Association between location of prenatal care services and non-consented cesarean sections in Mexico: A secondary analysis of the National Survey on the Dynamics of Household Relationships 2016.

BACKGROUND: Mexico has one of the world's highest rates of cesarean section (C-section). Little is known about Mexico's frequency of and risk factors for non-consented C-sections, a form of obstetric violence. We examined the prevalence of sociodemographic and obstetric-specific characteristics of Mexican women who delivered via C-section, as well as the association between the location of prenatal care services and experiencing a non-consented C-section. METHODS: We conducted a secondary analysis of data collected from Mexico's 2016 National Survey on the Dynamics of Household Relationships (ENDIREH 2016) of women who reported a C-section during their latest delivery. Adjusted logistic regressions were calculated to explore the associations between the location of prenatal care services and experiencing a non-consented cesarean delivery, stratifying by Indigenous belonging. RESULTS: The sample size for this analysis was 10,256 ENDIREH respondents, with 9.1% not consenting to a C-section. ENDIREH respondents between the ages of 26 and 35 years old, living in urban settings, living in Central or Southern Mexico, and married or living with a partner experienced a higher prevalence of non-consented C-sections. For both women who identified as Indigenous and those who did not, the odds of experiencing a non-consented C-section were higher when receiving prenatal services in private settings. Receiving more than one type of prenatal service was also associated with increased odds of non-consented C-sections, while ENDIREH 2016 respondents who did not identify as Indigenous and received prenatal care at the State Institute for Social Security and Services for State Workers facility had lower odds of experiencing a non-consented C-section. CONCLUSIONS: This analysis indicates that receiving prenatal care at a private facility or a combination of public and private services increases the risk of experiencing a non-consented C-section in Mexico. Additional research is required to further understand the factors associated with non-consented C-sections in Mexico.

Prevalence of different variations of non-consented care during the childbirth process in Mexico by geographical regions: comparing ENDIREH survey data from 2016 to 2021.

INTRODUCTION: Non-consented care, a form of obstetric violence involving the lack of informed consent for procedures, is a common but little-understood phenomenon in the global public health arena. The aim of this secondary analysis was to measure the prevalence and assess change over time of non-consented care during childbirth in Mexico in 2016 and 2021, as well as to examine the association of sociodemographic, pregnancy-, and childbirth-factors with this type of violence. METHODS: We measured the prevalence of non-consented care and three of its variations, forced sterilization or contraception, forced cesarean section, and forced consent on paperwork, during childbirth in Mexico for 2016 (N = 24,036) and 2021 (N = 19,322) using data from Mexico's cross-sectional National Survey on the Dynamics of Household Relationships (ENDIREH). Weighted data were stratified by geographical regions. We performed adjusted logistic regression analyses to explore associations. RESULTS: The national prevalence of non-consented care and one of its variations, pressure to get a contraceptive method, increased from 2016 to 2021. A decrease in the prevalence was observed for forced contraception or sterilization without knowledge, forcing women to sign paperwork, and non-consented cesarean sections nationally and in most regions. Women between the ages of 26 and 35 years, married, cohabiting with partner, living in urban settings, who do not identify as Indigenous, and who received prenatal services or gave birth at the Mexican Institute of Social Security (IMSS) facilities experienced a higher prevalence of non-consented care. Being 26 years of age and older, living in a rural setting, experiencing stillbirths in the last five years, having a vaginal delivery, receiving prenatal services at IMSS, or delivering at a private facility were significantly associated with higher odds of reporting non-consented care. CONCLUSION: While a decrease in most of the variations of non-consented care was found, the overall prevalence of non-consented care and, in one of its variations, pressure to get contraceptives, increased at a national and regional level. Our findings suggest the need to enforce current laws and strengthen health systems, paying special attention to the geographical regions and populations that have experienced higher reported cases of this structural problem.

Perceptions of preparedness, timing of cancer diagnosis, and objective emergency preparedness among gynecological cancer patients in Puerto Rico before and after Hurricane Maria.

OBJECTIVES: This study investigated the impact of cancer diagnosis status, individual feelings of preparedness, and other covariates on objective emergency preparedness among women diagnosed with gynecological cancers before or after the 2017 Hurricanes Irma and Maria in Puerto Rico. METHODS: This study included 240 women who were interviewed by telephone from 9/2019-11/2020. Objective emergency preparedness was assessed using a list of six items. Subjective emergency preparedness was assessed by asking the women how prepared they felt (well, somewhat, or not at all) to face an emergency. Crude and multivariable logistic regression analyses were conducted to assess the associations (odds ratios [ORs] and 95% confidence intervals [CIs]) between variables of interest and objective preparedness. RESULTS: Before and after the hurricanes, 60% and 66% of women, respectively, were objectively prepared. Before the hurricanes, women reporting feeling well-prepared (vs. not prepared) (OR=9.31, 95%CI:3.96-21.91) and those who were diagnosed before (vs. after) the hurricanes (OR=1.71, 95%CI:0.95-3.09) were more likely to be objectively prepared. After the hurricanes, self-perceived well-preparedness (OR=2.46, 95% CI: 1.10-5.51) was positively associated with emergency preparedness when compared to feeling unprepared. CONCLUSIONS: Perceptions of emergency preparedness and having a cancer diagnosis increased the likelihood of being objectively prepared for an emergency. POLICY SUMMARY: This study demonstrates the need for state, territorial, and federal governments to include emergency preparedness plans for cancer patients in the Comprehensive Cancer Control plans. The study also indicates a need for cancer specific emergency preparedness information to be readily available for patients.

Through our own eyes and voices: The experiences of those "left-behind" in rural, indigenous migrant-sending communities in western Guatemala.

Migration from Central America to the United States has become a strategy to escape economic poverty, exclusionary state policies and violence for people of Mayan descent. Under the principles Community Based Participatory Research, we explored the health concerns of Indigenous Mayans in rural migrant-sending communities of Guatemala using their own visual images and narratives through a Social Constructivist lens. Half of households in the study region have at least one member emigrated to the United States, making many "transnational families." Focus groups and photographs and narratives from 20 Photovoice participants, aged 16-65, revealed significant health challenges related to conditions of poverty. Drivers of immigration to the United States included lack of access to healthcare, lack of economic opportunity, and an inability to pay for children's education. Health implications of living in communities "left-behind" to immigration centered around changes in societal structure and values. Mental health challenges, sadness and loss were experienced by both children and adults left behind. An increase in substance use as a coping mechanism is described as increasingly common, and parental absence leaves aging grandparents raising children with less guidance and supervision. Lack of economic opportunity and parental supervision has left young adults vulnerable to the influence of cartel gangs that are well-established in this region. Findings from this study provide insight into challenges driving immigration, and the health impacts faced by rural, Indigenous communities left behind to international immigration. Results may inform research and interventions addressing disparities and strategies to cope with economic and health challenges.

Deportation and mental health among migrants who inject drugs along the US-Mexico border.

This study describes the prevalence and factors of depressive symptoms among a sample of persons who inject drugs (PWID) with a history of deportation from the US in Tijuana, Mexico. In 2014, 132 deported PWID completed a structured questionnaire. Depressive symptoms were measured using the Center for Epidemiologic Studies Short Depression Scale (CESD-10) screening instrument. Eligible participants were ≥18 years old, injected drugs in the past month, spoke English or Spanish, and resided in Tijuana. Multivariate analyses identified factors associated with depressive symptoms. Among deported PWID, 45% reported current symptoms of depression. Deported PWID who were initially detained in the US for a crime-related reason before being deported (adjusted odds ratio (AOR): 5.27; 95% CI: 1.79-15.52) and who perceived needing help with their drug use (AOR: 2.15; 95% 1.01-4.61) had higher odds of reporting depressive symptoms. Our findings highlight the need for effective strategies targeting deported migrants who inject drugs to treat mental health and drug abuse in Tijuana. Investing in the mental health of deported PWID may also be a viable HIV prevention strategy.

Exposure to smoking in soap operas and movies: smoking cessation and attempts to quit. / Exposição ao cigarro em telenovelas e filmes: tentativas de parar de fumar e abstinência.

The objectives of this research were to evaluate whether there was an association between seeing an actor smoke in telenovelas, Brazilian films, or international films, and trying to quit and quitting among adult Brazilian smokers. Data from 39,425 participants in the Global Adult Tobacco Survey were used. Quit ratio (former smoker/former smoker + ever smoker) and proportions of current, former, and never smokers were calculated. Multivariable weighted regression was used to determine significant associations between quitting smoking and exposure to telenovelas and films. For current smokers, the odds of trying to quit were significantly higher among those who saw an actor smoking in a Brazilian film. Those who believed smoking caused serious illness and had rules in the home prohibiting smoking were significantly more likely to have tried to quit or had quit smoking. Exposure to smoking in the media may be different in adults than adolescents. Influential factors for trying to quit and quitting are rules prohibiting smoking at home, belief that smoking causes serious illness, and hearing about dangers of smoking in media.

Exposição ao cigarro em telenovelas e filmes: tentativas de parar de fumar e abstinência / Exposición al tabaco en telenovelas y películas: dejar de fumar e intentos de abandono de este hábito / Exposure to smoking in soap operas and movies: smoking cessation and attempts to quit

Resumo O objetivo foi avaliar a existência de uma associação entre o fato de ver um ator fumando em telenovela brasileira, filme brasileiro ou filme internacional e as tentativas de parar de fumar e abstinência entre fumantes adultos brasileiros. Foram utilizados os dados de 39.425 participantes da versão brasileira do Global Adult Tobacco Survey. O estudo calculou a prevalência de ex-fumantes (ex-fumantes/ex-fumantes + fumantes atuais) e as proporções de fumantes atuais, ex-fumantes e indivíduos que nunca fumaram. Foi utilizada a regressão ponderada multivariada para testar associações significativas entre cessação e exposição ao tabagismo em telenovelas e filmes. Para fumantes atuais, as chances de tentar de parar foram significativamente mais altas entre aqueles que haviam visto ator fumando em filme brasileiro. Aqueles que acreditavam que o fumo causa doenças graves e tinham regras contra fumar em casa apresentavam chances significativamente maiores de terem tentativas de parar e de abstinência. A exposição ao tabagismo na mídia pode ser diferente em adultos e adolescentes. Fatores que influenciam as tentativas e o sucesso na cessação incluem as regras contra fumar em casa, a crença de que o fumo provoca doenças graves e receber informação sobre os perigos do tabagismo através da mídia.

Resumen: Este trabajo tiene el fin de evaluar si existe una asociación entre ver a un actor fumando en telenovelas brasileñas o películas internacionales y dejar de fumar o intentar dejarlo entre fumadores adultos brasileños. Se usaron datos de 39,425 participantes en la Global Adult Tobacco Survey. La ratio de abandono de este hábito (ex fumadores/ex fumadores + fumadores) y los porcentajes de fumadores habituales, ex fumadores y no fumadores también fueron calculados. Se usaron análisis de regresión multivariable para determinar asociaciones significativas entre dejar de fumar y la exposición a telenovelas y películas. Para los fumadores habituales, la probabilidad de intentar dejar de fumar fueron significativamente mayores entre quienes vieron a un actor fumando en una película brasileña. Aquellos que creyeron que fumar causaba enfermedades serias y tenían normas en casa prohibiendo fumar eran más significativamente propensos a haber intentado dejar de fumar o haberlo dejado. La exposición al tabaco en los medios audiovisuales puede diferir entre adultos y adolescentes. Existen factores que influencian intentar o dejar de fumar y son: normas prohibiendo fumar en casa, y la creencia de que el tabaco provoca enfermedades muy serias, así como informarse sobre los peligros del tabaco en los medios de comunicación.

Abstract: The objectives of this research were to evaluate whether there was an association between seeing an actor smoke in telenovelas, Brazilian films, or international films, and trying to quit and quitting among adult Brazilian smokers. Data from 39,425 participants in the Global Adult Tobacco Survey were used. Quit ratio (former smoker/former smoker + ever smoker) and proportions of current, former, and never smokers were calculated. Multivariable weighted regression was used to determine significant associations between quitting smoking and exposure to telenovelas and films. For current smokers, the odds of trying to quit were significantly higher among those who saw an actor smoking in a Brazilian film. Those who believed smoking caused serious illness and had rules in the home prohibiting smoking were significantly more likely to have tried to quit or had quit smoking. Exposure to smoking in the media may be different in adults than adolescents. Influential factors for trying to quit and quitting are rules prohibiting smoking at home, belief that smoking causes serious illness, and hearing about dangers of smoking in media.

Diabetes Cultural Beliefs and Traditional Medicine Use Among Health Center Patients in Oaxaca, Mexico.

Type II diabetes mellitus is currently the leading cause of death in Mexico. Oaxaca is one of the poorest states in Mexico with the largest concentration of indigenous people in the country. Despite the alarming increase of diabetes rates in this region, little is known about the indigenous populations' cultural understandings and related practices for this chronic disease. This study examined diabetes cultural beliefs and traditional medicine use among a sample of 158 adults with and without diabetes in Oaxaca, Mexico. Individuals with and without diabetes did not differ in their traditional culture beliefs regarding diabetes in this study. Younger age (OR = 1.04) and stronger beliefs in punitive and mystical retribution (OR = 5.42) regarding diabetes causality increased the likelihood of using traditional medicine (p < .05). Findings may aid in the development of culturally tailored programs to address diabetes prevention and management efforts in the region.

Police Victimization Among Persons Who Inject Drugs Along the U.S.-Mexico Border.

OBJECTIVE: Problematic policing practices are an important driver of HIV infection among persons who inject drugs (PWID) in the U.S.-Mexico border region. This study identifies factors associated with recent (i.e., past 6 months) police victimization (e.g., extortion, physical and sexual violence) in the border city of Tijuana, Mexico. METHOD: From 2011 to 2013, 733 PWID (62% male) were recruited in Tijuana and completed a structured questionnaire. Eligible participants were age 18 years or older, injected illicit drugs within the past month, and spoke Spanish or English. Multivariable logistic regression analyses identified correlates of recent experiences of police victimization (e.g., bribes, unlawful confiscation, physical and sexual violence). RESULTS: Overall, 56% of PWID reported a recent police victimization experience in Tijuana. In multivariable logistic regression analyses, factors independently associated with recent police victimization included recent injection of methamphetamine (adjusted odds ratio [AOR] = 1.62; 95% CI [1.18, 2.21]) and recently received injection assistance by a "hit doctor" (AOR = 1.56; 95% CI [1.03, 2.36]). Increased years lived in Tijuana (AOR = 0.98 per year; 95% CI [0.97, 0.99]) and initiating drug use at a later age (AOR = 0.96 per year; 95% CI [0.92, 0.99]) were inversely associated with recent police victimization. CONCLUSIONS: Physical drugusing markers may increase PWID susceptibility to police targeting and contribute to experiences of victimization. Interventions aimed at reducing police victimization events in the U.S.-Mexico border region should consider PWID's drug-using behaviors. Reducing problematic policing practices may be a crucial public health strategy to reduce HIV risk among PWID in this region.

Control de la calidad del seguimiento de contactos de tuberculosis pulmonar en Camagüey, Cuba (2008-2011) / Quality control in the follow-up of pulmonary tuberculosis contacts in Camaguez, Cuba (2008-2011)

Introducción La tuberculosis constituye en la actualidad un problema de salud en el municipio de Camagüey. ObjetivoEvaluar el cumplimiento de los lineamientos del Programa Nacional para el Control de la Tuberculosis para el seguimiento de los contactos de casos positivos de tuberculosis pulmonar en el municipio de Camagüey, Cuba. DiseñoEstudio descriptivo de corte transversal en el municipio de Camagüey entre los años 2008 y 2011. Métodos Se incluyeron 1.242 contactos resultantes de 39 casos de tuberculosis reportados en el período en estudio. Se revisaron las encuestas epidemiológicas y registros epidemiológicos de los casos reportados. Los resultados se procesaron y analizaron en el software estadístico SPSS 17.0, luego se representaron en tablas y gráficos. Se utilizó el porcentaje como medida de resumen. Se empleó como herramienta guía el “Formulario de seguimiento de los contactos de tuberculosis pulmonar” creado por expertos del grupo de investigación y vigilancia de tuberculosis, infecciones respiratorias agudas y lepra del Instituto de Medicina Tropical Pedro Kourí. Resultados Los contactos con examen inicial y cuatro controles completados presentaron 96,2 por ciento de aceptabilidad; en tanto, los contactos que tuvieron menos de cuatro controles reportaron resultados inferiores a 10 por ciento (3,3 por ciento). Todos los contactos fueron investigados desde el inicio y se les administró tratamiento de acuerdo a los lineamientos del programa.Conclusión Se observó que hay cumplimiento en los lineamientos del Programa Nacional de Control de la Tuberculosis para el seguimiento de los contactos de casos positivos de tuberculosis pulmonar. Éste es más riguroso en las edades tempranas y laboralmente activas (entre 25 y 54 años). La evaluación contribuyó a la identificación de las debilidades existentes como la poca sensibilidad de la población para someterse a los exámenes correspondientes en el Programa Nacional de Control de la Tuberculosis.

Introduction Tuberculosis is currently a health problem in the municipality of Camagüey. Purpose To assess compliance of guidelines issued by the National Program for the Control of Tuberculosis for the follow-up of contacts of positive cases of pulmonary tuberculosis in the municipality of Camagüey, Cuba. Design Descriptive cross-sectional design. Methods1,242 contacts resulting from 39 reported cases of tuberculosis during the study period were included in the municipality of Camagüey between 2008 and 2011. Epidemiological surveys and records of reported cases were reviewed. The results were processed and analyzed in SPSS 17.0 statistical software and subsequently presented in tables and graphs. The results were summarized by percentages. The “Follow-up form for contacts of pulmonary tuberculosis” was used as main guideline, which was created by experts of the Investigation and Monitoring of Tuberculosis, Acute Respiratory Infections, and Leprosy Workshop of Tropical Medicine Institute Pedro Kourí. Results Contacts that had an initial examination and four checkups had 96.2 percent of acceptability. Contacts that had fewer than four checkups showed less than 10 percent acceptability (3.3 percent). All contacts were assessed from the outset and were treated, in accordance with program guidelines. Conclusion We found adequate compliance of National Program for the Control of the Tuberculosis guidelines for follow-up of contacts of positive cases of pulmonary tuberculosis. Compliance is greater in younger age groups and in the actively employed (25 to 54 years). This evaluation contributed to identify existing weaknesses in follow-up, such as low interest of this population to undergo appropriate testing in the National Program of Control of Tuberculosis.

Navigating changing food environments - Transnational perspectives on dietary behaviours and implications for nutrition counselling.

United States (US) migrants are often characterised as experiencing unhealthy nutrition transitions. 'Looking-back' into dietary behaviours and the processes that affect dietary changes before migration may improve counselling interventions. We conducted a qualitative study of an indigenous Zapotecan transnational community based in Monterey, California, and Oaxaca, Mexico. Four focus groups and 29 interviews were conducted with transnational participants concerning health beliefs around and dietary differences between the US and Oaxaca. Analysis focused on nutrition-related themes. The four major themes were: (1) the paradox between participants' experience growing up with food insecurity and fond memories of a healthier diet; (2) mothers' current kitchen struggles as they contend with changes in food preferences and time demands, and the role 'care packages' play in alleviating these challenges; (3) positive views about home-grown versus store-bought vegetables; and (4) the role of commercial nutritional supplements and the support they provide. Counselling implications include (1) taking a detailed medical/social history to explore experiences with food insecurity and views on the role of nutrition in maintaining health and (2) exploring patients' struggles with different dietary preferences within their families. Transnational experiences may provide new insights for dietary counselling and patient-centred health communication.

Good and bad death: exploring the perspectives of older Mexican Americans.

The purpose of this study was to identify and describe the domains that define a good death from the perspectives of healthy Mexican American older adults. Qualitative data from face-to-face interviews with 18 participants residing in Southern California were analyzed. Five categories regarding the concepts of good and bad death include no suffering, living life with faith, having time for closure with family, dying at home, and a natural death. Understanding the meaning of good and bad death within specific cultural contexts is integral to promoting cultural sensitivity when working with older adults, especially in end-of-life care.

Respuestas adaptativas de mujeres en climaterio y menopausia / Adaptative responses of women during climateric and menopause

Resumen

Introducción: el climaterio y menopausia son acontecimientos propios del género femenino, es un fenómeno fisiológico que se presenta en un periodo vulnerable debido al proceso reproductivo que está concluyendo.

Objetivo: determinar cómo se adaptan en su ambiente laboral y familiar las mujeres en esta etapa de su vida.

Metodología: descriptiva y transversal, el tamaño de la muestra se determinó a través de muestreo no probabilístico, se estudiaron 130 mujeres entre 45 y 60 años de edad, se utilizó un instrumento de 25 preguntas para cada grupo. El grupo I estuvo integrado por mujeres que laboran en el espacio público y el grupo II por mujeres que se dedican al hogar.

Resultados: a menor edad son más las mujeres que acudieron a consulta, el nivel de escolaridad fue más alto para el grupo I, los signos y síntomas que más manifestaron ambos grupos fueron: cefalea, bochornos, fatiga, disminución del deseo sexual, crisis repentinas de llanto, irritabilidad, depresión, entre otros; adaptándose a través de la ministración de analgésicos, bañarse y salir a caminar. Con base en la teoría de Callista Roy, se considera que el grupo I (ambiente laboral) se adaptan más a los cambios hormonales en climaterio y menopausia, no así las mujeres que se dedican al hogar, estas se sienten incomprendidas, rechazadas, con autoestima baja y no les reconocen su trabajo.

Summary

Introduction: the climacteric, or menopause, is a female event. It is a physiological phenomenon that occurs in a vulnerable period due to the conclusion of the reproductive process.

Objective: to determine how women in this stage of life adapt in their family and work environments.

Methodology: the study design was descriptive and transversal. A nonprobability sample of 130 women between the ages of 45 and 60 were interviewed with an instrument of 25 questions. Group 1 consisted of 60 women who work outside of the home. Group 2 consisted of 70 women who work in the home.

Results: younger women were more likely to come for consultation. Group 1 had a higher educational level. Both groups experienced headaches, hot flashes, fatigue, decreased sexual desire, crying episodes, irritability, and depression. Adaptation was through the use of analgesics, taking a bath, and going for walks. Based in Roy’s Adaptation Model, we saw that the women in Group 1 (working women) adapted more easily to the hormonal changes of the climacteric than did the women of Group 2 (homemakers), who experienced low self esteem, felt misunderstood, rejected, and that their work was unappreciated.