Intimate partner violence and perinatal health: a systematic review.

BACKGROUND: Physical, psychological and sexual intimate partner violence (IPV) has been described in the literature as different types of IPV experienced by women during pregnancy all over the world. OBJECTIVES: To review and summarise systematically the empirical evidence on the links between IPV during pregnancy and the perinatal health of mothers and fetuses/neonates. SEARCH STRATEGY: MEDLINE (Ovid), CINAHL, Embase, Nursing@ovid (Ovid) and LILACS were searched (2008-2018). SELECTION CRITERIA: Observational studies that examined perinatal health outcomes (i.e. pre-term birth, low birthweight, miscarriage, perinatal death and premature rupture of membranes) in pregnant women exposed to IPV. DATA COLLECTION AND ANALYSIS: Information on study characteristics, type of IPV measured, study design, methodological quality and outcome variable extracted. RESULTS: Fifty studies were included. Twenty-nine analysed undifferentiated IPV (n = 25 489), 34 included physical IPV (n = 7333), 22 analysed psychological IPV (n = 7833) and 18 examined sexual IPV (n = 2388). Fifteen studies were from Asia, 12 from North America and Oceania, and 12 from Central and South America. The studies examined the association between IPV and 39 different perinatal health outcomes. The most frequent outcomes reported were pre-term birth (50%), low birthweight (46%), miscarriage (30%), perinatal death (20%) and premature rupture of membranes (20%). A significant association with perinatal health outcomes was reported by 12 of the studies analysing undifferentiated IPV, 18 physical IPV, six psychological IPV and two sexual IPV. CONCLUSIONS: The relation between IPV and perinatal health outcomes can be seen in different epidemiological designs and countries. In all, 39 different outcomes were identified and 29 were associated with IPV. TWEETABLE ABSTRACT: A variety of poor perinatal health outcomes are associated with psychological, physical and sexual IPV.

A systematic review of evidence on the association between cocaine use and seizures.

BACKGROUND: Institutional monographs/medical textbooks mention seizures as a neurological complication of cocaine, but no systematic reviews (SRs) have been published on this issue. We aimed to conduct a SR of the literature on the relationship between cocaine use and seizures and to summarize the biological plausibility of that relationship. METHODS: The pathophysiological mechanisms that may underlie an association between cocaine and seizures were summarized; a SR was then performed using three databases (EMBASE, Medline, PsycINFO) and the Cochrane-library to search for published papers (1980-2012) aimed at quantifying the associations between cocaine use and seizures. The inclusion criteria for selection were: articles based on clinical trials, cohort, case-control (CC) or cross-sectional (CS) studies, participants ≥ 14 years old and not pregnant, and use of cocaine in the last 72 h. Information was extracted, evaluated and cross-checked independently by two researchers. RESULTS: Of the 1243 potentially relevant articles initially identified; one CC and 22 CS studies were finally selected. The CC study did not find cocaine use to be a risk-factor for seizures. In addition to the limitations of the CS design, these studies had important methodological weaknesses and biases. CONCLUSIONS: Despite its biological plausibility, no rigorous scientific evidence supports a causal relationship between cocaine use and seizures. The misinterpretation of the role of cocaine may have important implications in medical services. Well-conducted studies are urgently needed.

Personal and psychosocial predictors of psychological abuse by partners during and after pregnancy: a longitudinal cohort study in a community sample.

OBJECTIVE: To describe the incidence and risk factors of psychological intimate partner violence (IPV) during pregnancy and the first year after childbirth. DESIGN: Longitudinal cohort study. SETTING: Nine primary care centers in the Valencia Region (Spain). POPULATION: A consecutive sample of 1400 women in the first trimester of pregnancy, attending the prenatal programme in the Valencia Region of Spain in 2008, with follow-up in the third trimester of pregnancy, and at 5 and 12 months postpartum. A total of 888 women (66.5%) participated in all four phases. METHODS: A logistic regression model was fitted using generalised estimating equations to assess the effects of previous partner violence, consumption of alcohol or illicit drugs and social support on subsequent psychological partner violence. MAIN OUTCOME MEASURE: Psychological IPV during follow-up. RESULTS: We observed an increase in the incidence of psychological IPV after birth, particularly at 5 months postpartum. The strongest predictor of psychological IPV was having experienced abuse 12 months before pregnancy (OR 10.46, 95%CI 2.40-45.61). Other predictors were consumption of alcohol or illicit drugs by the partner or a family member (OR3.50, 95%CI 1.38-8.85) and lack of affective social support (OR2.83, 95%CI 1.31-6.11). CONCLUSIONS: Previous abuse and psychosocial risk factors predict partner psychological abuse after birth. Monitoring psychological IPV and effective interventions are needed not only during pregnancy but also during the postpartum period.

Do social inequalities exist in terms of the prevention, diagnosis, treatment, control and monitoring of diabetes? A systematic review.

The major increase in the prevalence of diabetes mellitus (DM) has led to the study of social inequalities in health-care. The aim of this study is to establish the possible existence of social inequalities in the prevention, diagnosis, treatment, control and monitoring of diabetes in Organisation for Economic Co-operation and Development (OECD) countries which have universal healthcare systems. We searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews for all relevant articles published up to 15 December 2007. We included observational studies carried out in OECD countries with universal healthcare systems in place that investigate social inequalities in the provision of health-care to diabetes patients. Two independent reviewers carried out the critical assessment using the STROBE tool items considered most adequate for the evaluation of the methodological quality. We selected 41 articles from which we critically assessed 25 (18 cross-sectional, 6 cohorts, 1 case-control). Consistency among the article results was found regarding the existence of ethnic inequalities in treatment, metabolic control and use of healthcare services. Socioeconomic inequalities were also found in the diagnosis and control of the disease, but no evidence of any gender inequalities was found. In general, the methodological quality of the articles was moderate with insufficient information in the majority of cases to rule out bias. This review shows that even in countries with a significant level of economic development and which have universal healthcare systems in place which endeavour to provide medical care to the entire population, socioeconomic and ethnic inequalities can be identified in the provision of health-care to DM sufferers. However, higher quality and follow-up articles are needed to confirm these results.

Años de vida ajustados por discapacidad de las personas con infección por el VIH/sida usuarias de drogas por vía parenteral / Disability adjusted life years among people with HIV/AIDS injecting drug users

Determinar la asociación entre ser usuario de droga por vía parenteral (UDVP) y el nivel de salud de personas con virus de la inmunodeficiencia humana (VIH)/sida (en años de vida ajustados por discapacidad [AVAD]) y por sexo, antes del TARGA (terapias antiretrovirales de gran actividad), en uso limitado de TARGA y TARGA. Material y métodos. Estudio descriptivo, incluyendo a 8.800 personas del registro de sida de Andalucía entre 1983-2004. Variables dependientes: años de vida perdidos (AVP), AVAD y estado vital. Variables independientes: sexo, edad al diagnóstico, edad al morir, categoría de transmisión y período de diagnóstico. Se han considerado 3 períodos según el grado de implementación del TARGA; antes de 1996, uso limitado de TARGA (1997 y 1998) y TARGA (después de 1998). Se efectuó un análisis bivariante para analizar si existían diferencias en la muerte y ser UDVP (prueba de ji cuadrado de Pearson) y en los AVP, AVD y AVAD y ser UDVP (prueba de la «t» de Student y la tabla ANOVA). Resultado. En ningún período, ser UDVP se encontró estadísticamente asociado con la muerte. Se han encontrado mayores AVP y AVAD en los UDVP en los 3 períodos. Para los AVD, se encontraron diferencias en los UDVP con respecto a los no UDVP en el período pre-TARGA, en los demás períodos se mantienen las diferencias pero se pierde significación estadística. Conclusiones. No se han encontrado diferencias entre ser UDVP con la muerte en ningún período (pre-TARGA, uso limitado de TARGA y TARGA). Sí se han encontrado diferencias entre los UDVP y los demás grupos con respecto a los AVP y los AVAD (AU)

Objectives. To determine the association between being injecting drug user (IDU) and the level of health of people living with HIV/AIDS (disability adjusted life years [DALY]), differentiated by gender, in three periods, before HAART (highly active antiretroviral therapies) -before 1996, limited use of HAART -1997 and 1998- and HAART ¿after 1998¿. Material and methods. Descriptive study, including 8,800 people in the AIDS registry of Andalusia between 1983-2004. Dependent variables: years of life lost (YLL), years of living with disabilities (YLD), DALY and vital state. Independent variables: gender, age at diagnosis, age at death, category transmission and diagnosis period (have been considered 3 periods according to the degree of implementation of HAART); before HAART (before 1996), limited use of HAART (1997 and 1998) and HAART (after 1998). Bivariate analysis was conducted to examine whether there were differences in dependent variables being injecting drug user (Pearson chi-square, Student¿s t test and ANOVA table). Results. In different periods (pre-HAART, limited use of HAART and HAART), being IDU was not statistically associated with death. We have found higher YLL and DALY in IDU in the 3 studied periods (pre-HAART, as limited use of HAART and HAART). For the YLD, we found differences in injecting drug users compared with non injecting drug users in the period pre-HAART. In the other periods remain differences but lost statistical significance. Conclusions. We have not found any differences between IDU by death in any of the periods studied (pre-HAART, limited use of HAART and HAART). Differences were found between being IDU and other groups with respect to the YLL and DALYs (AU)

Influence of antiretroviral treatment on quality of life in seropositive inmates.

The aim of the study is to evaluate the influence of antiretroviral treatment on health-related quality of life (HRQOL) of three groups of HIV-positive inmates: those who are taking antiretroviral treatment, those who are not on treatment as it has not yet been indicated, and those who refuse to take treatment even though it has been recommended. A cross-sectional study was conducted on 585 HIV+ inmates in three prisons. The response variable was HRQOL. Independent variables were: sociodemographic variables, psychosocial and drug-related variables. Two multivariate linear regression models were constructed in order to determine the HRQOL, physical health score (PHS) and mental health score (MHS), for each of the three groups identified, using patients who refused treatment as the reference category. Patients who refused therapy had a lower MHS compared with patients in whom treatment was not indicated (P = 0.038). With regard to PHS, patients refusing therapy had a lower score than patients who were not indicated therapy (P = 0.005), and than patients receiving therapy (P = 0.010).

[Patients who refuse antiretroviral treatment in prison]. / Pacientes que rehúsan el tratamiento antirretroviral en el medio penitenciario.

INTRODUCTION: Current studies of HIV+ patients in the prison population have been carried out without considering differences that might exist between patients who accept retroviral treatment and those who do not. One possible reason for this may be the difficulty in gaining access to patients who refuse antiretroviral treatment. However, the prison environment makes it possible to locate and study this type of patient, who up till now has not been the subject of study. The aim of this article is to describe the clinical and psychosocial state of HIV+ inmates who refuse ARVT and compare this data with patients receiving treatment and others for whom treatment has not been indicated. METHODS: Cross-sectional study using 585 HIV+ inmates in three prisons in Andalusia from May to June 2004. Refusal, acceptance and non-indication of ARVT treatment was the grouping variable used. The independent variables were socio-demographic, psychosocial, clinical and other variables relating to the prison environment. RESULTS: 16.8% of patients refused ARVT, while 56.3% were receiving treatment and another 26.8 were not indicated for any medication. Amongst the patients that refused ARVT there was a greater prevalence of HIV co-infection, higher inprison consumption of opiates and methadone treatment, more cases pending and higher rates of recidivism. CONCLUSIONS: these results highlight the existence of a group with unique characteristics that is accessible thanks to the special conditions within the prison environment. It is a group that chooses not to follow therapeutic indications and which represents a risk factor not only for its own health, but also for the community at large.

Pacientes que rehúsan el tratamiento antirretroviralen el medio penitenciario / Patients who refuse antiretroviral treatment in prison

Introducción: En los estudios existentes sobre pacientes VIH+ la población a estudio ha sido tomada de manera homogénea,sin diferenciar aquella que cumple los requerimientos terapéuticos de la que no lo hace. Quizás por la dificultad en elacceso al grupo de pacientes que rehúsan el tratamiento antirretroviral. El medio penitenciario nos permite acceder a esta población,hasta hoy no estudiada. El objetivo de este estudio es describir el estado clínico y psicosocial de los reclusos seropositivosque rehúsan el TARV, comparándolo con el de aquellos que sí están en TARV o no se les indica tomarlo.Métodos: Estudio transversal con 585 reclusos VIH positivos ingresados en tres prisiones andaluzas entre mayo-juliode 2004. Como variable de agrupación se empleó rehusar el TARV, tomarlo o no hacerlo por no estar indicado. Como independientesse incluyeron sociodemográficas, psicosociales, clínicas y relacionadas con el medio penitenciario.Resultados: El 16,8% de los reclusos rehusaban el TARV, mientras el 56,3% estaban en tratamiento y al 26,8% no le estabaindicado. Entre los reclusos que rehusaban el TARV aparece una mayor prevalencia de coinfección por VHC, mayorconsumo intrapenitenciario de opiáceos y tratamiento con metadona, más juicios pendientes y más entradas en prisión.Conclusiones: Estos resultados ponen de relieve la existencia de un grupo poblacional, accesible gracias al medio penitenciario,con características propias que no sigue las indicaciones terapéuticas y que representa un riesgo no sólo para su salud, sino para la de la comunidad (AU)

Introduction: Current studies of HIV+ patients in the prison population have been carried out without considering differencesthat might exist between patients who accept retroviral treatment and those who do not. One possible reason forthis may be the difficulty in gaining access to patients who refuse antiretroviral treatment. However, the prison environmentmakes it possible to locate and study this type of patient, who up till now has not been the subject of study. The aim of thisarticle is to describe the clinical and psychosocial state of HIV+ inmates who refuse ARVT and compare this data with patientsreceiving treatment and others for whom treatment has not been indicated.Methods: Cross-sectional study using 585 HIV+ inmates in three prisons in Andalusia from May to June 2004. Refusal,acceptance and non-indication of ARVT treatment was the grouping variable used. The independent variables were socio-demographic, psychosocial, clinical and other variables relating to the prison environment.Results: 16.8% of patients refused ARVT, while 56.3% were receiving treatment and another 26.8 were not indicated (AU)

[Differences in sociodemographic, clinical, psychosocial and health care characteristics between men and women diagnosed with fibromyalgia]. / Diferencias en características sociodemográficas, clínicas y psicológicas entre hombres y mujeres diagnosticados de fibromialgia.

INTRODUCTION: Health differences between men and women are determined by biological differences although health services often contribute to gender inequalities. Very few studies that analyze gender differences have been made up to date in these patients. This study aims to analyze sociodemographic, clinical and psychosocial differences between men and women diagnosed with FM and to examine the differential impact of their symptoms on their usual activities, including work environment, and the response these patients obtain from the health care system. MATERIAL AND METHODS: A descriptive cross-sectional survey was carried out with all the patients diagnosed with FM in 2003 in three clinics rheumatology units of a university hospital in Spain. RESULTS: The sociodemographic characteristics were very similar in men and women. However, there was a greater proportion of men diagnosed with FM on sick leave, compared to women with the same diagnosis. Men had a worse perception of their health, a higher percentage of psychiatric history and current mental illness and more impact of the disease. DISCUSSION: This is one of the first studies in Spain examining the differences between men and women diagnosed with FM. The results obtained in this study corroborate that, as in other diseases, there are gender differences in the clinical and psychosocial characteristics of men and women diagnosed with FM.

Diferencias en características sociodemográficas, clínicas y psicológicas entre hombres y mujeres diagnosticados de fibromialgia / Differences in sociodemographic, clinical, psychosocial and health care characteristics between men and women diagnosed with fibromyalgia

Introducción. Las diferencias en salud entre hombres y mujeres tienen origen biológico, aunque con frecuencia los sistemas sanitarios contribuyen a ellas. Hasta la fecha son escasos los trabajos que analizan diferencias de género en este síndrome. El objetivo del presente trabajo es analizar las diferencias sociodemográficas clínicas y psicológicas entre hombres y mujeres diagnosticados con fibromialgia (FM), y examinar el impacto diferencial de los síntomas en las actividades habituales, incluyendo el entorno de trabajo, y la respuesta del sistema sanitario en estas situaciones. Material y métodos. Se realizó un estudio descriptivo transversal incluyendo a todos los pacientes diagnosticados de FM en 2003 en el servicio de Reumatología de un hospital universitario. Resultados. Las características sociodemográficas resultaron muy similares en hombres y mujeres. Hay una mayor proporción de hombres diagnosticados de FM en situación de baja laboral en comparación con mujeres con similar diagnóstico. Los hombres tienen peor percepción de su salud, mayor porcentaje de antecedentes psiquiátricos y patología mental actual y mayor impacto de la enfermedad. Discusión. Éste es uno de los primeros trabajos en nuestro país que aborda la FM examinando las diferencias entre hombres y mujeres. Los resultados obtenidos corroboran que, como se ha demostrado previamente para otras patologías, existen diferencias de género en las características clínicas y psicosociales de mujeres y hombres diagnosticados con FM (AU)

Introduction. Health differences between men and women are determined by biological differences although health services often contribute to gender inequalities. Very few studies that analyze gender differences have been made up to date in these patients. This study aims to analyze sociodemographic, clinical and psychosocial differences between men and women diagnosed with FM and to examine the differential impact of their symptoms on their usual activities, including work environment, and the response these patients obtain from the health care system. Material and methods. A descriptive cross-sectional survey was carried out with all the patients diagnosed with FM in 2003 in three clinics rheumatology units of a university hospital in Spain. Results. The sociodemographic characteristics were very similar in men and women. However, there was a greater proportion of men diagnosed with FM on sick leave, compared to women with the same diagnosis. Men had a worse perception of their health, a higher percentage of psychiatric history and current mental illness and more impact of the disease. Discussion. This is one of the first studies in Spain examining the differences between men and women diagnosed with FM. The results obtained in this study corroborate that, as in other diseases, there are gender differences in the clinical and psychosocial characteristics of men and women diagnosed with FM (AU)

[Progress of clinical parameters amongst prison inmates receiving antiretroviral treatment]. / Evolución de los parámetros clínicos en reclusos en tratamiento antirretroviral.

INTRODUCTION: Among HIV positive patients the CD4 lymphocyte count, especially the viral load, are the best predictors for progress to full blown AIDS or death. OBJECTIVE: To analyze the factors associated with progress of the CD4 lymphocyte count and viral load in prison inmates in antiretroviral treatment. METHODS: A fixed cohort study was conducted with HIV positive inmates receiving antiretroviral therapy in three Spanish prisons. Adherence to antiretroviral treatment was assessed with the SMAQ questionnaire. To analyze the progress of CD4 and viral load clinical parameters, two fixed effect multilevel linear regression models were utilised. RESULTS: 10% of the sample were women, 42% referred for anxiety or symptoms of depression in the final week, and 46.6% reported having social support inside the prison. CD4 and viral load clinical parameter means were 2.48 and 2.89 respectively, and 38.6% had an undetectable viral load. A negative correlation between viral load and CD4 lymphocyte count (p<0.001) was found. Those inmates who did not present psychological morbidity showed a significant reduction in plasma viral load (p=0.017). CONCLUSIONS: The results of this study show the relevance of psychosocial factors in the immune system.

Evolución de los parámetros clínicos en reclusos en tratamiento antirretroviral / Progress of clinical parameters amongst prison inmutes receiving antirretroviral treatment

Introducción: Entre los pacientes infectados por el VIH el recuento linfocitario y fundamentalmente la carga viral, sonlos mejores predictores al estado definitorio de SIDA o muerte. Objetivo: analizar los factores asociados a la evolución delrecuento de linfocitos CD4 y carga viral en reclusos en tratamiento con antirretrovirales. Métodos: Se realizó un estudio decohorte fija a reclusos VIH positivos en tratamiento con antirretrovirales de tres prisiones españolas. La adherencia al tratamientoantirretroviral se midió a través del cuestionario SMAQ. Para analizar la evolución de los parámetros clínicos de CD4y carga viral se realizaron dos modelos de regresión lineal multinivel de efectos fijos. Resultados: El 10% eran mujeres, el42% refirió padecer ansiedad o depresión en la última semana y el 46,6% refirió tener apoyo social dentro de la prisión. Encuanto a la media de los parámetros clínicos de log10 CD4 y log10 carga viral fueron de 2,48 y 2,89 respectivamente, teniendoel 38,6% carga viral indetectable. Se encontró una relación inversa entre la carga viral y el recuento de linfocitos CD4(p<0,001). En cuanto a la carga viral plasmática aquellos reclusos sin morbilidad psíquica mostraron una reducción significativa(p=0,017) de la misma. Conclusiones: se pone de manifiesto la importancia de los factores psicosociales en el sistemainmunitario (AU)

Introduction: Among HIV positive patients the CD4 lymphocyte count, especially the viral load, are the best predictorsfor progress to full blown AIDS or death. Objective: To analyze the factors associated with progress of the CD4lymphocyte count and viral load in prison inmates in antiretroviral treatment. Methods: A fixed cohort study was conductedwith HIV positive inmates receiving antiretroviral therapy in three Spanish prisons. Adherence to antiretroviral treatmentwas assessed with the SMAQ questionnaire. To analyze the progress of CD4 and viral load clinical parameters, two fixedeffect multilevel linear regression models were utilised. Results: 10% of the sample were women, 42% referred for anxietyor symptoms of depression in the final week, and 46.6% reported having social support inside the prison. CD4 andviral load clinical parameter means were 2.48 and 2.89 respectively, and 38.6% had an undetectable viral load. A negative correlationbetween viral load and CD4 lymphocyte count (p<0.001) was found. Those inmates who did not present psychologicalmorbidity showed a significant reduction in plasma viral load (p=0.017). Conclusions: The results of this study showthe relevance of psychosocial factors in the immune system (AU)

Evolución de los parámetros clínicos en reclusos en tratamiento antirretroviral / Progress of clinical parameters amongst prison inmates receiving antiretroviral treatment

Introducción: Entre los pacientes infectados por el VIH el recuento linfocitario y fundamentalmente la carga viral, sonlos mejores predictores al estado definitorio de SIDA o muerte. Objetivo: analizar los factores asociados a la evolución delrecuento de linfocitos CD4 y carga viral en reclusos en tratamiento con antirretrovirales. Métodos: Se realizó un estudio decohorte fija a reclusos VIH positivos en tratamiento con antirretrovirales de tres prisiones españolas. La adherencia al tratamientoantirretroviral se midió a través del cuestionario SMAQ. Para analizar la evolución de los parámetros clínicos de CD4y carga viral se realizaron dos modelos de regresión lineal multinivel de efectos fijos. Resultados: El 10% eran mujeres, el42% refirió padecer ansiedad o depresión en la última semana y el 46,6% refirió tener apoyo social dentro de la prisión. Encuanto a la media de los parámetros clínicos de log10 CD4 y log10 carga viral fueron de 2,48 y 2,89 respectivamente, teniendoel 38,6% carga viral indetectable. Se encontró una relación inversa entre la carga viral y el recuento de linfocitos CD4(p<0,001). En cuanto a la carga viral plasmática aquellos reclusos sin morbilidad psíquica mostraron una reducción significativa (p=0,017) de la misma. Conclusiones: se pone de manifiesto la importancia de los factores psicosociales en el sistema inmunitario (AU)

Introduction: Among HIV positive patients the CD4 lymphocyte count, especially the viral load, are the best predictorsfor progress to full blown AIDS or death. Objective: To analyze the factors associated with progress of the CD4lymphocyte count and viral load in prison inmates in antiretroviral treatment. Methods: A fixed cohort study was conductedwith HIV positive inmates receiving antiretroviral therapy in three Spanish prisons. Adherence to antiretroviral treatmentwas assessed with the SMAQ questionnaire. To analyze the progress of CD4 and viral load clinical parameters, two fixedeffect multilevel linear regression models were utilised. Results: 10% of the sample were women, 42% referred for anxietyor symptoms of depression in the final week, and 46.6% reported having social support inside the prison. CD4 andviral load clinical parameter means were 2.48 and 2.89 respectively, and 38.6% had an undetectable viral load. A negative correlationbetween viral load and CD4 lymphocyte count (p<0.001) was found. Those inmates who did not present psychologicalmorbidity showed a significant reduction in plasma viral load (p=0.017). Conclusions: The results of this study showthe relevance of psychosocial factors in the immune system (AU)

Women's autonomy and the evaluation of the information available on the Internet on hormone therapy after menopause.

This study was designed to examine the information in Spanish, provided by different Web sites, related to hormone therapy and climacteric symptoms. Web sites evaluated included those belonging to government and scientific institutions and to a miscellaneous group. In Web sites in Spanish, there was more extensive information on the benefits of hormone therapy than there were on other items. The Web sites of governmental institutions provided significantly more information on the risks (P < .01) and benefits (P = .02) of hormone therapy than did the other sites. Governmental institutions from the United States, unlike those from Spain, did not make recommendations regarding when hormone therapy should be considered and instead emphasized the woman's decision. The variability of information in Spanish on hormone therapy and postmenopausal symptoms presented on the Internet is related to the organization responsible for the Web site. Besides, cultural differences in the concept of patient autonomy could partly explain the differences in emphasis made on women's role in the decision-making process.

Health-related quality of life of patients with HIV: impact of sociodemographic, clinical and psychosocial factors.

OBJECTIVES: This study aims to analyse how a wide group of clinical, social, demographic and psychological factors are related to both physical and mental quality of life in HIV + patients. DESIGN: A cross-sectional study was carried out of 320 HIV + patients in antiretroviral treatment who attended infectious diseases units in four hospitals in the region of Andalusia (Spain). METHODS: Health-Related Quality of Life was measured by the MOS-HIV. Included as independent variables were: sociodemographic variables, variables related to antiretroviral therapy, psychosocial variables like social support (Duke-UNC-11) and psychological morbidity (GHQ-28), variables related to main risk behaviours and clinical variables. RESULTS: In the multiple linear regression analysis, a better PHS quality of life was found to be associated with the absence of mental illness, social support, not being an intravenous drug user and using more than one type of non-injectable drug. A better quality of life, in mental terms, was found to be associated with fewer years as a non-intravenous drug user, having social support, absence of mental illness, not being an intravenous drug user taking only one additional pill, not having any difficulty in taking the medication, and being female. CONCLUSIONS: The study of other non-biological factors that may be related to quality of life has been limited practically to social support and the emotional state. This study highlights the importance of these factors independently from the clinical state, as well as the existence of other psychological and behavioural factors that are also related.

[Mental morbidity and social support in prisoners in treatment with antiretrovirals]. / Morbilidad psíquica y apoyo social en reclusos en tratamiento con antirretrovirales.

OBJECTIVE: To define the incidence of depressive disorders and anxiety disorders in prisoners of three prisons of CCAA in treatment with antiretrovirals, and moreover the associated variables and the intensity of social support within the prison. METHODS: Through a cross-sectional design 281 prisoners were studied. RESULTS: 42% showed mental morbidity and 53.4% lacked social support. To be imprisoned in the Granada prison, to be a woman, poor health state, to describe difficulties for compliance with antiretrovirals drug, a history greater than 13 years for drugs consumption, and usual residence with the couple of family, all were factors associated with mental morbidity. Factors associated with social support non-existence were history of more than one imprisonment, lack of familiarity with the medical equipment, to be more than 35 years old, and to suffer mental morbidity.

Morbilidad psíquica y apoyo social en reclusos en tratamiento con antirretrovirales / Mental morbidity and social support in prisoners in treatment with antiretrovirals

Objetivo. Detectar la frecuencia de trastornos depresivos y de ansiedad y la frecuencia de apoyo social dentro de la cárcel en reclusos de tres prisiones de la CCAA en tratamiento con antirretrovirales y las variables asociadas. Métodos. Mediante un diseño transversal se estudiaron 281 reclusos. Resultados. El 42% tenían morbilidad psíquica y el 53,4% carecían de apoyo social. Estar ingresado en la cárcel de Granada, ser mujer, tener un peor estado de salud, referir dificultad para tomar los fármacos antirretrovirales, más de 13 años de consumo de drogas y convivir habitualmente con la pareja o familia se asociaron a la morbilidad psíquica. Los factores que se asocian a no tener apoyo social fueron tener más de una entrada en prisión, no tener confianza en el equipo médico, tener más de 35 años y presentar morbilidad psíquica (AU)

Objective. To define the incidence of depressive disorders and anxiety disorders in prisoners of three prisons of CCAA in treatment with antiretrovirals, and moreover the associated variables and the intensity of social support within the prison. Methods. Through a cross-sectional desing 281 prisoners were studied. Results. 42% showed mental morbidity and 53.4% lacked social support. To be imprisoned in the Granada prison, to be a woman, poor health state, to describe difficulties for compliance with antiretrovirals drug, a history greater than 13 years for drugs consumption, and ususal residence with the couple of family, all were factors associated with mental morbidity. Factors associated with social support non-existence were history of more than one imprisonment, lack of familiarity with the medical equipment, to be more than 35 years old, and to suffer mental morbidity (AU)

[Domestic violence as a factor associated to women's health problems]. / La violencia contra la mujer en la pareja como factor asociado a una mala salud física y psíquica.

OBJECTIVE: To study the impact of intimate partner violence (IPV) on women's physical and psychological health. DESIGN: Cross-sectional study. SETTING: Primary care centers in 3 Andalusian provinces. PATIENTS: A total of 425 women, aged 18 to 65 years, were recruited following the same randomisation process in 6 primary care centers. MEASUREMENTS: A self-administered structured questionnaire for this study was used to gather the information. As well as sociodemographic variables, the instrument included questions about IPV, physical health indicators (chronic disease and type, lifetime surgeries, days in bed), psychological health (psychological morbidity, use of tranquilizers, antidepressants, pain killers, alcohol and recreational drugs), self-perceived health and social support. RESULTS: Of 425 women, 31.5% ever experienced any type of partner violence. Women experiencing IPV were more likely to suffer a chronic disease. IPV was significantly associated with a number of adverse health outcomes, including spending more than 7 days in bed in the last three months (ORa=2.96; CI 95%, 1.00-8.76), psychological morbidity (ORa=2.68; CI 95%, 1.60-4.49) and worse self-perceived health (ORa=1.89; CI 95%, 1.04-3.43), after controlling for potential confounding variables. CONCLUSION: This study shows that ever experiencing IPV is associated with a worse psychological and self-perceived health. Physical injuries are not the only "evidence" of the presence of IPV. Primary health care professionals are in a privileged position to help women who are abused by their partners.

[Variation in the prevention of cardiovascular risk factors. A population-based study]. / Variaciones en la prevención del riesgo cardiovascular: estudio poblacional.

BACKGROUND: Published studies on clinical practice variability have mainly focussed on variability in the rates of hospitalization and surgical procedures. The objective of this study was to evaluate variability in the measurement of cholesterolemia and blood pressure in four professional groups and in the general population. METHODS: A cross-sectional survey was performed by mail in the city of Valencia (Spain). Five population groups were selected: physicians, nurses, lawyers, architects and the general population. The sample was obtained by random sampling of each group. RESULTS: Of all the questionnaires returned, only those returned by individuals surveyed (1,755) and their partners (1,296) were used (total: 3,050). The frequency of preventive cholesterolemia measurement was greater among nurses (55.7%) and physicians (54.1%) than among architects (38.9%), lawyers (38.2%) and the general population (35.1%). The frequency of preventive blood pressure measurement was also greater among physicians (47.7%) and nurses (42.2%) followed by architects (39.4%) and lawyers (38.8%) and was lower among the general population (32.2%). After adjusting by sex, age group, marital status, level of education, and employment, only lawyers (RR = 0.79; 95% CI, 0.6-0.9) and architects (RR = 0.77; 95% CI, 0.68-0.88) showed a significantly lower probability of determining cholesterol levels than physicians (basal category) and nurses (RR = 1.05; 95% CI, 0.93-1.18). The general population showed the lowest probability of measuring blood pressure (RR = 0.8; 95% CI, 0.65-0.97), although the differences were statistically significant only when compared with physicians. CONCLUSIONS: Preventive practices should be increased among groups in which they are less frequently performed until they are performed with the same frequency as among physicians and nurses. Efforts should be directed to increasing cardiovascular prevention programs in health centers.

Variaciones en la prevención del riesgo cardiovascular: estudio poblacional / Variation in the prevention of cardiovascular risk factors. A population-based study

Fundamentos: Las investigaciones realizadas sobre las variaciones de la práctica médica se han centrado principalmente en la variabilidad en las tasas de admisión hospitalaria y en los procedimientos quirúrgicos. El objetivo del estudio es evaluar la variabilidad de la medición de la colesterolemia y de la toma de la presión arterial en cuatro grupos profesionales diferentes y en la población general. Métodos: Se realizó una encuesta transversal por correo en la ciudad de Valencia. Se seleccionaron 5 grupos poblacionales: médicos, enfermeros, abogados, arquitectos y población general. La muestra se obtuvo mediante un muestreo aleatorio simple de cada colectivo. Resultados: Del total de cuestionarios devueltos, se utilizaron únicamente las respuestas del encuestado (1.755) y su pareja (1.296), en total 3.050. La frecuencia de realización de la colesterolemia por prevención fue mayor entre los enfermeros (55,7 per cent) y médicos (54,1 per cent) que entre los arquitectos (38,9 per cent), abogados (38,2 per cent) y población general (35,1 per cent). Igualmente la frecuencia de toma de la presión arterial por prevención fue mayor en médicos (47,7 per cent) y en enfermeros (42,2 per cent), seguidos por arquitectos (39,4 per cent), abogados (38,8 per cent) y menor en la población general (32,2 per cent). Tras ajustarse por sexo, grupo de edad, estado civil, nivel de estudios y situación laboral, sólo los abogados (riesgo relativo [RR] = 0,79; intervalo de confianza [IC] del 95 per cent, 0,6-0,9) y los arquitectos (RR = 0,77; IC del 95 per cent, 0,68-0,88) presentaban un riesgo de realizarse determinaciones de colesterol significativamente inferior al de los médicos (categoría basal) y enfermeros (RR = 1,05; IC del 95 per cent, 0,93-1,18). En cuanto a la toma de presión arterial, igualmente el riesgo más bajo lo presenta la población general (RR = 0,8; IC del 95 per cent, 0,65-0,97), aunque las diferencias son sólo estadísticamente significativas al compararlas con los médicos. Conclusiones: Se debería mejorar las prácticas preventivas en aquellos colectivos en los que se realiza con menos frecuencia para acercarse a los encontrados entre los médicos y enfermeros. Los esfuerzos deberían ir encaminados a mejorar la introducción de los programas de prevención en los centros de salud (AU)