Two girls with a de novo Xq rearrangement of paternal origin: t(X;9)(q24;q12) or rea(X)dup q.

OBJECTIVE: We report on two rare Xq rearrangements, namely a t(X;9)(q24;q12) found in a mildly-affected girl (Patient 1) and a rea(X)dup q concomitant with a rob(14;21)mat in a Down syndrome girl (Patient 2). CASE REPORT: Both rearrangements were characterized by banding techniques [Giemsa (G), constitutive heterochromatin (C), and bromodeoxyuridine (BrdU) pulse], fluorescence in situ hybridization (FISH) assays, human androgen receptor (HUMAR) assays, and microarray analyses. Patient 1 had a t(X;9)(q24;q12)dn. Patient 2 had a de novo rea(X)(qter→q23 or q24::p11.2→qter) concomitant with an unbalanced rob(14;21)mat. X-Inactivation studies in metaphases and DNA revealed a fully skewed inactivation: the normal homolog was silenced in Patient 1 and the rea(X) in Patient 2. Both rearranged X chromosomes were of paternal descent. Microarray analyses revealed no imbalances in Patient 1 whereas loss of Xp (∼52 Mb) and duplication of Xq (∼44 Mb) and 21q were confirmed in Patient 2. CONCLUSION: Our observations further document the cytogenetic heterogeneity and predominant paternal origin of certain de novo X-chromosome rearrangements.

Sociodemographic factors associated with obstacles to abortion care: findings from a survey of abortion patients in Mexico City.

BACKGROUND: First-trimester abortion was legalized in Mexico City in 2007, and services are now provided at public and private sites throughout the city. However, little is known about the obstacles women face when seeking abortion care. METHODS: We surveyed women who obtained abortion services (n = 398) at three public sector facilities in Mexico City to identify the obstacles women faced when obtaining abortions. We used logistic regression to test whether obstacles varied by sociodemographic characteristics. RESULTS: Women with low education were more likely than high school-educated women to report difficulty getting appointments. Unmarried women and women with low education were more likely than married women or high school educated women to report difficulty getting time off work for appointments and arranging for transportation to the facility. Separated or divorced women were more likely than married women to report partner or other family member opposition to the abortion. Women who lived outside of Mexico City were more likely than Mexico City residents to report difficulty with transportation. CONCLUSION: Education, marital status, and place of residence were associated with the obstacles women reported. Strategies to improve access to care should be targeted to the groups at highest risk of experiencing obstacles: Women with primary education or lower, single women, separated/divorced women, and those residing outside of Mexico City.

Clients' perceptions of the quality of care in Mexico city's public-sector legal abortion program.

CONTEXT: In 2007, first-trimester abortion was legalized in Mexico City. Limited research has been conducted to understand clients' perceptions of the abortion services available in public-sector facilities. METHODS: Perceptions of quality of care were measured among 402 women aged 18 or older who had obtained abortions at any of three public-sector sites in Mexico City in 2009. Six domains of quality of care (client-staff interaction, information provision, technical competence, postabortion contraceptive services, accessibility and the facility environment) were assessed, and ordinal logistic regression analysis was conducted to identify the domains that were important in women's overall evaluation of care. RESULTS: Clients gave overall services a high rating, with a mean of 8.8 out of 10. In multivariate analysis, overall ratings were higher among women who said the doctor made them feel comfortable (odds ratio, 3.3), the receptionist was respectful (1.7), the staff was very careful to protect their privacy (2.5), they had received sufficient information on self-care at home following the abortion and on postabortion emotions (1.9 and 2.0, respectively) and they felt confident in the doctor's technical skill (2.5). Rating site hours as very convenient (2.4), waiting time as acceptable (2.8) and the facility as very clean (1.9) were all associated with higher overall scores. Compared with women who had given birth, those who had not rated the services lower overall (0.6). CONCLUSION: Efforts to improve patient experiences with abortion services should focus on client-staff interaction, information provision, service accessibility, technical competence and the facility environment. The most highly significant factor appears to be whether a doctor makes a woman feel comfortable during her visit.

[Violence and pregnancy in female users of Ministry of Health care services in highly deprived states in Mexico]. / Violencia y embarazo en usuarias del sector salud en estados de alta marginación en México.

OBJECTIVE: To characterize intimate partner abuse and identify the main factors associated with violence in pregnancy in four highly deprived States in Mexico. MATERIAL AND METHODS: The data were taken from the National Survey on Violence against Women 2003 (ENVIM per its abbreviation in Spanish). Based on it a cross-sectional study was conducted on 1 949 women between 15 and 50 years of age, who were once pregnant and who utilized primary and secondary health care services from the Ministry of Health, Mexican Institute of Social Security, and the Institute for Social Security and Services for State Workers in Guerrero, Hidalgo, Oaxaca and Chiapas states, between November 2002 and March 2003. Logistic regression was used to assess the association between independent variables and violence during pregnancy. RESULTS: 250 women (13%) suffered a type of violence (physical, psychological, sexual or economical) during any of their pregnancies. Of these women 76 (30.40%) were battered on their abdomen. In most of these cases (91.39%) the husband was the aggressor. The variables significantly associated with violence in pregnancy were: woman's illiteracy (OR 2.2; CI 95:% .1,4.4); history of violence in childhood (OR 3.2; CI 95% 1.9, 5.4) as well as sexual abuse in her childhood (OR 2.4, CI 95% 1.3, 4.4) and her partner's daily alcohol consumption (OR 6.5; CI 95% 3.3, 12.9). CONCLUSIONS: The results show that violence during pregnancy is a regular event in the impoverished context and that its expression is more severe. These results point to the importance of continued study of the problem of violence against pregnant women in Mexico and the importance of identifying battered women in prenatal care.

Violencia y embarazo en usuarias del sector salud en estados de alta marginación en México / Violence and pregnancy in female users of ministry of health care services in highly deprived states in Mexico

OBJETIVO: Caracterizar la violencia de pareja e identificar los principales factores que se asocian a la violencia en el embarazo en cuatro estados de alta marginación en México. MATERIAL Y MÉTODOS: La fuente de información fueron los datos de la Encuesta Nacional sobre Violencia contra las Mujeres 2003. Con base en ésta se realizó un estudio transversal, donde se incluyeron 1 949 mujeres entre 15 y 50 años de edad, que alguna vez estuvieron embarazadas y que demandaron atención en los servicios de primer y segundo nivel de atención de la SSA, IMSS e ISSSTE de los estados de Guerrero, Hidalgo, Oaxaca y Chiapas durante el periodo noviembre 2002- marzo 2003. Mediante regresión logística simple y múltiple, se evaluó la asociación entre las variables de interés y la violencia en el embarazo. RESULTADOS: Del total de mujeres, 250 (13 por ciento) informaron haber sufrido violencia (física, psicológica, sexual y económica) durante alguno de sus embarazos; una de cada tres refirió haber recibido golpes en el abdomen durante el embarazo. En la mayor parte de los casos (91.4 por ciento) el agresor fue el cónyuge. Las variables que se asociaron positivamente con violencia en algún embarazo fueron: a) nivel de escolaridad de la mujer: las analfabetas, comparadas con las mujeres que tenían escolaridad superior a primaria completa, presentaron la asociación más fuerte (RM 2.2; IC 95: por ciento 1.1, 4.4); b) antecedentes de violencia en la niñez (RM 3.2; IC 95 por ciento 1.9, 5.4); c) antecedentes de abuso sexual antes de los 15 años (RM 2.4, IC95 por ciento 1.3, 4.4) y d) consumo diario de alcohol por la pareja (RM 6.5; IC 95 por ciento 3.3, 12.9). CONCLUSION: Los resultados de este estudio muestran que la violencia durante el embarazo es un hecho frecuente en contextos de alta marginación, además de que su expresión tiende a ser más severa. Los resultados sustentan la necesidad de seguir estudiando el problema de la violencia en el embarazo en México, además de identificarlo durante el proceso de atención prenatal a mujeres violentadas.

OBJECTIVE: To characterize intimate partner abuse and identify the main factors associated with violence in pregnancy in four highly deprived States in Mexico. MATERIAL AND METHODS: The data were taken from the National Survey on Violence against Women 2003 (ENVIM per its abbreviation in Spanish). Based on it a cross-sectional study was conducted on 1 949 women between 15 and 50 years of age, who were once pregnant and who utilized primary and secondary health care services from the Ministry of Health, Mexican Institute of Social Security, and the Institute for Social Security and Services for State Workers in Guerrero, Hidalgo, Oaxaca and Chiapas states, between November 2002 and March 2003. Logistic regression was used to assess the association between independent variables and violence during pregnancy. RESULTS: 250 women (13 percent) suffered a type of violence (physical, psychological, sexual or economical) during any of their pregnancies. Of these women 76 (30.40 percent) were battered on their abdomen. In most of these cases (91.39 percent) the husband was the aggressor. The variables significantly associated with violence in pregnancy were: woman's illiteracy (OR 2.2; CI 95: percent .1, 4.4); history of violence in childhood (OR 3.2; CI 95 percent 1.9, 5.4) as well as sexual abuse in her childhood (OR 2.4, CI 95 percent 1.3, 4.4) and her partner's daily alcohol consumption (OR 6.5; CI 95 percent 3.3, 12.9). CONCLUSIONS: The results show that violence during pregnancy is a regular event in the impoverished context and that its expression is more severe. These results point to the importance of continued study of the problem of violence against pregnant women in Mexico and the importance of identifying battered women in prenatal care.

Impacto de la violencia doméstica en la salud mental de las mujeres: análisis y perspectivas en México / Impacto of domestic violence in women's mental health: analysis and perspectives in Mexico

El presente trabajo trata de dar un panorama actual de la violencia doméstica como un problema de salud pública, considerando, por un lado la morbilidad y mortalidad que produce a nivel internacional y nacional, además del impacto en la calidad de vida de las mujeres. Se pone énfasis en la asociación entre la violencia doméstica y la salud mental de las mujeres, la cual se manifiesta por medio de malestares diversos, algunos de ellos con consecuencias fatales. Entre los padecimientos más frecuentes se encuentra: la depresión, la ansiedad, los trastornos de estrés postraumático, el abuso del alcohol y drogas, además del homicidio y el suicidio. Desafortunadamente, la relación entre violencia doméstica y salud mental ha sido poco explorada en nuestro país y los esfuerzos son aún incipientes, lo cual ha provocado un vacío de información tanto entre los prestadores de servicio de salud mental como en el área de la investigación. Por lo anterior, se revisan los hallazgos de la bibliografía internacional que se enfocan a describir la relación que hay entre la violencia doméstica y los trastornos mentales, con el objeto de darle su debida dimensión a los efectos adversos de la violencia en la salud mental de las mujeres. Se propone que esta información se incluya en la formación del personal de salud en general y, en particular, en el personal de salud especializado en los servicios de salud mental [psicoterapeutas, psiquiatras, trabajadores sociales, psicólogas(os), enfermeras]. Además, se sugieren las líneas de investigación que deben desarrollarse en este campo en México, poniendo énfasis en la propuesta de la promoción de la salud