Co-design of a Community-based Rehabilitation Program to Decrease Musculoskeletal Disabilities in a Mayan-Yucateco Municipality.

BACKGROUND: Chronic musculoskeletal (MSK) diseases are an important cause of disability in the Mayan community of Chankom in Yucatán, Mexico. OBJECTIVE: To understand a community-based participatory research (CBPR) strategy implemented in Chankom to design a community-based rehabilitation (CBR) program for people living with MSK diseases. METHODS: Qualitative descriptive thematic analysis from an ethnographic work conducted in Chankom, during the implementation of a CBPR strategy from 2014 to 2017. RESULTS: Four main themes describe the main processes that formed our CBPR strategy: 1) forming and maintaining an alliance between academic and community members, 2) prioritizing community needs, 3) integrating local and global knowledge and 4) shared-decision-making. This CBPR strategy allowed the design of a CBR program formed by six main interventions: 1) health services coordination, 2) personal support, 3) community venous blood sampling services, 4) community specialized services, 5) health promotion, and 6) health transportation services. CONCLUSIONS: Co-designing a CBR program for people living with chronic MSK diseases in Chankom was possible through an extensive community engagement work structured around four main processes, including the essential principles of CBPR. The designed CBR program includes culturally sensitive interventions aimed at improving the quality, availability, accessibility, and acceptability of health care services. Moreover, the program mainly addressed the "health" component of the World Health Organization-CBR matrix, suggesting a need for a new CBPR cycle after it is implemented and evaluated in the future.

Syndemic and syndemogenesis of low back pain in Latin-American population: a network and cluster analysis.

INTRODUCTION: Although low back pain (LBP) is a high-impact health condition, its burden has not been examined from the syndemic perspective. OBJECTIVE: To compare and assess clinical, socioeconomic, and geographic factors associated with LBP prevalence in low-income and upper-middle-income countries using syndemic and syndemogenesis frameworks based on network and cluster analyses. METHODS: Analyses were performed by adopting network and cluster design, whereby interrelations among the individual and social variables and their combinations were established. The required data was sourced from the databases pertaining to the six Latin-American countries. RESULTS: Database searches yielded a sample of 55,724 individuals (mean age 43.38 years, SD = 17.93), 24.12% of whom were indigenous, and 60.61% were women. The diagnosed with LBP comprised 6.59% of the total population. Network analysis showed higher relationship individuals' variables such as comorbidities, unhealthy habits, low educational level, living in rural areas, and indigenous status were found to be significantly associated with LBP. Cluster analysis showed significant association between LBP prevalence and social variables (e.g. Gender inequality Index, Human Development Index, Income Inequality). CONCLUSIONS: LBP is a highly prevalent condition in Latin-American populations with a high impact on the quality of life of young adults. It is particularly debilitating for women, indigenous individuals, and those with low educational level, and is further exacerbated by the presence of comorbidities, especially those in the mental health domain. Thus, the study findings demonstrate that syndemic and syndemogenesis have the potential to widen the health inequities stemming from LBP in vulnerable populations. Key points • Syndemic and syndemogenesis evidence health disparities in Latin-American populations, documenting the complexity of suffering from a disease such as low back pain that is associated with comorbidities, unhealthy habits, and the social and regional context where they live. • The use of network and cluster analyses are useful tools for documenting the complexity and the multifaceted impact in health in large populations as well as the differences between countries. • The variability and impact of socioeconomic indicators (e.g., Gini index) related to low back pain and comorbidities could be felt through the use of cluster analysis, which generates evidence of regional inequality in Latin America. • Populations can be studied from different models (network and cluster analysis) and grouping, presenting new interpretations beyond geographical groupings, such as syndemic and inequity in health.

Estructura factorial y propiedades de la Escala de Comportamientos para Madres y Padres con Niños Pequeños (ECMP) / Factor structure and properties of a Measure of Parenting Young Children (ECMP)

Este trabajo analiza la estructura factorial de la Escala de Comportamientos para Madres y Padres con Niños Pequeños (ECMP); este instrumento es una adaptación al castellano del Parent Behavior Checklist, que evalúa las prácticas paternas. Se seleccionó una muestra representativa de niños (1.0-5.11 años), de una Cd. de México. La ECMP fue contestada por las mamás (n=982), o por los papás (n=618) de esos niños. Los análisis factoriales permitieron identificar una versión de la ECMP con 99 ítems y tres factores con valores eigen mayores de uno (i.e., expectativas, disciplina y crianza); el porcentaje de varianza explicada por los tres factores fue de 31.8. El coeficiente alta total fue de .95. Estos resultados indican que la estructura factorial y la consistencia interna de la ECMP son adecuadas. Además, como apoyo adicional de la adecuación de la ECMP, se presentan comparaciones entre mamás y papás y entre padres con niños de diferente edad (AU)

This study analyzes the factor structure of a measure of parenting young children (ECMP); this instrument is a Spanish version of the Parent Behavior Checklist. A representative sample of children aged between one yr. and five yrs. 11 months was drawn from an urban area of Mexico. The ECMP was administered to mothers (n= 982) or fathers (n= 618) of the selected children. Factor analysis identified a version of the scale with a pool of 99 items, and three legitimate factors with eigenvalues greater than one (i.e., expectations, discipline and nurturing); the three factors accounted for 31.8 percent of the variance. The coefficient alpha value for the scale was: .95. The present results provide evidence of the adequate factor structure and internal consistency of the ECMP. Further support for the adequacy of the ECMP is reported via comparisons between mothers’ and fathers’ scores, and between parents of different-aged children (AU)