Gestational Weight Gain: Is the Role of Genetic Variants a Determinant? A Review.

Excessive or insufficient gestational weight gain (GWG) leads to diverse adverse maternal and neonatal outcomes. There is evidence that pregestational body mass index (pBMI) plays a role in GWG, but no genetic cause has been identified. In this review, we aim to analyze genotype variants associated with GWG. Results: We identified seven genotype variants that may be involved in GWG regulation that were analyzed in studies carried out in Brazil, Romania, the USA, Turkey, Ukraine, and Canada. Some genetic variants were only associated with GWG in certain races or depending on the pBMI. In women who were obese or overweight before gestation, some genetic variants were associated with GWG. Environmental and genetic factors together showed a greater association with GWG than genetic factors alone; for example, type of diet was observed to have a significant influence. Conclusions: We found little scientific evidence of an association between genotype variants in countries with a high prevalence of women of reproductive age who are overweight and obese, such as in Latin America. GWG may be more dependent on environmental factors than genetic variants. We suggest a deeper study of genetic variants, cytokines, and their possible association with GWG, always with the respective control of potential cofounding factors, such as pBMI, diet, and race.

Individual, Family, and Social Factors Associated with Gestational Weight Gain in Adolescents: A Scoping Review.

About 56% to 84% of pregnant adolescents have inappropriate (insufficient or excessive) gestational weight gain (GWG); however, the factors associated with GWG in this age group have not been systematically identified. This scoping review aimed to synthesize the available scientific evidence on the association of individual, family, and social factors with inappropriate gestational weight gain in pregnant adolescents. To carry out this review, the MEDLINE, Scopus, Web of Science, and Google Scholar databases were searched for articles from recent years. The evidence was organized according to individual, family, and social factors. The analyzed studies included 1571 adolescents from six retrospective cohorts, 568 from three prospective cohorts, 165 from a case-control study, 395 from a cross-sectional study, and 78,001 from two national representative samples in the USA. At the individual level, in approximately half of the studies, the pre-pregnancy body mass index (pBMI) was positively associated with the GWG recommended by the Institute of Medicine of the USA (IOM). The evidence was insufficient for the other factors (maternal age, number of deliveries, and family support) to determine an association. According to the review, we concluded that pBMI was positively associated with the GWG. More quality studies are needed to assess the association between GWG and individual, family, and social factors.

Trauma-related symptoms and severity among women in the Pacific Rim.

Current understandings of the effects trauma exposure on women's health are limited because prior research has largely focused on intimate partner and sexual violence in homogenous samples. In this descriptive study, the authors examined the relationships between lifetime trauma exposure and psychological well-being among women across the Pacific Rim. Psychological well-being differed significantly between the four locations and increased trauma exposures were related to poorer psychological well-being across and within locations. The authors report relevant findings on the relationship between trauma exposure and psychological well-being and provide evidence for future research to enhance knowledge on the effects of trauma in women's lives.

Childhood trauma is associated with depressive symptoms in Mexico City women.

OBJECTIVE: To describe childhood trauma and depressive symptoms in Mexican women and to explore the relationships between number and type of childhood traumatic events and depressive symptoms. METHODS: A community-based sample of 100 women was interviewed using a demographic questionnaire, the Life Stressor Checklist-Revised (LSC-R), and the Center for Epidemiologic Studies Depression Scale (CES-D). Childhood trauma (trauma at or before 16 years of age) and depressive symptoms were described, and logistic and linear regressions were used to analyze the relationship between childhood traumatic events and current depressive symptoms. RESULTS: Participants reported a mean of 9.46 (standard deviation (SD): 4.18) lifetime traumas and 2.76 (SD: 2.34) childhood traumas. The mean CES-D score was 18.9 (SD: 12.0) and 36.0% of participants had clinically significant depression (CES-D > 24). Depression scores were correlated with lifetime trauma, childhood trauma, education level, employment status, and number of self-reported current medical conditions. Depression scores were not significantly correlated with age, marital status, number of children, or socioeconomic status. For every additional childhood trauma experienced, the odds of clinically significant depressive symptoms (CES-D > 24) increased by 50.0% (adjusted odds ratio (OR): 1.50; 95% confidence interval: 1.14-1.96), after controlling for number of children, age, education level, employment status, and number of self-reported medical conditions. CONCLUSIONS: The results indicated that the number of childhood trauma exposures is associated with current depression among urban Mexican women, suggesting a need for trauma-informed care in this setting.

Childhood trauma is associated with depressive symptoms in Mexico City women / Los traumas durante la niñez se asocian con síntomas depresivos en las mujeres de la Ciudad de México

OBJECTIVE: To describe childhood trauma and depressive symptoms in Mexican women and to explore the relationships between number and type of childhood traumatic events and depressive symptoms. METHODS: A community-based sample of 100 women was interviewed using a demographic questionnaire, the Life Stressor Checklist-Revised (LSC-R), and the Center for Epidemiologic Studies Depression Scale (CES-D). Childhood trauma (trauma at or before 16 years of age) and depressive symptoms were described, and logistic and linear regressions were used to analyze the relationship between childhood traumatic events and current depressive symptoms. RESULTS: Participants reported a mean of 9.46 (standard deviation (SD): 4.18) lifetime traumas and 2.76 (SD: 2.34) childhood traumas. The mean CES-D score was 18.9 (SD: 12.0) and 36.0% of participants had clinically significant depression (CES-D > 24). Depression scores were correlated with lifetime trauma, childhood trauma, education level, employment status, and number of self-reported current medical conditions. Depression scores were not significantly correlated with age, marital status, number of children, or socioeconomic status. For every additional childhood trauma experienced, the odds of clinically significant depressive symptoms (CES-D > 24) increased by 50.0% (adjusted odds ratio (OR): 1.50; 95% confidence interval: 1.14-1.96), after controlling for number of children, age, education level, employment status, and number of self-reported medical conditions. CONCLUSIONS: The results indicated that the number of childhood trauma exposures is associated with current depression among urban Mexican women, suggesting a need for trauma-informed care in this setting.

OBJETIVO: Describir los traumas durante la niñez y los síntomas depresivos en mujeres mexicanas, y explorar las relaciones entre el número y tipo de sucesos traumáticos durante la niñez y los síntomas depresivos. MÉTODOS: Se entrevistó a una muestra comunitaria de 100 mujeres mediante un cuestionario demográfico, la Lista de Verificación de Estresores Vitales Revisada (LSC-R, por sus siglas en inglés), y la Escala de Depresión del Centro de Estudios Epidemiológicos (CES-D, por sus siglas en inglés). Se describieron los traumas durante la niñez (por debajo de los 16 años) y los síntomas depresivos. Se utilizaron regresiones logísticas y lineales para analizar la relación entre los sucesos traumáticos durante la niñez y los síntomas depresivos actuales. RESULTADOS: Las participantes notificaron un promedio de 9,46 (desviación estándar [SD] = 4,18) traumas a lo largo de la vida y 2,76 traumas (SD = 2,34) durante la niñez. La puntuación media obtenida en el CES-D fue de 18,9 (SD = 12,0). Un 36,0% de las participantes mostró una depresión clínicamente significativa (CES-D > 24). Las puntuaciones de la escala de depresión se correlacionaron con los traumas a lo largo de la vida, los traumas durante la niñez, el nivel de formación, la situación laboral, y el número de trastornos médicos actuales autonotificados por las participantes. Las puntuaciones de la escala de depresión no se correlacionaron significativamente con la edad, el estado civil, el número de hijos o la situación socioeconómica. Por cada trauma adicional durante la niñez, las probabilidades de síntomas depresivos clínicamente significativos (CES-D > 24) se incrementaron en 50,0% (razón de posibilidades [OR] ajustada: 1,50; intervalo de confianza [IC] de 95%: 1,14-1,96), tras controlar el número de hijos, la edad, el nivel de formación, la situación laboral y el número de trastornos médicos autonotificados. CONCLUSIONES: Los resultados indicaron que el número de exposiciones traumáticas durante la niñez se asociaba con la depresión actual en las mujeres mexicanas residentes en un entorno urbano; ello indica la necesidad de una atención que tenga en cuenta los antecedentes de sucesos traumáticos en este entorno.

Translation and adaptation of the life stressor checklist-revised with Colombian women.

We undertook the translation and adaptation of an instrument developed to measure women's lifetime trauma exposure, the Life Stressor Checklist-Revised (LSC-R), in order to determine its utility and cultural appropriateness with Colombian Spanish-speaking women. The LSC-R was forward and backward translated and administered to a sample (N = 217) of community-based women volunteers in Medellín, Colombia. Open-ended questions were included to assess the construct validity and cultural appropriateness of the LSC-R. The LSC-R was found to be valid and easily understood. Trauma exposure was common, but its assessment was not overly distressing to Colombian women.

[Abnormal eating behaviours are not associated with micronutrient deficiencies among women of childbearing age from Mexico City]. / Las conductas alimentarias de riesgo no se asocian con deficiencias de micronutrimentos en mujeres en edad repro- ductiva de la ciudad de México.

The aim of this study was to evaluate the association between the risk of abnormal eating behaviors (AEB) and vitamin and mineral deficiencies among women. Women of childbearing age (n = 282) were systematically sampled with a random start (21.9% adolescents) in 6 suburbs in the west side of Mexico City, they were non pregnant or breastfeeding. Vitamin A, C, E, B12, folic acid, hemoglobin, ferritin, cupper, iron and zinc concentrations were measured. A questionnaire validated in the Mexican population was used for screening AEB. Data were analyzed by descriptive statistics and by using Fisher's test. Approximately 68% of the sample belonged to a mid-low or lower socioeconomic status. 14% had risk of AEB, without statistical differences between adults and teenagers. 10% used diuretics or laxatives to reduce weight within the trimester preceding the survey. Vitamin E, zinc and iron were the most widespread deficiencies affecting 47%, 44% and 27% of the population, respectively. There was no association between the AEB and micronutrient deficiencies neither when AEB were analyzed globally nor individually. Considering these results and the high prevalence of the AEB and overweight in this population, it is important to promote the adoption or healthy behaviors to achieve an adequate weight.

Percepción de la cantidad de flujo menstrual y su asociación con las deficiencias de hierro, ácido fólico y vitamina B12 en mujeres de la ciudad de méxico / Menstrual Bleeding perception and its association with iron, folic acid and vitamin B12 deficiencies among women from mexico city

La anemia de origen nutricio afecta a un tercio de las mujeres en edad reproductiva a nivel mundial y puede deberse a la deficiencia de uno o varios nutrimentos involucrados en la hematopoyesis, principalmente el hierro. Las mujeres constituyen un grupo en riesgo dadas las pérdidas menstruales. Por ello, el objetivo de este trabajo fue evaluar la relación entre la percepción de cantidad de flujo menstrual y las deficiencias de hierro, folato y vitamina B12 en una muestra de mujeres de la Ciudad de México. Se realizó un estudio transversal, con mujeres de 12 a 49 años, no embarazadas ni amamantando. Se midieron las concentraciones de hemoglobina, ferritina, hierro y vitamina B12 en suero y ácido fólico eritrocitario. La cantidad de flujo menstrual percibida se examinó con una escala analógica visual de 10 cm de longitud. Las asociaciones se evaluaron mediante las pruebas T de Student, Chi² y el coeficiente de correlación de Pearson. La sensibilidad y especificidad se representaron en una curva ROC. Los resultados mostraron que las anémicas tuvieron una percepción de la cantidad de flujo menstrual significativamente mayor que las no anémicas (p<0.05). No se observaron diferencias en las calificaciones informadas por las mujeres con deficiencias de otros nutrimentos y aquellas sin deficiencias. La escala analógica visual propuesta en este trabajo puede ser utilizada en poblaciones sanas como una herramienta subjetiva de tamizaje para el riesgo de padecer anemia, que además es fácil de contestar y económica(AU)

Nutritional anaemias affect more than one third of women of reproductive age worldwide as a result of a lack of one or various nutrients involved in the haematopoiesis, mainly iron. Women are at higher risk because of menstruation. The objective of this paper was to evaluate the association between the perception of the amount of menstrual bleeding and iron, folic acid, vitamin B12, ferritin and hemoglobin deficiencies, among women from Mexico City. This cross-sectional study included 12-49 year old women, that were not pregnant or breastfeeding. Hemoglobin, ferritin, iron, folate, and vitamin B12 were quantified. Self reported menstrual bleeding was estimated by using a 10 cm long visual analogue scale. Associations were calculated by Student’s T test, Chi2 and Pearson’s correlation coefficient. Sensibility and specificity were depicted in a ROC curve. Results showed that anaemic women perceived a larger menstrual blood loss than those non anaemic (p<0.05). No differences were observed in any other of the micronutrients studied.The visual analogue scale is an easy-to-answer and cheap screening test that could be used in apparently healthy populations to detect the risk of anaemia(AU)

Las conductas alimentarías de riesgo no se asocian con deficiencias de micronutrimentos en mujeres en edad reproductiva de la Ciudad de México / Abnormal eating behaviours are not associated with micronutrient deficiencies among women of childbearing age from Mexico City

El objetivo de este trabajo fue evaluar la asociación entre las conductas alimentarias de riesgo (CAR) y las deficiencias de vitaminas y nutrimentos inorgánicos en una muestra de mujeres en edad reproductiva. Participaron 282 mujeres de 12 a 49 años (21.9 por ciento adolescentes) no embarazadas ni lactando, muestreadas de manera sistemática con arranque aleatorio en 6 colonias del poniente del Distrito Federal. Se evaluaron las concentraciones de las vitaminas A, C, E, B12 y ácido fólico así como de hemoglobina, ferritina y hierro y zinc séricos. Para las CAR se usó un cuestionario validado en la población mexicana. La información se analizó con estadística descriptiva y la prueba de Fisher. Aproximadamente el 68 por ciento de la muestra fue de nivel socioeconómico medio-bajo o inferior. El 14.8 por ciento tuvo un puntaje de riesgo para las CAR, sin diferencias entre adolescentes y adultas. Las CAR más frecuentes fueron la preocupación por engordar y comer demasiado. El 10 por ciento de las mujeres, aproximadamente, usaron diuréticos o laxantes durante el trimestre anterior a la encuesta. Las deficiencias más importantes fueron las de Vitamina E, zinc y hierro, que afectan al 47 por ciento, 44 por ciento y 27 por ciento de la población, respectivamente. No hubo asociación significativa entre las CAR y las deficiencias de micronutrimentos de manera global ni al analizar por conductas aisladas. A pesar de ello, y dada la alta prevalencia de las CAR y la obesidad en esta población, es necesario hacer campañas para promover la adopción de conductas saludables que permitan alcanzar un peso adecuado.

The aim of this study was to evaluate the association between the risk of abnormal eating behaviors (AEB) and vitamin and mineral deficiencies among women. Women of childbearing age (n=282) were systematically sampled with a random start (21.9 percent adolescents) in 6 suburbs in the west side of Mexico City, they were non pregnant or breastfeeding. Vitamin A, C, E, B12, folic acid, hemoglobin, ferritin, cupper, iron and zinc concentrations were measured. A questionnaire validated in the Mexican population was used for screening AEB. Data were analyzed by descriptive statistics and by using Fisher´s test. Approximately 68 percent of the sample belonged to a mid-low or lower socioeconomic status. 14 percent had risk of AEB, without statistical differences between adults and teenagers. 10 percent used diuretics or laxatives to reduce weight within the trimester preceding the survey. Vitamin E, zinc and iron were the most widespread deficiencies affecting 47 percent, 44 percent and 27 percent of the population, respectively. There was no association between the AEB and micronutrient deficiencies neither when AEB were analyzed globally nor individually. Considering these results and the high prevalence of the AEB and overweight in this population, it is important to promote the adoption or healthy behaviors to achieve an adequate weight.

Violencia de género, embarazo y autoestima en un área urbana de la ciudad de México / Gender violence, pregnancy and self-esteem in an urban area of Mexico city

Objetivo: Estimar la violencia de género con la autoestima en mujeres con y sin embarazo para brindar atención de enfermería. Material y Métodos: Estudio transversal y analítico; muestra: 490 mujeres seleccionadas aleatoriamente conforme criterios de inclusión: edad de 15-45 años, con y sin embarazo, con pareja y participación voluntaria. Se utilizó la Encuesta Nacional de Violencia contra las Mujeres/ENVIM, el Inventario de Autoestima de Coopersmith- A y datos sociodemográficos y obstétricos; para el análisis se utilizó la estadística descriptiva y regresión logística. Resultados: El 52% estuvo embarazada con edad entre 15 a 25 años (p=0,000), con menor que 3 años de convivencia (p=0,000), trabajo no remunerado (p=0,00), el cónyuge percibiendo salario menor que al mínimo (p=0,00); de O a 1 gestación (p=0,001); el 94% refirió violencia por parte de su pareja, las embarazadas presentaron mayor violencia psicológica (RM 2,29 IC 95% 1,39-3,75) y económica (RM 1,38 IC 95% 1,09-1,76) y autoestima baja (RM 1,06 IC 95% 1,63- 2,78); salario menor que al mínimo del cónyuge (RM 1,90 IC 95% 1,00-3,60) y edad entre 15 a 25 años (RM 1,76 IC 95% 1,42-3,98); destacándose la violencia física en las mujeres sin embarazo (RM 1,43 IC 95% 1,08-3,84) y autoestima baja (RM 1,52 IC 95% 1,05-2,21). Conclusiones: Existen diferencias de violencia entre las embarazadas (psicológica y económica) versus no embarazadas (física), siendo la autoestima baja un factor de riesgo. Cabe a las enfermeras identificar factores de riesgo para violencia de género en las consultas y realizar la referencia correspondiente, así como promoción educativa entre las mujeres.

Objective: To estimate gender violence with the self-esteem in women with and without pregnancy to provide nursing care. Material and Methods: Cross-sectional and analytical study; sample: 490 women randomly selected following inclusion criteria: age 15 to 45 years old, with or without pregnancy, with partner and voluntary participation. We used the National Survey of Violence against Women/ENVIM, Self-Esteem lnventory of Coopersmith-A and demographic and obstetric data, for analysis was used descriptive statistic and logistic regression. Results: 52% was pregnant with an age between 15 to 25 years old (p=0.000), with less than 3 years of cohabitation (p=O.OOO), unpaid work (p=0.000), partner receiving salary less than to minimum (p=0.000), from Oto 1 pregnancy (p=O.OOO), 94% referred violence by partner, pregnant women presented more psychological (OR 2.29 CI 95% 1.39-3.75), and economic violence (OR 1.38 CI 95% 1.09-1.76) and low self-esteem (RM 1.06 CI 95% 1.63-2.78); salary menor que amount to a minimum of partner (OR 1.90 CI 95% 1.00-3.60), and age between 15 to 25 years (OR 1.76 CI 95% 1.42-3.98), it is highlighted physical violence against women without pregnancy (OR 1.43 CI 95% 1.08-3.84) and low self-esteem (RM 1.52 CI 95% 1.05-2.21). Conclusions: there are differences of violence among pregnant women (psychological-economic) vs. non-pregnant (physical); being low self-esteem a risk factor. Nursing should identify risk factors for gender violence at consultation and carry out necessary referral, as well educational promotion among women.

Papel de la preeclampsia en la evolución clínica, antropométrica y bioquímica en el primer año posparto / Role of preeclampsia in clinical, anthropometric and biochemistry evolution in the first postpartum year

Antecedentes: La enfermedad inducida por el embarazo complica de 5 a 10% de todos los embarazos en la población mexicana y es la principal causa de morbimortalidad materna. Las mujeres con historia de preeclampsia (PE) tienen un riesgo significativo de desarrollar hipertensión y enfermedades cardiovasculares (ECV) años más tarde. En los desórdenes hipertensivos, se propone como un factor etiológico el síndrome metabólico o de resistencia a la insulina. Objetivo: Evaluar el papel de la PE en la evolución clínica, antropométrica y bioquímica durante el primer año posparto. Material y métodos: Se realizó un estudio de cohorte en un grupo de mujeres de 18a 45 años con PE en el último embarazo pertenecientes al Instituto Nacional de Perinatología Isidro Espinosa de los Reyes (INPerIER). Las variables analizadas fueron las características del síndrome metabólico: presión sanguínea, obesidad abdominal, triglicéridos, lipoproteínas de alta densidad y glucosa de ayuno. Se midieron en tres ocasiones durante el primer año posparto, a los tres, seis y 12 meses posparto (MPP). El grupo control estuvo formado por aquellas mujeres con las mismas características, pero con embarazo sin patología. Resultados: El antecedente de PE es un factor que se encuentra con mayor frecuencia relacionado con mayores cifras de tensión arterial en el posparto. La distribución de grasa, glucosa de ayuno, triglicéridos y lipoproteínas de alta densidad (LAD) no fueron factores que cambiaran, por contar con la condición de cursar con PE, tampoco cambiaron con el paso del tiempo.

Introduction: Hypertension induced by pregnancy complicates between 5 to 10% of all pregnancies among Mexican women and represents the principal cause of maternal, fetal and neonatal morbimortality. Woman with a personal history of preeclampsia (PE) have a higher risk to develop further hypertension and cardiovascular disease (CV). Among hypertensive disorders, metabolic syndrome and insulin resistance are suggested as etiologic factors. Objective: To evaluate the role of PE among anthropometric, clinic and biochemical evolution during the first year postpartum. Material and Methods: A cohort study was performed with woman between 18 to 45 years, with a history PE in their last pregnancy who receives attention at the Instituto Nacional de Perinatología (INPerIER). The analyzed variables were the ones that are characteristic of the metabolic syndrome such as blood pressure, abdominal obesity, triglycerides, high density lipoprotein (HDL) and fasting plasma glucose. During the 1st year postpartum, the variables were measured three times, at three, six and 12 months. The control group had the same measurements and also the same characteristics than the other group, except for the presence of PE. Results: In the postpartum period, the history of PE is commonly related with higher blood pressure. Fat distribution, fasting plasma glucose, triglycerides and HDL neither change across time no changed when presence of previous PE.

Conocimientos y actitudes del personal de enfermería sobre la violencia de género / Knowledge and nurses' attitudes about gender violence

Objetivo: Identificar los conocimientos y las actitudes sobre la violencia de género (VG), así como las barreras personales e institucionales existentes en el personal de enfermería del Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes" (INPerIER), con el fin de identificar necesidades de capacitación del personal. Material y métodos: Es un estudio transversal, observacional y analítico. La población seleccionada fueron enfermeras que estuvieron en contacto con mujeres que acudieron a una institución de salud reproductiva de tercer nivel de atención. La recolección de la información fue voluntaria, informada y anónima, a través de la "Encuesta de Violencia contra la Mujer por parte de su pareja: Opinión del Personal de Salud". Para el análisis estadístico, se utilizó un modelo de regresión logística para evaluar el conocimiento sobre normas, guías e instituciones de referencia a los casos de VG y actitudes. Resultados: Participaron 136 enfermeras (tasa de no-aceptación de 9.4%). El promedio de edad fue 37 años, no tenía pareja 52.9% de las encuestadas, la proporción de enfermeras generales fue 51.5%, tenían estudios carrera técnica postsecundaria 47.1% y laboraban en el turno matutino 54.4%. El conocimiento sobre la VG del personal fue 92.6% nulo a bajo y 7.4% medio. Los factores asociados con la actitud cognitiva y conductual de rechazo con la VG fueron: tener edad de 23 a 35 años (RM 2.93 IC 95% 3.0-8.0), familiares con violencia (RM 2.47 IC 95% 1.13-5.37) y nivel de bachillerato (RM 5.03 IC 95% 1.20-10.21). El ser autora de violencia tiene una actitud afectiva desfavorable hacia la VG (OR 5.30 IC 95% 11.08-25.88). Las barreras institucionales y personales para la identificación de los casos de VG, fueron 74.3%. Conclusiones: Se requiere sensibilizar y capacitar para identificar y referir a los casos con VG, además de implementar programas de salud mental para las enfermeras que sean autoras o víctimas de violencia.

Objective: To identify attitudes and knowledge among nurses from Instituto Nacional de Peinatologia (INPerIER) regarding Gender Violence (GV). Material and methods: This is a cross-section, observational and analytic study. Participants were nurses who had been in contact with women attending INPerIER. Information was collected anonymously and voluntary through the "Partner violence against women: healthcare professional's opinion Survey". A logistic regression model was calculated to evaluate the association among several factors including knowledge of guidelines, counselling and centers for assistance to affected women. Results: A total of 136 nurses participated in the study (9.4% non-participants). Average age was 37 years, 52.9% did not have a partner, 51.5% were non-specialized nurses, 47.1% had a post-high school education and 54.4% had an afternoon shift. Knowledge regarding was none-low in 92.6% of the nurses and moderate in 7.4%. Factors associated with cognitive and behavioural attitude and GV included age between 23-35 years (OR 2.93; IC 95%: 3.0-8.0), family members with violence (OR 2.47; IC 95%: 1.13-5.37) and bachelor's level (OR 5.03; IC 95%: 1.20-10.21). The being violence author has an unfavourable affective attitude (OR 5.30; IC 95%: 11.08-25.88). Personal and institutional barriers to identify GV cases were present in 74.3% of the cases. Conclusions: It is necessary to sensitize and train nurses to give assistance or counselling to GV cases, as well as to implement mental health programs for nurses who act violent or are victims of violence.

Validación de un instrumento para evaluar la adherencia terapéutica en diabéticas durante el embarazo

Introducción: La adherencia a la terapéutica (AT) en la diabética tipo 2 durante el embarazo (DM2) ha demostrado ser un elemento sustancial para reducir la morbimortalidad materna y perinatal. Hasta el momento no existen instrumentos específicos para evaluar la AT en diabéticas durante el embarazo. Objetivo: Construir y validar un instrumento específico para medir adherencia terapéutica en DM2. Material y métodos: Se diseñó un instrumento autoaplicable, el cual fue sometido a revisión por un panel multidisciplinario de expertos para determinar su validez lógica y de contenido. Se aplicó, en dos diferentes días, a 81 diabéticas tipo 2 embarazadas. Resultados: Después de la depuración de ítems se obtuvo un instrumento conformado por 25 preguntas cerradas, distribuidas en seis dominios: a) conocimiento que tiene el paciente de su régimen terapéutico, b) regularidad en la aplicación de los medicamentos, c) apego al plan alimentario, d) actitud para tomar los medicamentos, e) cumplimiento a las citas, y f) si ha requerido atención de urgencia por su enfermedad. El alpha de Cronbach para la calificación total de los ítems fue de 0.9094. Para evaluar la confiabilidad análisis de varianza, no encontramos diferencias estadísticas significativas (F 0.005 p = 0.946). Para la validez de criterio utilizamos HbA 1c como estándar de oro, encontrando que 40 (0.77) de las pacientes con adherencia inadecuada tenían concentraciones anormales de este indicador (χ ² = 4.239 p ≤ 0.0.3), la sensibilidad del instrumento fue 76.92. Conclusiones: El instrumento para medir la adherencia terapéutica tiene validez aparente, validez de contenido y buen nivel de consistencia.

Introduction: Therapeutic adherence (TA) in diabetes type 2 women were seen during pregnancy (DM2P), has proven to be a substantial element in decreasing maternal and perinatal morbi-mortality. At last were not exist specific instruments to value the AT in pregnancy diabetics. Objective: To develop and validate a specific instrument to measure therapeutic adherence in diabetes type 2 women were seen during pregnancy (DM2P). Material and Methods: A self administered instrument was designed to measure TA. It was submitted for review by multidisciplinary group of experts who assessed its logical and content validity to measure TA. The instrument was administered to 81 DM2P on two different days. Results: After depuration of items, the instrumen had 25 closed items grouped in 6 domains: a)The knowledge that the patient has about the therapeutic regimen, b) the regularity in the medication, c) adherence to nutrition, d) attitude for the medication, e) asistance at the appointments, and f) if requieres emergency attention for the disease. The global rating of the questionnaire had a Crobach's alpha of 0.9094. For the confiability evaluation we use variance analysis, and were not found statistical differences (F.005 p 0.946). For the validation we use the HbA 1c criterion like gold standar, founded that 40 (.77) of the patients with inadecuated adherence, have anormal contractions for this indicator (χ ² = 4.239 p ≤ 0.3). Conclusions: The questionnaire has logical validity, content validity and good level of consistency.

Conceptos y prácticas sobre salud y enfermedad en mujeres residentes de la ciudad de México / Concepts and practices in health and disease, in women residents in Mexico city

Antecedentes. La conceptualización de salud y enfermedad es un proceso dinámico, varía en cada población, matizada individual y colectivamente por las condiciones histórico-sociales prevalecientes. Material y métodos. Se analizó encuesta aplicada a 81 mujeres, en una comunidad del Distrito Federal, consignando conceptos de salud y enfermedad (aspectos orgánicos, juicios de valor y otros factores), factores que afectan la salud (conductas personales y factores ambientales) y qué alterntivas eligen cuando se enferman (médico, remedios caseros o automedicación). Resultados y discusión. Se encuestó a mujeres entre 21 y 60 años, con escolaridad básica 0.60, dedicadas al hogar 0.76, nacidas en el Distrito Federal 0.68, con pareja 0.80, en familia nuclear 0.65, con menos de 4 hijos 0.73, con dos o menos salarios mínimos de ingreso 0.70, con vivienda hacinada 0.52 y con agua intradomiciliaria 0.89. Los conceptos de salud y enfermedad correspondieron en mayor proporción a aspectos orgánicos (0.41 y 0.38), a juicios de valor (0.37 y 0.30) y a otros factores (0.22 y 0.32). Las conductas personales se consideraron como que afectan la salud en 0.59, los factores ambientales en 0.41. Se acude al médico para problemas de salud en 0.48. Se analizan interrelaciones entre variables. Conclusiones. Se encontró una asociación entre el uso de juicios de valor y recurrir al médico preferentemente y entre los conceptos basados en características orgánicas y preferir otros recursos no médicos. Tal asociación no alcanzó a ser significativa.