Denuncias por agresión a mujeres en la Plana Baixa (Castellón) / Formal complaints of assault against women in Plana Baixa in Castellón, Spain

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¿Techos de cristal y escaleras resbaladizas? Desigualdades degénero y estrategias de cambio en SESPAS / Glass ceiling and slippery stairs? Gender inequalities and strategies for change in the Spanish Society of Public Health and Health Services Administration

En las sociedades científicas, como en otros espacios públicos, la presencia de las mujeres en la toma de decisiones es menor que la de los varones. Describimos la situación en la Sociedad Española de Salud Pública y Administración Sanitaria (SESPAS) donde, a pesar de existir un 40% de socias, las mujeres han estado escasamente representadas en los puestos donde se toman las decisiones y en los de reconocimiento profesional. Se explica el proceso de cambio que se ha impulsado en los últimos años y algunos de los efectos de las acciones emprendidas. Visualizar las desigualdades de género existentes provocó el debate y el interés por la acción. Se ha establecido un grupo de trabajo de género y salud pública. En los dos últimos años se han incorporado más mujeres a los puestos de poder y de reconocimiento profesional en SESPAS (AU)

In scientific societies, as in other social fields, women's participation in decision making is lower than that of men. We describe the situation in SESPAS (Spanish Society of Public Helath and Health Services Administration) where, despite representing a 40% of its members, very few women have been in positions in which decisions are taken or in those of professional recognition. The process of change implemented during recent years and some of the effects of the actions taken are presented. Making the existing inequalities known has generated debate and interest in the intervention. A gender and public health working group was set up. In the last two years more women have been prometed to more senior positions in SESPAS (AU)

[Glass ceiling and slippery stairs? Gender inequalities and strategies for change in the Spanish Society of Public Health and Health Services Administration]. / 'Techos de cristal y escaleras resbaladizas? Desigualdades de género y estrategias de cambio en SESPAS.

In scientific societies, as in other social fields, women's participation in decision making is lower than that of men. We describe the situation in SESPAS (Spanish Society of Public Health and Health Services Administration) where, despite representing a 40% of its members, very few women have been in positions in which decisions are taken or in those of professional recognition. The process of change implemented during recent years and some of the effects of the actions taken are presented. Making the existing inequalities known has generated debate and interest in the intervention. A gender and public health working group was set up. In the last two years more women have been promoted to more senior positions in SESPAS.

Prevención del VIH/sida en el medio penitenciario: una experiencia de planificación participativa / HIV/AIDS prevention in prisons: experience of participatory planning

Objetivo: Describir la aplicación de metodologías participativas en el medio penitenciario en la identificación de los contenidos y métodos más adecuados para una intervención frente al VIH/sida. Métodos: Estudio comunitario en la población del Centro de Cumplimiento del Establecimiento Penitenciario de Valencia(1.250 internos/as). El estudio se ha realizado en dos fases: la identificación de informadores clave y la recogida de información. En esta etapa se ha realizado un Foro Comunitario con los internos e internas del centro, entrevistas personales a internas penadas, y un cuestionario autocumplimentado a los profesionales de la salud y directivos del centro, y a personas expertas en promoción de la salud. Resultados: Foro Comunitario. Las propuestas que los internos e internas del centro formularon con relación a cómo combatirla infección por VIH/sida fueron: a) las dirigidas a ellos/asmismos/as, en el sentido de aumentar las medidas preventivas en el uso de material de inyección de drogas y en las relaciones sexuales, y b) las dirigidas a la Administración (aumentarla distribución de preservativos, maquinillas de afeitar y lejía, e iniciar la entrega de material de inyección estéril). En las entrevistas personales, en relación a cómo debería ser un (..) (AU)

Objetive: To describe the application of participatory methodology in the prison setting for the determination of the most appropiate contents and methods of a HIV/AIDS prevention program. Methods: Community study in the Centro de Cumplimiento del Establecimiento Penitenciario in Valencia (1250 inmates)in Spain. The study was carried out in two phases: identification of key informants and collection of information. In the second phase, a community forum composed of the center’s male and female inmates was created, personal interviews with convicted female prisoners were carried out and a self-administered questionnaire was distributed to the center’s health professionals and management as well as to health promotion experts. Results: Community forum. The following proposals for HIV/AIDS prevention were made by the male and female prisoners: a) those (..) (AU)

[Assessment of the effectiveness of health training courses offered for food handlers in a health care district of Gandía, Valencia]. / Evaluación de la eficacia de los cursos de formación sanitaria dirigidos a los manipuladores de alimentos del área sanitaria de Gandía, Valencia.

BACKGROUND: Food poisoning is a major Health Care issue. Health training is one of the mechanisms available for preventing these illnesses. The purpose of this study is that of ascertaining whether food handlers improve their knowledge regarding food handling practices by attending the courses which are offered for being awarded the handler card and of analyzing the impact of sociodemographic variables on the degree of knowledge prior to taking the course. METHOD: Pre-Post type assessment study on a sample of 500 handlers who came to the Public Health Center in the town of Gandfa (Valencia) to take a training course in October 1997-February 1998. A self-test questionnaire taken prior to and following the course to gauge knowledge and other variables was used. RESULTS: A significant difference was found between the pre-test and the post-test, except with regard to the subject of personal hygiene. Those handlers having worked at this occupation for a longer number of years or who had prior health training answered correctly more often. CONCLUSIONS: The training courses heighten the degree of knowledge regarding food-handling practices. In training courses, greater emphasis must be placed on the subjects of food preservation, preparation and serving than on those of personal hygiene or facility cleanliness. Nonetheless, it would be of interest to research whether any changes in attitudes occur as an initial approach to assessing the effectiveness of the training and ascertaining whether any intention exists of putting the knowledge acquired into practice.

[A hearing in prison: health needs perceived by women deprived of freedom]. / Una audición en prisión: necesidades de salud percibidas por mujeres privadas de libertad.

OBJECTIVE: To identify the perceived necessities and proposals for health action of women committed to a detention centre. DESIGN: A study of needs through a method of social intervention, the hearing. SETTING: The detention centre of the penitentiary of Valencia (Picassent). The area of application is primary care in the penitentiary. PARTICIPANTS: 38 women were chosen on criteria of proportional representation in line with the profile of the total number of women (112) who lived in module 8 of the centre, and according to agreed defining variables such as age, ethnic background and drugs consumption. RESULTS: The women's replies showed they had an integrated view of the concept of health. They identified HIV/AIDS infection, drugs and food as the health problems that most concerned them; and formulated proposals aiming at actions on these and other aspects such as personal relationships, psychological problems and their surrounds. CONCLUSIONS: The method employed was shown to be useful for identifying the needs and proposals of women deprived of liberty. This information could certainly be used to discuss and rework with the inmates themselves, so as to win their participation in the actions decided on.

Una audición en prisión: necesidades de salud percibidas por mujeres privadas de libertad / A hearing in prison: health needs perceived by women deprived of liberty

Objetivo. Identificar las necesidades percibidas y las propuestas de acción con relación a la salud de las mujeres internas de un centro de cumplimiento. Diseño. Estudio de necesidades a través de un método de intervención social, la audición. Emplazamiento. Se ha realizado en el Centro de Cumplimiento del Establecimiento Penitenciario de Valencia (Picassent). El ámbito de aplicación es el de la atención primaria en el medio penitenciario. Participantes. Se seleccionaron 38 mujeres atendiendo a criterios de representatividad proporcional según el perfil del total de mujeres que habitaban el módulo 8 del centro, 112 mujeres, y según las variables definitorias acordadas edad, etnia y consumo de drogas. Resultados. Las mujeres, según las respuestas, tienen una visión integral del concepto de salud; identifican la infección por VIH/sida, las drogas y la alimentación como los problemas de salud que más les preocupan, y formulan propuestas dirigidas a actuar sobre estos y otros aspectos como las relaciones interpersonales, los problemas psicológicos y el entorno. Conclusiones. El método empleado se ha demostrado útil para identificar las necesidades y propuestas de las mujeres privadas de libertad, y esta información puede resultar muy útil para ser discutida y reformulada con las propias internas de cara a conseguir su participación en las acciones que se decidan emprender (AU)

[Women's opinion about their health: a qualitative study]. / La opinión de las mujeres sobre su salud: un estudio cualitativo.

OBJECTIVE: To find out what urban low and middle class women think about the relationship between health and daily behaviours, their social and family situation and the setting in which they live. DESIGN: Qualitative methodology and the focus group technique. SETTING: Urban population. PARTICIPANTS: Low and middle class women aged between 25 and 45. MEASUREMENTS AND MAIN RESULTS: For the sample design homogeneity variables (applicable to the whole group) such as socio-economic level and age were chosen and for heterogeneity variables (only applicable to some of the group's participants) motherhood and paid work outside the home. Two focus groups were conducted. For the analysis the opinions expressed by the women were identified, and were classified according to the scheme that the study group had made previously. Opinions were identified on the importance of food and information about it, concern for their children and for the options provided for the establishment of healthy lifestyles. Only the group of low socioeconomic level identified money as relevant for access to health services. No reference was made to smoking and alcohol. Mental health aspects were predominant. CONCLUSIONS: The opinions of women about aspects which influence their health differ according to social class. The factors identified by scientific literature are not a priority for them. They are not necessarily concerned about health problems with highest mortality and morbility.

[Volunteerism and the reorientation of health services]. / El voluntariado y la reorientación de los servicios de salud.

UNLABELLED: Volunteers are increasingly viewed as health agents. This seems to be linked to the reorientation towards primary health care and the current reforms in the health services. Seen as a way of breaking down social and cultural barriers between the formal health care system and the client community it also claims to cut the cost of services. OBJECTIVE: To know the roles of volunteers in promoting health and the practical aspects of implementation and evaluation. DESIGN: This paper is based on a review of published and sentinel papers from the bibliographic databases, MEDLINE (1991-1995), ERIC (1982-1995) and ERIC INTERNATIONAL (1965-1995). We have also reviewed the IME (until 1997) and the Spanish journals in MEDLINE to know the Spanish context (from 1995-98). RESULTS: The practical experiences from developing countries, the USA and the UK were reviewed within the framework of health promotion. A wide variety of experiences exist. There is a striking difference between activities in these countries, depending of the health service provision. In developing countries the aim is to bring primary health care services to areas with few professional resources. In developed countries, however, experiences have developed in response to failings in the formal health care system, to facilitate illness prevention and health promotion. The settings are different but the process is the same, factors fundamental to performance have therefore been identified in: recruitment, training, monitoring, continuing support and evaluation. The impact on health improvements and the quality of services in both systems, developed and developing countries, seems to be positive. We haven't found too much details from the Spanish experience, then, it emphasizes the need to know abroad experiences. CONCLUSIONS: Finally, the benefits and constraints derived from this type of voluntary action in the health field have been raised. Some specific social changes and health care system reforms contribute to establish volunteering in the health system, but we have to remark organization, coordination and community participation.

[Health visit to the newborn]. / Visita de salud al recién nacido.

Each child's medical record was reviewed to pick out any health problems detected in 1) the Newborn Checkup, 2) the first 15 days of life, and 3) during the child's first year. The number of visits was also recorded. Each mother was interviewed about the acceptability/usefulness of these checkups. The newborn checkup facilitates compliance with programmed checkups in the health plan for a healthy child. This program is useful to detect health problems precociously, to increase the knowledge mothers possess, to build confidence in nurses, and in general, to build up links with the pediatrics services of a health center.

[The duration of breast feeding and work activity]. / Duración de la lactancia materna y actividad laboral.

The objective of this work was to study the influence of working conditions and socio-demographic, personal and social support factors on the duration of breast-feeding. The study population consisted of primiparous or secundiparous women who have had a child in a Valencian public hospital and who have carried out a professional activity during their pregnancy. Information was collected by means of a face-to-face interview in the maternity ward two days after childbirth, a telephone interview five months later and a postal questionnaire one hear after childbirth. A total of 545 surveys were obtained. A simple analysis of the data was carried out. A total of 64% of the mothers reported after one year that they had breast-fed. Seventeen percent breast-fed for one month or less, 13.3% for two months, 24.8% for three months, 12.7% for four months and 32.3% for 5 or more months. The duration of breast-feeding was longer among women over 25 years of age, among secundiparous women and among those who did not return to work after childbirth. It was shorter among those whose maternity leave was shorter and among those whose husbands work without a contract. Therefore, among women who carry-out paid work, the main factor which limits the duration of breast-feeding is the return to work after childbirth. The application of certain measures which favour maintaining breast-feeding (reduction of working day, flexibility in work hours, etc.) should be done so with caution and always with the mother's consent and without this implying a risk for the continuity in work and professional promotion.

[Evolution of fecundity in the Valencian community during the 1975-1990 period]. / Evolución de la fecundidad en la Comunidad Valenciana durante el período 1975-1990.

BACKGROUND: To study the evolution of specific cases of fertility by age groups in the Autonomous Region of Valencia, between 1975 and 1990, and compare this development with the evolution on a national level. METHODS: The specific fertility rates were calculated for seven 5-year age groups within the female fertility period (15-49 years). The number of births per age of mother (Natural Movement of the Spanish Population) has been used and the denominator is the female population calculated be geometrical interpolation from the figures provided by different censuses and electoral roles for each one of the age groups. The study period is 1975 to 1990. RESULTS: The evolution of the fertility rate in the Autonomous Region of Valencia is declining in all age groups except the 30-34 year age group, where fertility showed a slight increase at the end of the eighties, the same as in the rest of the country. Worthy of mentioned is the 15-19 year old group, with figures below the national level, and the 25-29 year old group, where the figures are greater than for the rest of the country as a whole. On a province (county) level, the development is similar to what has been described above. Alicante has the highest figure out of the three provinces (counties) for women in the 15-19 and 35-39 year age ranges. CONCLUSION: The evolution of the fertility rate in the Autonomous Community of Valencia is similar to the development in the rest of the country, a slight increase being detected in women in the 30 to 40 year group, which is similar to what has happened in other European countries.

[Hospital admissions of children for conditions treatable by ambulatory care in the community of Valencia]. / Ingresos hospitalarios infantiles por procesos susceptibles de cuidados ambulatorios en la Comunidad Valenciana.

OBJECTIVE: To describe the importance which ambulatory care sensitive conditions (ACSC) have for the child population of the Valencia Community during the period 1980 to 1988, taken from the Hospital Morbidity Survey (HMS). DESIGN: Descriptive, retrospective study. SETTING: Hospital discharges collected in the HMS from the Valencia Community. PATIENTS: Children under 15 years old. MEASUREMENTS AND MAIN RESULTS: The total percentage of hospital discharges from ACSC observed were 16, 13.2 and 10% for the provinces of Valencia, Castellón and Alicante respectively. The highest percentage was shown in the 1 to 4 year old age group (19%). The proportion of discharges for ACSC was higher in girls (15%) than in boys (13%). Children under one year old show the highest rates. Valencia has for the whole period the highest rate ratio than 1 of being hospitalised for ACSC. CONCLUSIONS: The magnitude of these conditions is important and suggest the possibility of their use as a monitoring instrument of certain health care activities.

[Promotion of mother-infant health: a comparative study of legislation of pregnancy protection]. / Promoción de la salud maternoinfantil: estudio comparativo de la legislación para la protección del embarazo.

OBJECTIVE: To describe the legislative measures aimed at protecting working women during pregnancy, which exist in France, Italy, the United Kingdom and Spain. DESIGN: The aspects studied were employment protection and modifications in work conditions for the pregnant woman. Existing Spanish legislation, the third Programme of Community Action for Equal Opportunities and some relevant scientific articles were reviewed. MEASUREMENTS AND MAIN RESULTS: Regarding protection of pregnant women from dismissal, legislation is more explicit in France and Italy, where protection covers the whole of the pregnancy, extending in France until 4 weeks after the end of the period off-work for the birth and in Italy until the child is one year old. Likewise, both in France and Italy, there is a long list of jobs which a pregnant woman is not allowed to do, with the possibility of a change of post if necessary. In Spain there is a Health at Work draft law, where measures relating to this question have been assembled. CONCLUSION: In general, the legislation referring to the protection of pregnant women at work is not widely known and leaves without protection those women in a more vulnerable work situation. Health professionals could support the equality and health of working women by informing them adequately of their rights.

[A support intervention for giving up smoking at health centers. A pilot experience with trained volunteer therapists]. / Intervención de apoyo para dejar de fumar en centros sanitarios. Experiencia piloto con terapeutas voluntarios entrenados.

BACKGROUND: The work presented describes a descriptive research whose main objective was to quantify the degree of interest and participation of health service centres in the Valencian Community in a voluntary therapist description intervention to support giving up smoking in the workplace. As complementary objectives the process was evaluated as well as the effectiveness of the multimodal treatment used and the possibilities for improvement. METHOD: The proposal of joining the programme was offered by the IVESP who provided a specific training course for the volunteers designated by their centres. A multimodal program was the method of intervention for smoking cessation. Three methods to take back the information (questionnaires, discussion group and delphi study) were used. RESULTS: Of the 170 centres contacted from the whole of the Regional Ministry for Health and Consumer Affairs, 45% showed a wish to participate, 16% designated a monitor to do the training course and 7% carried out the treatment in their workplaces; in these centres the average of success was 30%. CONCLUSIONS: One of the main conclusions of the study was the difficulty to carry out the intervention with volunteers who do not perceive this work as part of their occupational obligations as well as the need of detailed planning of communication strategies with the centres and the commitment of their involvement.

[The expectations of a woman's return to work after childbirth]. / Las expectativas de reincorporación de la mujer al trabajo tras el nacimiento de un hijo.

The objective of this study is to assess the relationship between the decision to return to work during the first year after delivery and socio-demographic and professional factors, as well as the reasons why the decision is made. Data collection was carried out by a personal interview in the hospital, two days after childbirth. 597 primiparous or secundiparous women who had developed a professional activity during pregnancy were interviewed. Uni and multivariate statistical analysis techniques were used. Blue collar workers (ORadjusted = 0.13), administrative staff (ORadjusted = 0.16), women who give up work more than a month before the birth (ORadjusted = 0.33 and 0.28), women without a contract (ORadjusted = 0.19) and temporary workers (ORadjusted = 0.30) were less likely to make the decision of returning to work. According to these results, the continuity of the women in the labour market after maternity is determined to a great extent by the social and employment context where she works; a fact which must be taken into account when putting into practice maternal and child health promotion programmes.