Association between violence and depression during pregnancy with perinatal outcomes: a moderated mediation analysis.

OBJECTIVE: To assess the direct, indirect, and total effects of violence during pregnancy on perinatal outcomes, and to evaluate the effect of violence as a moderator of the mediated relationship of depression with perinatal outcomes. METHODS: Data was collected from the prenatal study and follow-ups of the BRISA cohort, São Luís, Maranhão, Brazil. The perinatal outcomes investigated were: birth weight (BW), intrauterine growth restriction (IUGR) and gestational age (GA). Violence against women was evaluated using the World Health Organization Violence against Women instrument (Violence during pregnancy - regardless of the type of violence; Physical violence during pregnancy; Psychological violence during pregnancy). Depressive symptoms during pregnancy were evaluated as a mediating variable. Moderated mediation analysis was performed to estimate the effects of violence and depression on perinatal outcomes. RESULTS: Three types of violence analyzed by depression had an indirect effect in BW and GA. None of the types of violence showed an association with IUGR. All types of violence analyzed showed a moderated mediation effect with BW and GA. Only among women who experienced violence were birth weight and gestational age lower the higher the values of depressive symptoms. CONCLUSION: Violence and depression are only associated with lower BW and GA when they occur simultaneously.

Envejecimiento poblacional y desigualdades sociales en la mortalidad del adulto mayor en Colombia ¿Por qué abordarlos ahora y dónde comenzar? / Population aging and social inequalities in the mortality of the elderly in Colombia. Why should we approach it now and where to start? / Envelhecimento populacional e desigualdades sociais na mortalidade de pessoas idosas na Colômbia: por que abordá-los agora e por onde começar?

Resumen Objetivo: analizar la magnitud del envejecimiento poblacional y las desigualdades sociales presentes en la mortalidad del adulto mayor en Colombia. Métodos: estudio ecológico usando datos sub-nacionales de mortalidad, pobreza, barreras de acceso a los servicios de salud y analfabetismo, y de la población adulta mayor para analizar brechas. Se calcularon y compararon tendencias de tres indicadores de impacto: la esperanza de vida (2005-2020), los Índices de envejecimiento y sobre-envejecimiento (2005-2012). Se estimaron tres medidas para resumir la desigualdad absoluta y relativa: el Índice de Desigualdad de la Pendiente (IDP), el Índice Relativo de Desigualdad (IRD) de Kunst y Mackenbach y el Índice de Concentración (IC). Todos los análisis se realizaron usando la biblioteca para medición de desigualdades de Epidat 4.2. Resultados: la proporción de personas mayores será cada vez mayor en Colombia. Las barreras de acceso a los servicios de salud fue la dimensión más inequitativa. Dos patrones de desigualdad fueron identificados: una exclusión marginal en el 60% de los adultos mayores con más ventajas y oportunidades, y un patrón de gradiente lineal presente solo en la incidencia de pobreza. El quintil 3 fue el grupo de departamentos más afectado por la inequidad a lo largo de las dimensiones evaluadas. Discusión: este estudio aporta evidencia sobre patrones de desigualdad en la mortalidad del adulto mayor. A nivel de tendencias, solo fue posible conocer que la brecha ha empeorado en incidencia de pobreza. Conclusiones: las recomendaciones se centran en cinco áreas de acción, para lograr un contexto deseable para el abordaje del envejecimiento poblacional y la reducción de las desigualdades, como desafíos del sistema de salud y de protección social, y que pueden socavar la realización progresiva de la cobertura universal en salud y el logro de los objetivos de desarrollo sostenible para 2030.

Abstract Objective: to analyze the magnitude of population aging and the social inequalities existing in the mortality of the elderly in Colombia. Methodology: an ecological study which analyzed the breaches between the people via sub-national data on mortality, poverty, barriers preventing access to healthcare services, illiteracy and the elderly population. The trends of three impact indicators were calculated and compared: life expectancy (2005-2020), aging and over-aging indices (2005-2012). Furthermore, three measures were estimated to summarize absolute and relative inequality: the slope index of inequality (SII), Kunst and Makenbach's relative index of inequality (RII) and the concentration index (CI). All analyses were performed using the library for measuring inequalities included with Epidat 4.2. Results: the ratio of elderly people will be ever increasing in Colombia. The barriers preventing access to healthcare services were the most inequitable dimension. Two patterns of inequality were identified: a marginal exclusion for 60% of the elderly who had the most advantages and opportunities, and a linear gradient pattern existing only in the incidence of poverty. The third quintile was the group of departments most affected by the inequity throughout the assessed social dimensions. Discussion: this study provides evidence of inequality patterns in the mortality of the elderly. Regarding the trends, it was only possible to know that the breach has become larger in terms of poverty incidence. Conclusions: five areas of action are described in order to achieve a desirable context to address population aging and the reduction of social inequalities as challenges for the healthcare and social protection system. These challenges may undermine the progressive realization of universal healthcare coverage and the achievement of sustainable development goals by 2030.

Resumo Objetivo: Analisar a dimensão do envelhecimento populacional e das desigualdades sociais presentes na mortalidade de pessoas idosas na Colômbia. Metodologia: Estudo ecológico que se utiliza de dados regionais de mortalidade, pobreza, barreiras de acesso aos serviços de saúde e analfabetismo, e da população idosa para analisar lacunas. Foram calculadas e comparadas as tendências de três indicadores de impacto: a expectativa de vida (2005-2020), os Índices de envelhecimento e de sobre-envelhecimento (2005-2012). Foram estimadas três medidas para resumir a desigualdade absoluta e relativa: o Índice de Desigualdade da Inclinação (IDP), o Índice Relativo de Desigualdade (IRD) de Kunst e Mackenbach e o Índice de Concentração (IC). Todas as análises foram realizadas com a utilização da biblioteca para medição de desigualdades Epidat 4.2. Resultados: A proporção de pessoas idosas será cada vez maior na Colômbia. As barreiras de acesso aos serviços de saúde foi o aspecto mais desigual. Dois padrões de desigualdade foram identificados: uma exclusão marginal nos 60% de adultos idosos com mais vantagens e oportunidades; e um padrão de gradiente linear presente somente na incidência de pobreza. O quintil 3 foi o estrato mais afetado pela desigualdade no decorrer das dimensões avaliadas. Discussão: Este estudo contribui com a evidência sobre padrões de desigualdade na mortalidade da pessoa idosa. Em termos de tendências, só foi possível reconhecer que a lacuna agrava-se com a incidência de pobreza. Conclusões: As recomendações concentram-se em cinco áreas de ação com o intuito de que se alcance um contexto desejável para a abordagem do envelhecimento populacional e da redução das desigualdades como desafios do sistema de saúde e de proteção social, e que podem enfraquecer a realização progressiva da cobertura universal em saúde e realização dos objetivos de desenvolvimento sustentável para 2030.

Observatorio de Discapacidad de Colombia / The Colombian Observatory of Disability / Observatório de Deficiência da Colômbia

La Dirección de Epidemiología y Demografía (ded) y la Oficina de Promoción Social del Ministerio de Salud y Protección Social (msps), dando cumplimiento a las competencias y obligaciones de seguimiento, evaluación y gestión del conocimiento establecidas para el sector salud y desde el rol de esta cartera como rector del Sistema Nacional de Discapacidad (snd), ha priorizado el Observatorio de Discapacidad de Colombia como un instrumento técnico para la formulación, desarrollo y evaluación de acciones de inclusión social para la población con discapacidad en el marco del Sistema Nacional de la Discapacidad y el cumplimiento de la Convención sobre los Derechos de las Personas con Discapacidad. El propósito de este artículo es describir la experiencia del Ministerio de Salud y Protección Social en la implementación del Observatorio de Discapacidad de Colombia, describiendo las actividades de planeación, mejoramiento y estructuración requeridas, así como la recolección sistemática, el análisis e interpretación de datos e información sobre la situación de discapacidad en el país.

The Direction of Epidemiology and Demography (DED) and the Social Promotion Office of the Ministry of Health and Social Protection (MSPS), in compliance with the responsibilities and duties of monitoring, assessing and managing the knowledge in the health sector and as the Director of the National System of Disability (SND), has prioritized the Observatory of Disability of Colombia as a technical instrument for the formulation, development and assessment of the actions of social inclusion for people with disabilities within the framework of the National System of Disability and in compliance with the Convention on the Rights of people with Disabilities. The purpose of this paper is to describe the experience of the Ministry of Health and Social Protection in the implementation of the Observatory of Disability of Colombia. The paper describes the required planning, improvement and structuring activities as well as the systematic gathering, analysis and interpretation of data and information on the situation of disability in Colombia.

A Direção de Epidemiologia e Demografia (DED) e o Escritório de Promoção Social do Ministério da Saúde e Assistência Social (MSPS), dando cumprimento às competências e obrigações de seguimento, avaliação e gestão do conhecimento estabelecidas para a área da saúde e desde o papel desta carteira como Reitor do Sistema Nacional de Deficiência (SND), tem priorizado o Observatório de Deficiência da Colômbia como um instrumento técnico para a formulação, desenvolvimento e avaliação de ações de inclusão social para a população com deficiências no quadro do Sistema Nacional da Deficiência e o cumprimento da Convenção sobre os Direitos das Pessoas com Deficiências. O intuito deste artigo é descrever a experiência do Ministério da Saúde e Assistência Social na implementação do Observatório de Deficiência da Colômbia, descrevendo as atividades de planejamento, melhoria e estruturação necessárias, bem como a coleta sistemática, a análise e interpretação de dados e informação sobre a situação de deficiência no país.

Factores asociados con lactancia materna exclusiva hasta el sexto mes en madres adolescentes. Medellin, 2010 / Factors associated with exclusive breastfeeding until the sixth month in teenage mothers. Medellin, 2010

Objetivo Determinar los factores asociados con la lactancia materna exclusiva hasta el sexto mes en madres adolescentes de los niveles I y II del SISBEN de la ciudad de Medellín. Métodos Se realizó un estudio de casos y controles con 323 madres adolescentes, 197 casos y 126 controles de la "Estrategia Buen Comienzo Había una Vez-BCHV" de Metrosalud y la Alcaldía de Medellín. Se aplicó estadística descriptiva para el análisis univariado. Se hizo un análisis de correspondencias. La comparación de variables cualitativas se realizó mediante tablas de contingencia y para las variables cuantitaivas con distribución no normal, U-Mann-Whitney. Para identificar los factores asociados con la lactancia materna exclusiva hasta el sexto mes, se utilizó regresión logística. Se realizaron curvas de Kapplan-Meier para la duración de la lactancia materna y las variables significativas en el modelo. Se calcularon los riesgos atribuibles en expuestos y riesgos atribuibles poblacionales. Resultados El 27,9 % de las madres adolescente lograron lactancia materna exclusiva hasta el sexto mes. La media de la edad de la madre fue de 17,56 años. En el análisis de regresión logística se encontró que el tiempo en la Estrategia, recibir educación después del nacimiento del niño y pertenecer a una familia nuclear están asociados a una mayor duración de lactancia materna. Conclusiones De acuerdo a los resultados encontrados en la población de madres adolescentes, la duración de la lactancia materna exclusiva puede extenderse haciendo énfasis en el tipo de educación y la continuidad en el programa.(AU)

Objective Ascertaining factors associated with exclusive breastfeeding until the sixth month in teenage mothers included in SISBEN system levels I and II in the city of Medellin. Methodology This was a case-control study which included 323 teenage mothers, involving 197 cases and 126 controls for the "Buen comienzo había una vez -BCHV" (good start) strategy. Univariate analysis involved using descriptive statistics; a correspondence analysis was also made. Qualitative variables were compared using contingency tables and the Mann-Whitney U test was used for quantitative variables having non-normal distribution. Logistic regressions was used to identify factors associated with exclusive breastfeeding until the sixth month. Kapplan-Meier curves were made for the duration of breastfeeding and for the significant variable in the model. The attributable risk to which the population was exposed was calculated, as were population attributable risks. Results 27.9% of teenage mothers in the sample managed exclusive breastfeeding until the sixth month. Average maternal age was 17.56 years. Logistic regression analysis revealed that the time spent involved in the strategy and education following the birth of a child for those belonging to a nuclear family were associated with a longer duration of breastfeeding. Conclusions The duration of exclusive breastfeeding in the teenage mother population could be extended, emphasizing continuity and the type of education received by being in the program.(AU)

[Factors associated with exclusive breastfeeding until the sixth month in teenage mothers. Medellin, 2010]. / Factores asociados con lactancia materna exclusiva hasta el sexto mes en madres adolescentes. Medellin, 2010.

OBJECTIVE: Ascertaining factors associated with exclusive breastfeeding until the sixth month in teenage mothers included in SISBEN system levels I and II in the city of Medellin. METHODOLOGY: This was a case-control study which included 323 teenage mothers, involving 197 cases and 126 controls for the "Buen comienzo había una vez -BCHV" (good start) strategy. Univariate analysis involved using descriptive statistics; a correspondence analysis was also made. Qualitative variables were compared using contingency tables and the Mann-Whitney U test was used for quantitative variables having non-normal distribution. Logistic regressions was used to identify factors associated with exclusive breastfeeding until the sixth month. Kapplan-Meier curves were made for the duration of breastfeeding and for the significant variable in the model. The attributable risk to which the population was exposed was calculated, as were population attributable risks. RESULTS: 27.9% of teenage mothers in the sample managed exclusive breastfeeding until the sixth month. Average maternal age was 17.56 years. Logistic regression analysis revealed that the time spent involved in the strategy and education following the birth of a child for those belonging to a nuclear family were associated with a longer duration of breastfeeding. CONCLUSIONS: The duration of exclusive breastfeeding in the teenage mother population could be extended, emphasizing continuity and the type of education received by being in the program.