Asset map in a Chilean Health Promoting University: 'a strategy for revitalization'.

Health Promoting Universities (HPUs) are more likely to perform actions intended to change habits and increase personal empowerment, than they are to develop community actions. The objective of this research is to create an asset map to visualize collective actions in a Chilean HPU. A qualitative study, based on the ABCD model was conducted. There were 149 people, distributed into 48 semi-structured interviews and 14 focus groups, who participated in this study (students, employees, ex-students and retirees). An asset map was elaborated, identifying the contributions of residents, associations and organizations, local institutions, physical resources, economic assets and local culture and with a new category, 'connecting assets'. These categories show the range of resources in a university. According to the participants, the questions on asset identification were a tool for reflection, and by giving their opinions and discovering or drawing attention to new resources, they gained a better understanding of the assets in the university. Several participants stated that these talks could generate a positive emotional environment, which boosted their wellbeing. There were gender- and group-based differences in how the assets were valued. Students stressed assets related to services and benefits from the institution, green areas, and collective spaces. Employees, retirees and ex-students emphasized assets related to belonging, identity and traditions. Men appreciated openness and privacy in physical spaces. Women highlighted assets related to the institution. The resulting map, displays a range of resources that can help the university develop new possibilities for comprehensive and collective actions that would revitalize the HPU strategy.

Impact of the Covid-19 pandemic on perinatal mental health (Riseup-PPD-COVID-19): protocol for an international prospective cohort study.

BACKGROUND: Corona Virus Disease 19 (COVID-19) is a new pandemic, declared a public health emergency by the World Health Organization, which could have negative consequences for pregnant and postpartum women. The scarce evidence published to date suggests that perinatal mental health has deteriorated since the COVID-19 outbreak. However, the few studies published so far have some limitations, such as a cross-sectional design and the omission of important factors for the understanding of perinatal mental health, including governmental restriction measures and healthcare practices implemented at the maternity hospitals. Within the Riseup-PPD COST Action, a study is underway to assess the impact of COVID-19 in perinatal mental health. The primary objectives are to (1) evaluate changes in perinatal mental health outcomes; and (2) determine the risk and protective factors for perinatal mental health during the COVID-19 pandemic. Additionally, we will compare the results between the countries participating in the study. METHODS: This is an international prospective cohort study, with a baseline and three follow-up assessments over a six-month period. It is being carried out in 11 European countries (Albania, Bulgaria, Cyprus, France, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom), Argentina, Brazil and Chile. The sample consists of adult pregnant and postpartum women (with infants up to 6 months of age). The assessment includes measures on COVID-19 epidemiology and public health measures (Oxford COVID-19 Government Response Tracker dataset), Coronavirus Perinatal Experiences (COPE questionnaires), psychological distress (BSI-18), depression (EPDS), anxiety (GAD-7) and post-traumatic stress symptoms (PTSD checklist for DSM-V). DISCUSSION: This study will provide important information for understanding the impact of the COVID-19 pandemic on perinatal mental health and well-being, including the identification of potential risk and protective factors by implementing predictive models using machine learning techniques. The findings will help policymakers develop suitable guidelines and prevention strategies for perinatal mental health and contribute to designing tailored mental health interventions. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04595123 .

Is health a right for all? An umbrella review of the barriers to health care access faced by migrants.

OBJECTIVE: To synthesise the scientific evidence concerning barriers to health care access faced by migrants. We sought to critically analyse this evidence with a view to guiding policies. DESIGN: A systematic review methodology was used to identify systematic and scoping reviews which quantitatively or qualitatively analysed data from primary studies. The main variables analysed were structural and contextual barriers (health system organisation) as well as individual (patients and providers). The quality of evidence from the systematic reviews was critically appraised. From 2674 reviews, 79 were retained for further scrutiny, and finally 9 met the inclusion criteria. RESULTS: The structural barriers identified were the lack of health insurance and the high cost of drugs (non-universal health system) and organisational aspects of health system (social insurance system and national health system). The individual barriers were linguistic and cultural. None of the reviews provided a quality appraisal of the studies. CONCLUSIONS: Barriers to health care for migrants range from entitlement in non-universal health systems to accessibility in universal ones, and determinants of access to the respective health services should be analysed within the corresponding national context. Generate social and institutional changes that eliminate barriers to access to health services is essential to ensure health for all.

Looking twice at the gender equity index for public health impact.

BACKGROUND: It has been shown that gender equity has a positive impact on the everyday activities of people (decision making, income allocation, application and observance of norms/rules) which affect their health. Gender equity is also a crucial determinant of health inequalities at national level; thus, monitoring is important for surveillance of women's and men's health as well as for future health policy initiatives. The Gender Equity Index (GEI) was designed to show inequity solely towards women. Given that the value under scrutiny is equity, in this paper a modified version of the GEI is proposed, the MGEI, which highlights the inequities affecting both sexes. METHODS: Rather than calculating gender gaps by means of a quotient of proportions, gaps in the MGEI are expressed in absolute terms (differences in proportions). The Spearman's rank coefficient, calculated from country rankings obtained according to both indexes, was used to evaluate the level of concordance between both classifications. To compare the degree of sensitivity and obtain the inequity by the two methods, the variation coefficient of the GEI and MGEI values was calculated. RESULTS: Country rankings according to GEI and MGEI values showed a high correlation (rank coef. = 0.95). The MGEI presented greater dispersion (43.8%) than the GEI (19.27%). Inequity towards men was identified in the education gap (rank coef. = 0.36) when using the MGEI. According to this method, many countries shared the same absolute value for education but with opposite signs, for example Azerbaijan (-0.022) and Belgium (0.022), reflecting inequity towards women and men, respectively. This also occurred in the empowerment gap with the technical and professional job component (Brunei:-0.120 vs. Australia, Canada Iceland and the U.S.A.: 0.120). CONCLUSION: The MGEI identifies and highlights the different areas of inequities between gender groups. It thus overcomes the shortcomings of the GEI related to the aim for which this latter was created, namely measuring gender equity, and is therefore of great use to policy makers who wish to understand and monitor the results of specific equity policies and to determine the length of time for which these policies should be maintained in order to correct long-standing structural discrimination against women.

A cross-country study on the impact of governmental responses to the COVID-19 pandemic on perinatal mental health.

This study aimed to analyse the role of governmental responses to the coronavirus disease 2019 (COVID-19) outbreak, measured by the Containment and Health Index (CHI), on symptoms of anxiety and depression during pregnancy and postpartum, while considering the countries' Inequality-adjusted Human Development Index (IHDI) and individual factors such as age, gravidity, and exposure to COVID-19. A cross-sectional study using baseline data from the Riseup-PPD-COVID-19 observational prospective international study (ClinicalTrials.gov: NCT04595123) was carried out between June and October 2020 in 12 countries (Albania, Brazil, Bulgaria, Chile, Cyprus, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom). Participants were 7645 pregnant women or mothers in the postpartum period-with an infant aged up to 6 months-who completed the Edinburgh Postnatal Depression Scale (EPDS) or the Generalised Anxiety Disorder Assessment (GAD-7) during pregnancy or the postpartum period. The overall prevalence of clinically significant depression symptoms (EPDS ≥ 13) was 30%, ranging from 20,5% in Cyprus to 44,3% in Brazil. The prevalence of clinically significant anxiety symptoms (GAD-7 ≥ 10) was 23,6% (ranging from 14,2% in Israel and Turkey to 39,5% in Brazil). Higher symptoms of anxiety or depression were observed in multigravida exposed to COVID-19 or living in countries with a higher number of deaths due to COVID-19. Furthermore, multigravida from countries with lower IHDI or CHI had higher symptoms of anxiety and depression. Perinatal mental health is context-dependent, with women from more disadvantaged countries at higher risk for poor mental health. Implementing more restrictive measures seems to be a protective factor for mental health, at least in the initial phase of the COVID-19.

Maternity care through the eyes of Southern European immigrant parents in Norway.

OBJECTIVE: To explore Southern European immigrant mothers and fathers' experiences of reproductive health services in Norway, and their perceptions of health providers' beliefs and attitudes regarding pregnancy and childbirth. METHOD: We employed a qualitative research methodology with two focus group discussions and 11 in-depth interviews with 4 fathers and 11 mothers from Italy, Spain, Portugal, and Greece, whose children were born in Norway. Thematic Analysis was conducted to identify and analyze patterns across the data. RESULTS: We identified three themes as key elements in parents' experiences: experiences with the coverage and organization of the Reproductive Health Services; relational experiences with health providers; and pregnancy and delivery as a culturally-shaped event. The immigrant parents experienced a clash between their expectations and the procedures and health facility environment encountered in Norway regarding check-ups, diagnosis tests, childbirth preparation courses, and health facilities. Informants perceived that the maternity care practices of the host country were underpinned by the health care providers' cultural understandings of labor and pregnancy. Particularly, they experienced a less interventionist approach towards pregnancy and childbirth. CONCLUSIONS: The experiences of immigrant parents provide relevant information to improve reproductive health services in a cross-cultural context. Inmigration brings new challenges that must be addressed from a perspective of cultural competence. These services should acknowledge diversity in cultural beliefs around childrearing and involve both fathers and mothers in decision-making.

Promoción de salud más allá de los estilos de vida saludables: propuestas de actuación en una universidad chilena.

Las intervenciones centradas en cambios de conducta, sumadas a la escasa evidencia de mapeo y dinamización de activos en Universidades Promotoras de Salud (UPS), hacen necesario potenciar enfoques integrales y sistémicos que contribuyan al bienestar y empoderamiento de sus integrantes. El objetivo de este artículo es explorar propuestas de acción que contribuyan a fortalecer activos en una comunidad universitaria chilena. Se desarrolló un estudio cualitativo con 72 hombres/77 mujeres (estudiantes, trabajadores, jubilados y exestudiantes). Se realizaron 48 entrevistas individuales y 14 grupos focales. Se efectuó un análisis de contenido utilizando el software QRS NVivo 12. Las propuestas identificadas se agruparon en: desarrollo de la participación e inclusión, promoción de la salud mental, mantenimiento y mejora de áreas verdes e infraestructura, y fortalecimiento del acceso a actividades deportivas, culturales y de extensión universitaria. Las mujeres valoraron la difusión de activos comunitarios y el cuidado de las personas y el entorno. Y los hombres, el fortalecimiento del capital social, la docencia y la transferencia de conocimiento. Las propuestas de acción tienen una orientación colectiva que favorece el vínculo de las personas con su entorno y el desarrollo del sentido de comunidad. Desde una perspectiva de género, se observa reproducción de roles y estereotipos arraigados en el sistema patriarcal. Esto constituye un desafío para potenciar las UPS en tanto política pública, considerando los principios de participación, justicia social y equidad.

Effect of conservative treatment of pelvic floor dysfunctions in women: An umbrella review.

OBJECTIVE: Due to their high worldwide prevalence, pelvic floor dysfunctions (PFD's) are a public health problem. There is high heterogeneity in the types and effectiveness of conservative treatment. The objective was to analyze the scientific evidence on conservative treatment of PFDs in women. METHODS: Umbrella review, covering MEDLINE (1950-2019), Scopus (1960-2019), Web of Science (1980-2019), and Cochrane Library (2000-2019). Inclusion criterion: review on conservative treatments about pelvic floor disorders in the adult women, in Spanish or English; exclusion criterion: studies about other urological, gynecological, and coloproctological pathologies, among others. RESULTS: Thirty-two reviews (2000-2019) and 12 meta-analyses were included. 53.1% showed an improvement on urinary incontinence. Pelvic floor muscle training worked on 70.6% of them, followed by electrical stimulation and estrogen (11.7%), and weight loss (5.9%). 6.3% of reviews and meta-analyses fulfilled all items in PRISMA, and 93.7% of them fulfilled more than 60% of the checklist. 60% de los ítems. CONCLUSIONS: PFMT and weight loss are the most effective treatments for UI, but there is no evidence for other PFDs. The methodological quality of conservative treatments must be improved for a more effective treatment of PFDs in women. Pelvic floor muscle training and weight loss are the most effective treatments for urinary incontinence. Only 6.3% of the reviews fulfilled all PRISMA ítems.

Psychometric properties of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) on Chilean women.

Introduction: Pelvic floor dysfunctions have an impact on women's sexual function. A Chilean study found that 74% of women have pelvic floor dysfunctions, but there is no validated tool for them. Objective: To evaluate the psychometric properties of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) for assessing sexual function in Chilean women with pelvic floor dysfunctions. Methods: Cross-sectional study of psychometrics in 217 women with pelvic floor dysfunction, age 18 or older, and sexually active (last 6 months). Non-probability, convenience sampling. Tool: PISQ-12. Experts checked content validity, construct validity with confirmatory factor analysis, reliability with Cronbach's alpha, and discriminating capacity with Pearson and McDonald's omega. Results: Population is mainly perimenopausal, highly educated with no income and with urinary incontinence (89.4%). Psychometric analysis supports a three-factor structure: sexual response, female sexual problems, and male sexual problems, with a good (α= 0.85), acceptable (α= 0.73), and poor (α= 0.63) reliability, respectively, but McDonald's omega was acceptable for all three. These were related to age (rs: -0.33), education (rs: 0.36), number of pregnancies (rs: -0.18) and vaginal births (rs: -0.25). Conclusions: PISQ-12 is valid and reliable for measuring sexual dimension and problems. Age, education, and number of pregnancies and vaginal births are moderately correlated to sexual response.

Introducción: Las disfunciones del piso pélvico impactan la función sexual de mujeres que la padecen. En un estudio chileno un 74% de las mujeres presentó disfunción sexual sin tener un instrumento validado para esta población. Objetivo: Evaluar las propiedades psicométricas del Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire (PISQ-12) para medir la función sexual en mujeres chilenas con disfunciones del piso pélvico. Métodos: Estudio transversal psicométrico de 217 mujeres con disfunción del piso pélvico, igual /mayor a 18 años, sexualmente activas (últimos 6 meses). Muestreo no probabilístico de conveniencia. Cuestionario: PISQ-12. Se realizó juicio de expertos para validez de contenido, análisis factorial confirmatorio para validez de constructo y el α de Cronbach para confiabilidad y capacidad discriminativa con Pearson y ω de McDonald. Resultados: Población principalmente perimenopáusica, alta escolaridad sin ingresos y con Incontinencia Urinaria (89.4%). El análisis psicométrico apoyó una estructura de tres factores: respuesta sexual, limitaciones sexuales femeninas y limitaciones sexuales masculinas, con confiabilidad buena (α= 0.85) aceptable (α= 0.73) y pobre (α= 0.63), respectivamente, aunque el ω de McDonald mostró valores aceptables para los tres. Éstos se relacionaron con edad (rs: -0.33), escolaridad (0.36), número de embarazos (-0.18) y partos vaginales (-0.25). Conclusiones: El PISQ-12 es válido y confiable, midiendo la dimensión sexual y limitaciones sexuales. La edad, escolaridad, número de embarazos y partos vaginales se correlaciona con la respuesta sexual en intensidad moderada.

[Geopolitical development inequalities in gender in Spain 1980-2005: a structural determinant of health]. / Desigualdades en el desarrollo geopolítico de género en España 1980-2005: Un determinante estructural de la salud.

BACKGROUND: Gender is a structural health determinant. This study analyses the changes in gender development inequalities in Spain and its regions (1980-2005). METHODS: Ecological study of the evolution of Gender Development Index and its components (Education, Income, Life Expectancy at Birth) by sex in Spain and its regions (1980-2005). Information Source: Gender Development Index (1980-2005) from the Human Capital Report, plus construction ad hoc of the Gender Development Index 2005 following the same methodology of Human Capital Report. INFORMATION SOURCES: National Statistics Institute, Active Population Survey, Municipal Register, Ministry of Education, Universities Council, EUROSTAT, and Wage Structure Survey. RESULTS: Spanish Gender Development Index 2005:0,903 and 1980:0,810. The range between regions under Spanish Gender Development Index was 3 times higher in 1980 (DifferenceC.Valenciana-Extremadura:0,068) than in 2005 (DifferenceAsturias-Extremadura:0,023). The regions above the Spanish Gender Development Index did not vary much. The three components (Education, Income, Life Expectancy at Birth) of the Gender Development Index improved from 1980 to 2005. The Spanish Education Index of men was higher than this value in women until 1985; later this index becomes higher in women than in men. The Spanish Income Index of women in 2005 (0,814) is inferior to that of men 25 years before (1980:0,867). CONCLUSIONS: Despite the improvement of the gender development happened in Spain between 1980 and 2005, the inter-regional inequalities between north-south persist. In 2005, women have more education level than men. However, the Spanish income media in women in 2005 are inferior to the media of the men in 1980.

Verbal marital conflict and male domination in the family as risk factors of intimate partner violence.

A systematic review was performed to analyse the characteristics and quality of the studies that consider the relationship between verbal marital conflict and/or male domination in the family and violent behaviour by men towards their partner. Only 11 articles were identified between 1986 and 2006. Most of them find a positive association between male domination in the family and/or verbal marital conflict and violence towards the woman in the couple. However, limitations such as misclassification bias, recall bias, selection bias, external validity and the problem of consistency (overestimation of effect) were acknowledged by authors of this studies. In eight of the 11 studies reviewed, preventive measures or interventions to deal with the problem were recommended. More and better empirical evidence is required in order to provide suitable measures to address the issue of verbal marital conflict and male domination and its influence on IPV.

Determinants in the process of seeking help for urinary incontinence in the Chilean health system.

OBJECTIVE: To analyze via the Andersen model what leads women with urinary incontinence (UI) to seek help and remain in the healthcare system. METHODS: An interpretative phenomenologic study enrolling women aged 18 years or older who were diagnosed with UI at a tertiary care hospital in Chile between January and March 2016. Data were collected by semi-structured interview. The categories explored experience with UI and reasons for seeking health care, and included the dimensions of the Andersen model. RESULTS: Ten women were enrolled. Characteristics that eased or hindered healthcare seeking were identified to come from the women (frequency and quantity of symptoms, coping strategies, and beliefs about its causes) and from their environment (reaction of partner, family, or coworkers to her condition). Some were associated with primary care (human and/or technical resources) and some with secondary care (pelvic floor units). CONCLUSION: The results reflect the complexities of asking for health care for women with UI, especially in a country such as Chile with different healthcare levels. Raising awareness of this complexity and developing an approach that includes all stakeholders (institution, community, and family) is crucial for professionals who want to offer both medical therapy and wellness-focused healthcare.

Childhood experiences of violence in perpetrators as a risk factor of intimate partner violence: a systematic review.

BACKGROUND: Perpetrators' experiences of violence during childhood are considered a risk factor for intimate partner violence (IPV). The objective of this study is to systematically review the characteristics and quality of papers which analyse the association between being battered during childhood, witnessing marital violence as a child within the family of origin and having an absent or rejecting father and the occurrence of IPV. METHODS: Nine scientific databases were consulted (1960-2004). After applying the exclusion criteria, 10 studies were analysed. Variables are sample characteristics, directionality/study design, IPV and perpetrators' childhood measurements, findings, limitations and interventions. RESULTS: All the studies found an association. Conflict Tactics Scale was the main tool used to measure the IPV. Different instruments were used to measure violent childhood experiences in men as an exposure. Recall bias (seven papers) and retrospective data (four papers) were reported as the main methodological limitations. Despite these, 50% of the studies proposed treatments/preventive measures. CONCLUSION: Our findings support the results of previous studies, implying that action recommendations within IPV prevention are still not evidence based. Methodological problems of the papers reviewed should be solved to obtain more useful data. Scientific evidence about the aetiology of IPV should be increased to guide effective prevention programmes.

[Gender development inequalities epidemiology in Spain (1990-2000)]. / Epidemiología de las desigualdades del desarrollo de género en España (1990-2000).

BACKGROUND: Gender is an important health determinant for public health policies. This study describes the changes in gender development inequalities in Spain and its autonomous regions from 1990 to 2000. METHODS: An ecological study using the Human Development Index (HDI) and the Gender Development Index (GDI) was done. IDG both men and women was analysed according to indexes of education, income and life expectancy at birth. RESULTS: Although the GDI has had an increase of 5,05% in the 90 s, 51,5% of the population was located above the global GDI of Spain in 1990, moreover this number decreased to 46,3% in 2000. Gender inequalities have been reduced both at national and regional levels. The regions with the lowest increase were Asturias (3.37%), Cantabria (3.68%) and Baleares Islands (3.71%). The regions with the highest increase were Madrid (6,46%) and Extremadura (6,75%). All the autonomous regions showed a number of GDI lower than the value of HDI. Both sexes achieved similar increase in life expectancy (Men: 5% and Women: 4%). An unequal variation was detected according to the autonomous region (Basque Country; Men: 7% and Women: 3%; Madrid; Men:8% and Women:5%). Women have improved their educational level in comparison to men (Men: 3% and Women: 6%). In the 90 s, men obtained more income than women, but women improved their situation three times more than men. CONCLUSIONS: Inequalities in Human Development analysed by gender have been reduced in the 90 s in Spain. However, the improvement of education, income and life expectancy occurred only in some autonomous regions. This situation shows the differences among Spanish autonomous regions.

[Appraisal of the Millennium Development Goals by means of a review of the scientific literature in 2008]. / Valoración de los Objetivos de Desarrollo del Milenio mediante la revisión de la literatura científica en 2008.

The Millennium Development Goals (MDGs) are now at the midterm of their target period, as 2015 is the date scheduled by the United Nations Organisation (UN) for their attainment. The purpose of this article is to review the current situation of the MDGs worldwide and to analyse the barriers which are preventing them from being attained in each of the MDG areas, as well as to assess a number of the indicators evaluated. In order to do so, a review has been made of the scientific literature published on the MDGs in the principal health sciences and social sciences databases, as well as the most significant reports on the issue drawn up by the United Nations. The scientific studies on the 8 MDGs and their 18 Targets make it possible to undertake a critical analysis of the situation in which each of these Goals are found at the present time, identifying the determinants that are preventing the attainment of the Goals and the actions considered necessary in order to achieve progress. Although there have been improvements in some of the goals on a world level, the research carried out to date reveals barriers to the attainment of the MDGs, as well as the insufficient weight of the developing countries in the economic and political decision-making processes, together with the incoherence between the economic policies and the social and health policies. Furthermore, Sub-Saharan Africa constitutes the most disadvantaged region, which means that it will not attain the majority of the MDGs. Spain and the developed countries, in addition to contributing resources, can also contribute to the MDGs by means of the identification and eradication of the barriers preventing attainment. This involves promoting international economic relations under conditions of social justice, by supporting a greater decision-making power for developing countries and denouncing actions that increase social inequalities and the impoverishment of the population.

[Epidemic of intimate partner violence against women in Spain. Temporal distribution and victim age]. / La epidemia por violencia del compañero íntimo contra las mujeres en España. Evolución temporal y edad de las víctimas.

OBJECTIVE: To explore temporal distribution and victim age in deaths and women's reports of intimate partner violence (IPV) to illustrate an approach to the results of the measures developed in Spain to combat this problem. METHODS: We performed a descriptive epidemiological study based on statistics from the Federation of Divorced and Separated Women, the Queen Sofía Centre for the study of Violence, and the Home Affairs databases (1998-2005). Rates of mortality and reports of IPV were calculated by age (< 21 years old, from 21 to 50 years, > 50 years) and year. The ratio between the actual number of IPV deaths and reports in a given month and the median number of cases in the same month in the 5 preceding years (epidemic index) was calculated. RESULTS: From the end of 2004, the epidemic index scores indicate that rates of mortality and reports due to intimate partner violence have tended to decrease. The highest IPV murder and report rates and epidemic index scores were observed in women aged 21-50 years old throughout the period, except in 2004, when mortality rates in women aged less than 21 years were highest, and in 2005, when report rates in women aged more than 50 years increased. CONCLUSION: In the last year, 2005, the IPV epidemic seemed to be decreasing. The fact that this problem affects women mostly in ages when they are fertile and active in the workforce suggests the instrumental use of IPV to keep women in a subordinate position.