retraining intervention program for male perpetrators and female victims of intimate partner violence. The intervention was coordinated by a team of previously trained professionals. The selection of participants was made by means of a specific screening test. Overall performance for both groups was analyzed, and based on the attendance they were classified in low adhesion (1-12) medium to high (13 and>). To determine the possibility of adhesion, Student's t tests, a bivariate analysis, and a logistic regression model were performed for each program. RESULTS: 5 539 screenings were applied, of which 88.3% (n = 4 891) were positive. 85% agreed to participate (n = 4 151), but only 75% of potential participants attended at least one session (n = 3 022). 78.5% attended between 1-12 sessions. In the women's program, significant differences in marital status, religion and age groups (p<0.05) were found. In the program for men, significant differences in religion and age groups (p<0.05) were found. CONCLUSIONS: In the Mexican context there are few studies that assess adherence to programs of care and retraining for partner violence. This study is a first approach that opens the possibility to enhance the design and evaluation of such interventions, which are crucial to dismantle violence against women.

Adherencia terapéutica a programas de reeducación para mujeres y hombres en relaciones de pareja violentas / Therapeutic adherence to retraining programs for women and men involved in abusive relationships in Mexico

Objetivo. Analizar la adherencia terapéutica en participantes de un programa de reeducación operado por los servicios estatales de salud en ocho estados de México en 2010. Material y métodos. Estudio transversal y descriptivo que evaluó la adherencia terapéutica de un programa de reeducación para hombres agresores y mujeres víctimas de violencia de pareja. La intervención fue coordinada por un equipo de profesionales previamente capacitados. La selección de los participantes se realizó con el cumplimiento estricto de criterios de inclusión/exclusión evaluados por una prueba de tamizaje. Con base en la asistencia, se clasificó en adherencia baja (1 a 12), media-alta (13 y más). Se realizó una prueba de t student, un análisis bivariado y un modelo de regresión logística para identificar la posibilidad de adherencia en cada programa. Resultados. Se aplicaron 5 539 tamizajes, 88.3% (n=4 891) fueron positivos; 85%(n=4 151) aceptó participar, 75% de los potenciales participantes asistió al menos a una sesión (n=3 699), siendo ésta la muestra del presente estudio. En el programa para mujeres hubo diferencias significativas por estado civil, religión y grupos de edad (p<0.05). En el programa para hombres hubo diferencias significativas por religión y grupos de edad (p<0.05). Conclusiones. En México son inexistentes los estudios que evalúan la adherencia a los programas de atención a la violencia; este estudio es una primera aproximación que abre la posibilidad de profundizar en el diseño y evaluación de este tipo de intervenciones, cruciales para desarticular la violencia contra las mujeres.

Objective. To analyze the therapeutic adherence among participants in the retraining program operated by the Ministry of Health of Mexico, in eight states in 2010. Materials and methods. This is a cross-sectional and descriptive study that assesses therapeutic adherence in a retraining intervention program for male perpetrators and female victims of intimate partner violence. The intervention was coordinated by a team of previously trained professionals. The selection of participants was made by means of a specific screening test. Overall performance for both groups was analyzed, and based on the attendance they were classified in low adhesion (1-12) medium to high (13 and>). To determine the possibility of adhesion, Student's t tests, a bivariate analysis, and a logistic regression model were performed for each program. Results. 5 539 screenings were applied, of which 88.3% (n = 4 891) were positive. 85% agreed to participate (n = 4 151), but only 75% of potential participants attended at least one session (n = 3 022). 78.5% attended between 1-12 sessions. In the women's program, significant differences in marital status, religion and age groups (p<0.05) were found. In the program for men, significant differences in religion and age groups (p<0.05) were found. Conclusions. In the Mexican context there are few studies that assess adherence to programs of care and retraining for partner violence. This study is a first approach that opens the possibility to enhance the design and evaluation of such interventions, which are crucial to dismantle violence against women.

Prevalence and severity of intimate partner violence in women living in eight indigenous regions of Mexico.

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.

[A review of health-service use (1996-2006 )]. / Revisión sobre la Utilización de Servicios de Salud, 1996-2006.

OBJECTIVE: Reviewing research papers published during 1996-2006 regarding ontological, methodological and epistemological proposals regarding the use of health services. MATERIAL AND METHODS: Pub Med was screened for identifying the most relevant research carried out to date in the field. The key words were used. RESULTS: 34 papers were included in the final analysis. 70 ,6 % referred to health service use in the USA ; 30 % analysed the socially disadvantaged population, focusing mainly on visits to the doctor (50 %). 31 papers (91,2 %) used a quantitative approach; the most studied variables in this approach regarded the individual (90,4%) the context (45,2 %) and the health system (41,9 %). The quantitative approaches used multiple regression for their statistical analysis; only 19 ,4 % of them incorporated more complex statistical models for analysing health service use. Qualitative studies analysed both discourse and content. CONCLUSIONS: The findings reflected how the nature of health service use becomes reduced to using objective terms which necessarily tend to hide that such use is dealing with social integration. A wider perspective is needed for tackling health service use. Complementary (qualitative-quantitative) approaches provide different results helping to shape an integral vision of the same problem .

Revisión sobre la utilización de servicios de salud, 1996-2006 / A review of health-service use (1996-2006)

Objetivo Revisar, en artículos publicados durante el período 1996-2006, cuáles son los supuestos ontológicos, metodológicos y epistemológicos prevalentes en los estudios de la utilización de servicios de salud. Material y métodos Para asegurar la identificación de estudios relevantes se realizó la búsqueda de los artículos indexados en la base de datos PubMed. Resultados Un total de 34 artículos fueron incluidos en el análisis final. El 70,6 por ciento fueron realizados en Estados Unidos de América, 30 por ciento trató con población en desventaja social y el objeto de análisis más frecuentemente estudiado fue la visita médica (50 por ciento). Treinta y un estudios (91,2 por ciento) abordaron el problema de estudio desde la aproximación cuantitativa y tres desde la cualitativa. Las variables más estudiadas desde la perspectiva cuantitativa fueron las del individuo en 90,4 por ciento de los estudios, seguidos de las variables del contexto (45,2 por ciento) y del sistema de salud (41,9 por ciento).Los análisis estadísticos de los estudios de corte cuantitativo se realizaron utilizando modelos de regresión múltiple y sólo 19,4 por ciento de los análisis incorporaron modelos que captan la complejidad del fenómeno de la utilización. Análisis del discurso y de contenido fueron realizados en los estudios cualitativos. Conclusiones Los hallazgos reflejan el carácter reducible del fenómeno de la utilización a términos objetivos y necesariamente tiende a oscurecer que la utilización es una es una practica social integradora. Se requiere una perspectiva más amplia para abordar el fenómeno de la utilización. El uso de aproximaciones cuantitativas y cualitativas nos arroja resultados distintos que ayudan a configurar una visión integral de una misma problemática.

Objective Reviewing research papers published during 1996-2006 regarding ontological, methodological and epistemological proposals regarding the use of health services. Material and Methods Pub Med was screened for identifying the most relevant research carried out to date in the field. The key words were used. Results 34 papers were included in the final analysis. 70 ,6 percent referred to health service use in the USA ; 30 percent analysed the socially disadvantaged population, focusing mainly on visits to the doctor (50 percent). 31 papers (91,2 percent) used a quantitative approach; the most studied variables in this approach regarded the individual (90,4 percent) the context (45,2 percent) and the health system (41,9 percent). The quantitative approaches used multiple regression for their statistical analysis; only 19 ,4 percent of them incorporated more complex statistical models for analysing health service use. Qualitative studies analysed both discourse and content. Conclusions The findings reflected how the nature of health service use becomes reduced to using objective terms which necessarily tend to hide that such use is dealing with social integration. A wider perspective is needed for tackling health service use. Complementary (qualitative-quantitative) approaches provide different results helping to shape an integral vision of the same problem.

¿Cuándo utilizan servicios de salud las mujeres que viven en condiciones de violencia de pareja?

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Abstract: Introduction Violence is recognized as a Public Health problem around the world. In the specific case of Intímate Partner Abuse, which occurs at home, women are particularly vulnerable to be abused by their partners. In Mexico, as in other countries in Latin America, the systematic study of violence towards women is incipient. However, it is a highly predominant problem, which has a big impact on women's health, and represents a significant challenge to the Health System demanding health care due to intentional injuries. This paper analyzed information generated by the first National Survey of violence against women in 2003 (ENVIM, by his name in Spanish). Objective The main objective is to identify the factors associated with the health services utilization by women, because of partner abuse. Methodology A cross-sectional design was used, including women users of health care services on public institutions all over the country in 2003. Intimate partner abuse was defined as "the repetitive event of abuse from the male partner side towards the woman, that is characterized by coercive conducts that could include physical, emotional or sexual violence". It was measure in a scale of 27 items, using the Index of Spouse Abuse (ISA) and the Severity of Violence against Women Scale (SVAWS). Both indexes were vali-dated previously in Mexican population. A factorial analysis was used and the factors that explain the variability were obtained. The selection of women to be interviewed was done using a probabilistic stratify biethapic sample. For the first one, medical unites were selected, and for the second, women over 14 years old who went to those medical unities to demand any kind of health care services. The ethic considerations were resolved using the next procedures: participants received information about the research objectives and signed an informant consent letter endorsed by the ethical committee of the Institution. They also received a brochure with information about the local institutions where they can go in case of abuse. Interviewers trained in technical areas as well as abuse management using a questionnaire on private spaces did the data collection. The answer rate was of 98%. The analyzed variables were Socio demographic, search of support on the health staff or reasons for not doing this. An index of socio-economic level categorized as very low, medium and high. Type of institution and services used. The dependent variable was utilization of the health services to attend the injuries due to a partner abuse event, during the last 12 months. The analysis used was simple and bivariate using chi square, and binary logistic regression model. The final model included the variables that in the binary showed a value of p<0.25. We ad-justed the model using the Goodness of Fit Test of Pearson. Results From 24,958 women that utilized public health services 21% reported to have had a partner abuse event in the last year. From these, only 7.3% utilized health services. The more important variables were: age between 25 to 34 years old, elementary schooling and women having a job. Of the sample 94% belong to the very low and medium socio-economic levels; almost half of them (47%) do not have health insurance. More than 80% have a partner at present; 7.6% reported severe violence. From those who had injuries, 72% declared to have had just one minor injury (bruises, body aches), 25.5% reported more than one type of injuries, from which 10.8% were severe and required surgery or hospitalization. The type of injuries that demand more utilization of health services were those subsequent to sexual abuse as genital infection and genital bleeding. Only 45% of the women users' report to have medical insurance. Less than 6% of abused women talked with the health staff about their abuse situation and the main reason was the lack of trust. The factors associated to the utilization of health services were ages over 24 years(ORA 1.57, CI 95% 1.9 - 2.06) alcohol intake by the women (ORA =1.66 CI 95% 1.57-1.75) High Socio economic status (ORA =1.29 CI95% 1.07-1.54). The model was adjusted by severity index and to having medical insurance. There were not significative interactions (p>0.15) and the global adjusted model was p= 0.23. Discussion and conclusions There is a low percentage of abused women injured that utilize formal medical care. This is a very important result for the identification of prevention and control strategies of the partner abuse problem in the health services. The study shows the existence of different types of injuries or medical problems such as genital infections and bleedings, fainting spells, body aches that provoked on one hand that women did not seek medical attention immediately and on the other that the health staff could not identify this kind of health problems with intimate partner abuse. There is a group of more vulnerable women who do not use health services to take care of the consequences of abuse, because they are uninsured. This inequality reveals that it is urgent to provide support services to poor women in the country. The finding about the difficulty for battered women to report their injuries to the health staff because of their lack of trust, agrees with different studies that report the different obstacles found by abused women in facing the health services. The last situation reveals the obstacles to be solved for the NOM implementation too. It is important to mention the study limitations related with the design utilized, and the selection bias due to the inclusion only of users of services. This situation leaves at one side women with less resources, who confront big obstacles for the utilization of health services, and at the other, women from high socio-economic levels, who utilize private health services; therefore there is no accuracy the point out differences. The way in which the question about the utilization of health services was made, makes it difficult to know the number of times these were used. This variable must be explored in future studies. The information generated by the ENVIM allows the Health Sector to define identification-attention strategies of battered women and provides information about the importance of training the health staff to generate trust among in partner-abused women.

[Violence and pregnancy in female users of Ministry of Health care services in highly deprived states in Mexico]. / Violencia y embarazo en usuarias del sector salud en estados de alta marginación en México.

OBJECTIVE: To characterize intimate partner abuse and identify the main factors associated with violence in pregnancy in four highly deprived States in Mexico. MATERIAL AND METHODS: The data were taken from the National Survey on Violence against Women 2003 (ENVIM per its abbreviation in Spanish). Based on it a cross-sectional study was conducted on 1 949 women between 15 and 50 years of age, who were once pregnant and who utilized primary and secondary health care services from the Ministry of Health, Mexican Institute of Social Security, and the Institute for Social Security and Services for State Workers in Guerrero, Hidalgo, Oaxaca and Chiapas states, between November 2002 and March 2003. Logistic regression was used to assess the association between independent variables and violence during pregnancy. RESULTS: 250 women (13%) suffered a type of violence (physical, psychological, sexual or economical) during any of their pregnancies. Of these women 76 (30.40%) were battered on their abdomen. In most of these cases (91.39%) the husband was the aggressor. The variables significantly associated with violence in pregnancy were: woman's illiteracy (OR 2.2; CI 95:% .1,4.4); history of violence in childhood (OR 3.2; CI 95% 1.9, 5.4) as well as sexual abuse in her childhood (OR 2.4, CI 95% 1.3, 4.4) and her partner's daily alcohol consumption (OR 6.5; CI 95% 3.3, 12.9). CONCLUSIONS: The results show that violence during pregnancy is a regular event in the impoverished context and that its expression is more severe. These results point to the importance of continued study of the problem of violence against pregnant women in Mexico and the importance of identifying battered women in prenatal care.

Violencia y embarazo en usuarias del sector salud en estados de alta marginación en México / Violence and pregnancy in female users of ministry of health care services in highly deprived states in Mexico

OBJETIVO: Caracterizar la violencia de pareja e identificar los principales factores que se asocian a la violencia en el embarazo en cuatro estados de alta marginación en México. MATERIAL Y MÉTODOS: La fuente de información fueron los datos de la Encuesta Nacional sobre Violencia contra las Mujeres 2003. Con base en ésta se realizó un estudio transversal, donde se incluyeron 1 949 mujeres entre 15 y 50 años de edad, que alguna vez estuvieron embarazadas y que demandaron atención en los servicios de primer y segundo nivel de atención de la SSA, IMSS e ISSSTE de los estados de Guerrero, Hidalgo, Oaxaca y Chiapas durante el periodo noviembre 2002- marzo 2003. Mediante regresión logística simple y múltiple, se evaluó la asociación entre las variables de interés y la violencia en el embarazo. RESULTADOS: Del total de mujeres, 250 (13 por ciento) informaron haber sufrido violencia (física, psicológica, sexual y económica) durante alguno de sus embarazos; una de cada tres refirió haber recibido golpes en el abdomen durante el embarazo. En la mayor parte de los casos (91.4 por ciento) el agresor fue el cónyuge. Las variables que se asociaron positivamente con violencia en algún embarazo fueron: a) nivel de escolaridad de la mujer: las analfabetas, comparadas con las mujeres que tenían escolaridad superior a primaria completa, presentaron la asociación más fuerte (RM 2.2; IC 95: por ciento 1.1, 4.4); b) antecedentes de violencia en la niñez (RM 3.2; IC 95 por ciento 1.9, 5.4); c) antecedentes de abuso sexual antes de los 15 años (RM 2.4, IC95 por ciento 1.3, 4.4) y d) consumo diario de alcohol por la pareja (RM 6.5; IC 95 por ciento 3.3, 12.9). CONCLUSION: Los resultados de este estudio muestran que la violencia durante el embarazo es un hecho frecuente en contextos de alta marginación, además de que su expresión tiende a ser más severa. Los resultados sustentan la necesidad de seguir estudiando el problema de la violencia en el embarazo en México, además de identificarlo durante el proceso de atención prenatal a mujeres violentadas.

OBJECTIVE: To characterize intimate partner abuse and identify the main factors associated with violence in pregnancy in four highly deprived States in Mexico. MATERIAL AND METHODS: The data were taken from the National Survey on Violence against Women 2003 (ENVIM per its abbreviation in Spanish). Based on it a cross-sectional study was conducted on 1 949 women between 15 and 50 years of age, who were once pregnant and who utilized primary and secondary health care services from the Ministry of Health, Mexican Institute of Social Security, and the Institute for Social Security and Services for State Workers in Guerrero, Hidalgo, Oaxaca and Chiapas states, between November 2002 and March 2003. Logistic regression was used to assess the association between independent variables and violence during pregnancy. RESULTS: 250 women (13 percent) suffered a type of violence (physical, psychological, sexual or economical) during any of their pregnancies. Of these women 76 (30.40 percent) were battered on their abdomen. In most of these cases (91.39 percent) the husband was the aggressor. The variables significantly associated with violence in pregnancy were: woman's illiteracy (OR 2.2; CI 95: percent .1, 4.4); history of violence in childhood (OR 3.2; CI 95 percent 1.9, 5.4) as well as sexual abuse in her childhood (OR 2.4, CI 95 percent 1.3, 4.4) and her partner's daily alcohol consumption (OR 6.5; CI 95 percent 3.3, 12.9). CONCLUSIONS: The results show that violence during pregnancy is a regular event in the impoverished context and that its expression is more severe. These results point to the importance of continued study of the problem of violence against pregnant women in Mexico and the importance of identifying battered women in prenatal care.

"No dejarse caer en cama": las mujeres y los servicios de salud / Women and healthcare services in Mexico: the struggle to avoid becoming

El objetivo del presente trabajo fue identificar, describir y analizar el ciclo de percepción-atención de salud de las mujeres de mediana edad de cinco regiones del país. Se realizó un análisis cualitativo de 24 entrevistas a profundidad, aplicadas a mujeres de mediana edad (40 a 60 años), procedentes de cinco regiones de México. Los hallazgos de la investigación muestran que la percepción de salud de las mujeres se caracteriza por "sentirse constantemente mal", sin embargo, no se "dejan caer en cama". La búsqueda de atención a la salud en todos los casos es tardía. Las consideran que su malestar no es suficientemente atendido, ni reciben la información necesaria para su cuidado. Al no encontrar la respuesta que ellas esperan de los servicios de salud, buscan sus propios caminos como la autorregulación de tratamientos y la automedicación. La experiencia de las mujeres, es un punto de referencia para conseguir que se reformulen algunos aspectos del modelo médico existente.

[Women and healthcare services in Mexico: the struggle to avoid becoming "bedridden"]. / "No dejarse caer en cama": las mujeres y los servicios de salud.

The objective of this study was to identify, describe, and analyze the perception of healthcare services by middle-aged women in five different regions of Mexico. The qualitative analysis was based on 24 in-depth interviews with middle-aged women (40-60 years) representing five different regions of the country. The women generally described their health as "constantly poor" but did not allow themselves to become "bedridden". The vast majority of the women postponed going to healthcare services. They considered their health problems insufficiently treated and did not receive enough information for proper self-care. When they did not receive the response they were looking for from healthcare services, women generally sought alternative solutions by regulating their own treatment regimes and self-medication. These experiences provide a strong reference for restructuring key aspects in the current medical model.

Violencia contra la mujer: conocimiento y actitud del personal médico del Instituto Mexicano del Seguro Social, Morelos, México / Violence against women: knowledge and attitudes of healthcare providers at the Mexican Institute of Social Security in Morelos, Mexico

OBJETIVO: Evaluar la actitud afectiva, cognoscitiva y conductual del personal médico del Instituto Mexicano del Seguro Social del estado de Morelos, México, hacia la identificación y canalización de mujeres maltratadas que acuden a consulta médica, así como identificar las barreras institucionales y de la práctica médica que dificultan el manejo dentro de los servicios de salud de las mujeres maltratadas. MATERIAL Y MÉTODOS: De septiembre a diciembre de 1999 se realizó un estudio transversal mediante un cuestionario de autoaplicación que se proporcionó a 269 médicos y médicas generales, especialistas y estudiantes de pre y posgrado que laboran en 30 unidades de salud, de primer y segundo nivel de atención, del Instituto Mexicano del Seguro Social del estado de Morelos. El instrumento se diseñó para evaluar el nivel de conocimiento sobre violencia doméstica y la actitud del personal médico hacia la atención, en la consulta, de mujeres maltratadas. Se construyó un índice de conocimiento, además de un análisis multivariado de los datos. RESULTADOS: El 90 por ciento de los entrevistados nunca ha recibido capacitación en violencia contra la mujer. La actitud afectiva y cognoscitiva del personal médico que recibió capacitación sobre el tema fue más favorable hacia la identificación y atención de mujeres maltratadas que llegan a consulta médica, en comparación con los que no la recibieron. Sobre el nivel de conocimiento acerca del tema, 21 por ciento de los entrevistados mostró un nivel bajo, 63 por ciento medio y 16 por ciento alto. En el personal médico, con nivel de conocimiento medio y alto, se observó 2.1 y 6 veces -respectivamente- una actitud afectiva más favorable respecto a la identificación y canalización de casos de mujeres maltratadas en comparación con el personal con nivel de conocimiento bajo. Las médicas mostraron 2.3 veces mejor actitud para identificar y canalizar mujeres maltratadas. El personal médico con interés por capacitarse...

OBJECTIVE: To asses the affective, cognitive, and behavioral attitudes of healthcare providers at the Mexican Institute of Social Security (MISS) in Morelos, Mexico; to identify the institutional and medical practice barriers that hinder screening and reference of battered women. MATERIAL AND METHODS: A cross-sectional study was conducted between September and December 1999. A self-administered questionnaire was applied to 269 general practitioners, specialists, and pre- and postdoctoral students working in 30 primary and secondary level of healthcare units in Morelos State. The data collection instrument was designed to assess healthcare providers' knowledge of and attitudes towards domestic violence during medical office visits. A knowledge index was constructed and analyzed using multivariate regression methods. RESULTS: Ninety percent of healthcare providers had never received training on violence against women. Healthcare providers' affective and cognitive attitudes after receiving training on the subject matter were more favorable compared to those with no training. Favorable attitudes were directly related to the number of training sessions. Most participants (63 percent) showed a moderate degree of knowledge on the subject, whereas 21 percent were slightly knowledgeable and 16 percent were highly knowledgeable. Medical personnel with a moderate or high level of knowledge were 2.1 and 6 times more likely, respectively, to have favorable attitudes than those with a low degree of knowledge. Female physicians showed more favorable attitudes towards identifying and referring battered women. Medical personnel interested in further training on the subject of violence against women were 7.6 times more likely to show favorable attitudes than personnel not interested on the subject. CONCLUSIONS: Healthcare providers were not sufficiently able to assess and manage battered women. General and family practitioners were more interested in being...

[Violence against women: knowledge and attitudes of the the medical staff at the Mexican Institute of Social Security, Morelos, Mexico]. / Violencia contra la mujer: conocimiento y actitud del personal médico del Instituto Mexicano del Seguro Social, Morelos, México.

OBJECTIVE: To asses the affective, cognitive, and behavioral attitudes of healthcare providers at the Mexican Institute of Social Security (MISS) in Morelos, Mexico; to identify the institutional and medical practice barriers that hinder screening and reference of battered women. MATERIAL AND METHODS: A cross-sectional study was conducted between September and December 1999. A self-administered questionnaire was applied to 269 general practitioners, specialists, and pre- and postdoctoral students working in 30 primary and secondary level of healthcare units in Morelos State. The data collection instrument was designed to assess healthcare providers' knowledge of and attitudes towards domestic violence during medical office visits. A knowledge index was constructed and analyzed using multivariate regression methods. RESULTS: Ninety percent of healthcare providers had never received training on violence against women. Healthcare providers' affective and cognitive attitudes after receiving training on the subject matter were more favorable compared to those with no training. Favorable attitudes were directly related to the number of training sessions. Most participants (63%) showed a moderate degree of knowledge on the subject, whereas 21% were slightly knowledgeable and 16% were highly knowledgeable. Medical personnel with a moderate or high level of knowledge were 2.1 and 6 times more likely, respectively, to have favorable attitudes than those with a low degree of knowledge. Female physicians showed more favorable attitudes towards identifying and referring battered women. Medical personnel interested in further training on the subject of violence against women were 7.6 times more likely to show favorable attitudes than personnel not interested on the subject. CONCLUSIONS: Healthcare providers were not sufficiently able to assess and manage battered women. General and family practitioners were more interested in being trained, as compared with specialist physicians. Training on violence against women should be included in graduate medical, nursing, social service, psychology, and other public health areas. The English version of this paper is available at:http://www.insp.mx/salud/index.html.

La violencia doméstica durante el embarazo y su relación con el peso al nacer / Domestic violence during pregnancy and its relation to birth weight

Objetivo. Determinar la prevalencia de la violencia doméstica durante el embarazo así como su asociación con el peso del producto al nacer y con las complicaciones en el parto y posparto inmediato. Material y métodos. Se exploró sobre violencia doméstica (física, emocional y sexual) a un total de 100 usuarias del servicio de ginecobstetricia del Hospital Civil de Cuernavaca, Morelos, utilizando para ello un cuestionario de preguntas cerradas, aplicado por personal especializado. Se usó un modelo de regresión lineal múltiple para ajustar las diferencias de medias en el peso del producto al nacer, por edad y paridad. Para el caso de la complicaciones se utilizó un modelo de regresión logística. Resultados. Las mujeres maltratadas (MM) víctimas de violencia durante el embarazo tiene tres veces más complicaciones durante el parto y posparto inmediato que las mujeres no maltratadas (MNM) (IC 95 por ciento 1.3-7.9). La diferencia en el peso del producto al nacer entre los dos grupos fue de 560 g (p<0.01 ajustado por edad y paridad), con desventaja para las MM. Las mujeres violentadas tuvieron cuatro veces más riesgo de tener productos de bajo peso en comparación con la MNM (IC 95 por ciento 1.3-12.3). Conclusiones. Se propone profundizar la investigación sobre el tema y estudiar otros grupos poblacionales, asimismo sensibilizar al personal de salud sobre la violencia hacia las mujeres como riesgo reproductivo

Objective. To determine the prevalence of domestic violence during pregnancy and its impact on birth weight and the immediate post-partum period. Material and methods. We conducted a survey of 110 pregnant women who delivered at the Hospital Civil in Cuernavaca, Morelos. The questionnaire was applied by specialized personal. We used multiple linear regression to adjust for differences between birth weight means and multiple logistic regression for complications. Results. In our study, women who suffered violence during pregnancy had three times more complications during delivery (CI 95% 1.3-7.9). The difference in birth weight of newborns of these women was 560 g less (p< 0.01 adjusted by age and parity) in comparison with women who did not undergo violence during pregnancy. Women who suffered violence during pregnancy had a four times greater risk for having low birth weight babies (CI 95% 1.3-12.3) than the non-battered women. Conclusions. We propose more research be done on this topic, including studies of other population groups. Also, health personnel should be educated that violence towards women could constitute a reproductive risk.