A cross-country study on the impact of governmental responses to the COVID-19 pandemic on perinatal mental health.

This study aimed to analyse the role of governmental responses to the coronavirus disease 2019 (COVID-19) outbreak, measured by the Containment and Health Index (CHI), on symptoms of anxiety and depression during pregnancy and postpartum, while considering the countries' Inequality-adjusted Human Development Index (IHDI) and individual factors such as age, gravidity, and exposure to COVID-19. A cross-sectional study using baseline data from the Riseup-PPD-COVID-19 observational prospective international study (ClinicalTrials.gov: NCT04595123) was carried out between June and October 2020 in 12 countries (Albania, Brazil, Bulgaria, Chile, Cyprus, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom). Participants were 7645 pregnant women or mothers in the postpartum period-with an infant aged up to 6 months-who completed the Edinburgh Postnatal Depression Scale (EPDS) or the Generalised Anxiety Disorder Assessment (GAD-7) during pregnancy or the postpartum period. The overall prevalence of clinically significant depression symptoms (EPDS ≥ 13) was 30%, ranging from 20,5% in Cyprus to 44,3% in Brazil. The prevalence of clinically significant anxiety symptoms (GAD-7 ≥ 10) was 23,6% (ranging from 14,2% in Israel and Turkey to 39,5% in Brazil). Higher symptoms of anxiety or depression were observed in multigravida exposed to COVID-19 or living in countries with a higher number of deaths due to COVID-19. Furthermore, multigravida from countries with lower IHDI or CHI had higher symptoms of anxiety and depression. Perinatal mental health is context-dependent, with women from more disadvantaged countries at higher risk for poor mental health. Implementing more restrictive measures seems to be a protective factor for mental health, at least in the initial phase of the COVID-19.

Conductas sexuales por sexo en población universitaria chilena que demanda test rápido de VIH / Sex-disaggregated sexual behaviors among Chilean university students taking a rapid HIV test

OBJETIVO: Caracterizar por sexo una población universitaria que accedió voluntariamente a una prueba de detección rápida del virus de la inmunodeficiencia humana (VIH). MÉTODO: Estudio analítico de 3864 universitarios/as. Variables: sociodemográficas y académicas, comportamiento sexual, prevalencia de infecciones de transmisión sexual (autorreporte) y motivos para realizarse el test rápido. RESULTADOS: El 61,4% son mujeres, edad media 21,64 años, edad de inicio de la actividad sexual 17,01 años. Actividad sexual casual: 36,8%, destacando los hombres (p < 0,001). Sexo anal: 44,5%. Prevalencia de infecciones de transmisión sexual: 7,5%, destacando los hombres en gonorrea (p < 0,001) y sífilis (p = 0,032). Test rápido VIH (+): 0,2%. Consumo de sustancias durante la actividad sexual: 50%. El 41,1% nunca pregunta a su contacto sexual el estado serológico de VIH, destacando los hombres (p < 0,001), y el 64,4% no sabe si ha tenido una pareja sexual VIH (+), destacando los hombres (p < 0,001). El 16,5% siempre ha usado preservativo, destacando las mujeres (p = < 0,001). El 26,21% usa redes sociales para encuentros sexuales, con diferencias por sexo. CONCLUSIONES: Las mujeres demandan más el test rápido de VIH que los hombres. Existen conductas de riesgo y diferencias por sexo: poco uso del preservativo, relaciones sexuales casuales y bajo la influencia de sustancias, prácticas sexuales anales y orales sin protección, desconocer el estado serológico de su contacto sexual y uso de redes sociales para encuentros sexuales.

OBJECTIVE: To characterize a university population that willingly took a rapid HIV test by sex. METHOD: An analytical study with 3,864 university students. Variables: socio-demographic and academic variables, sexual behavior, (self-reported) STI prevalence, and reasons to take the rapid test. RESULTS: 61.4% are women; average age: 21.64 years; age of first sexual intercourse: 17.01 years; casual sexual activity: 36.8%, mostly men (p < 0,001), anal sex: 44.5%; STI prevalence: 7.5%, with gonorrhea and syphilis being more common among men (p < 0.001 and p < 0.032, respectively; positive rapid HIV test: 0.2%; substance use during sex: 50%. 41.1% of the participants, most of them men (p < 0.001), have never asked their partner about their serologic HIV status, and 64.4% does not know if they have had a HIV+ partner, an attitude that is more prevalent among men (p < 0.001). 16.5% has always used prophylactics, mostly women (p < 0.001). 26.21% uses social networks to arrange sexual encounters. CONCLUSIONS: Women ask more for the rapid HIV test than men. There are several risky behaviors and gender differences: low use of prophylactics, casual sexual relationships under the influence of substances, unprotected anal and oral sex practices, ignorance of their sexual partners serologic status, and the use of social networks for sexual encounters.

Promoción de salud más allá de los estilos de vida saludables: propuestas de actuación en una universidad chilena.

Las intervenciones centradas en cambios de conducta, sumadas a la escasa evidencia de mapeo y dinamización de activos en Universidades Promotoras de Salud (UPS), hacen necesario potenciar enfoques integrales y sistémicos que contribuyan al bienestar y empoderamiento de sus integrantes. El objetivo de este artículo es explorar propuestas de acción que contribuyan a fortalecer activos en una comunidad universitaria chilena. Se desarrolló un estudio cualitativo con 72 hombres/77 mujeres (estudiantes, trabajadores, jubilados y exestudiantes). Se realizaron 48 entrevistas individuales y 14 grupos focales. Se efectuó un análisis de contenido utilizando el software QRS NVivo 12. Las propuestas identificadas se agruparon en: desarrollo de la participación e inclusión, promoción de la salud mental, mantenimiento y mejora de áreas verdes e infraestructura, y fortalecimiento del acceso a actividades deportivas, culturales y de extensión universitaria. Las mujeres valoraron la difusión de activos comunitarios y el cuidado de las personas y el entorno. Y los hombres, el fortalecimiento del capital social, la docencia y la transferencia de conocimiento. Las propuestas de acción tienen una orientación colectiva que favorece el vínculo de las personas con su entorno y el desarrollo del sentido de comunidad. Desde una perspectiva de género, se observa reproducción de roles y estereotipos arraigados en el sistema patriarcal. Esto constituye un desafío para potenciar las UPS en tanto política pública, considerando los principios de participación, justicia social y equidad.

Effect of conservative treatment of pelvic floor dysfunctions in women: An umbrella review.

OBJECTIVE: Due to their high worldwide prevalence, pelvic floor dysfunctions (PFD's) are a public health problem. There is high heterogeneity in the types and effectiveness of conservative treatment. The objective was to analyze the scientific evidence on conservative treatment of PFDs in women. METHODS: Umbrella review, covering MEDLINE (1950-2019), Scopus (1960-2019), Web of Science (1980-2019), and Cochrane Library (2000-2019). Inclusion criterion: review on conservative treatments about pelvic floor disorders in the adult women, in Spanish or English; exclusion criterion: studies about other urological, gynecological, and coloproctological pathologies, among others. RESULTS: Thirty-two reviews (2000-2019) and 12 meta-analyses were included. 53.1% showed an improvement on urinary incontinence. Pelvic floor muscle training worked on 70.6% of them, followed by electrical stimulation and estrogen (11.7%), and weight loss (5.9%). 6.3% of reviews and meta-analyses fulfilled all items in PRISMA, and 93.7% of them fulfilled more than 60% of the checklist. 60% de los ítems. CONCLUSIONS: PFMT and weight loss are the most effective treatments for UI, but there is no evidence for other PFDs. The methodological quality of conservative treatments must be improved for a more effective treatment of PFDs in women. Pelvic floor muscle training and weight loss are the most effective treatments for urinary incontinence. Only 6.3% of the reviews fulfilled all PRISMA ítems.

Maternity care through the eyes of Southern European immigrant parents in Norway / Experiencias de padres y madres inmigrantes del sur de Europa con los servicios noruegos de salud reproductiva

Objective: To explore Southern European immigrant mothers and fathers' experiences of reproductive health services in Norway, and their perceptions of health providers' beliefs and attitudes regarding pregnancy and childbirth. Method: We employed a qualitative research methodology with two focus group discussions and 11 in-depth interviews with 4 fathers and 11 mothers from Italy, Spain, Portugal, and Greece, whose children were born in Norway. Thematic Analysis was conducted to identify and analyze patterns across the data. Results: We identified three themes as key elements in parents' experiences: experiences with the coverage and organization of the Reproductive Health Services; relational experiences with health providers; and pregnancy and delivery as a culturally-shaped event. The immigrant parents experienced a clash between their expectations and the procedures and health facility environment encountered in Norway regarding check-ups, diagnosis tests, childbirth preparation courses, and health facilities. Informants perceived that the maternity care practices of the host country were underpinned by the health care providers' cultural understandings of labor and pregnancy. Particularly, they experienced a less interventionist approach towards pregnancy and childbirth. Conclusions: The experiences of immigrant parents provide relevant information to improve reproductive health services in a cross-cultural context. Inmigration brings new challenges that must be addressed from a perspective of cultural competence. These services should acknowledge diversity in cultural beliefs around childrearing and involve both fathers and mothers in decision-making. (AU)

Objetivo: Explorar cómo fueron las experiencias de padres y madres inmigrantes procedentes del sur de Europa al utilizar los servicios de salud reproductiva en Noruega, así como sus percepciones sobre las actitudes y las creencias del personal de salud con respecto al embarazo y el parto. Método: Estudio cualitativo, basado en dos grupos focales y 11 entrevistas en profundidad con 4 padres y 11 madres italianos, españoles, portugueses y griegos, quienes habían tenido algún/a hijo/a en Noruega. Los datos se analizaron usando análisis temático. Resultados: Emergieron tres temas: experiencias con la cobertura y la organización de los servicios de salud reproductiva; experiencias con profesionales de salud; y embarazo y parto como eventos culturales. Los padres y las madres inmigrantes experimentaron un choque entre sus expectativas y las prácticas de los servicios de salud reproductiva noruegos, especialmente en cuanto a consultas, procedimientos, pruebas diagnósticas, preparación para el parto e infraestructura sanitaria. Los informantes percibieron que las prácticas de los/las profesionales de los servicios de salud reproductiva están influenciadas por creencias culturales relacionadas con el embarazo y el parto en Noruega. En concreto, los informantes experimentaron un enfoque menos intervencionista al recibir los cuidados perinatales del personal de salud en Noruega. Conclusiones: Las experiencias de los padres y las madres inmigrantes ofrecen información relevante para contribuir a mejorar los servicios de salud reproductiva en un contexto intercultural. La inmigración supone nuevos retos que deben afrontarse desde una perspectiva de competencia cultural. Los servicios de salud reproductiva deben reconocer la diversidad cultural en el embarazo y el parto, e involucrar a ambos progenitores. (AU)

Maternity care through the eyes of Southern European immigrant parents in Norway.

OBJECTIVE: To explore Southern European immigrant mothers and fathers' experiences of reproductive health services in Norway, and their perceptions of health providers' beliefs and attitudes regarding pregnancy and childbirth. METHOD: We employed a qualitative research methodology with two focus group discussions and 11 in-depth interviews with 4 fathers and 11 mothers from Italy, Spain, Portugal, and Greece, whose children were born in Norway. Thematic Analysis was conducted to identify and analyze patterns across the data. RESULTS: We identified three themes as key elements in parents' experiences: experiences with the coverage and organization of the Reproductive Health Services; relational experiences with health providers; and pregnancy and delivery as a culturally-shaped event. The immigrant parents experienced a clash between their expectations and the procedures and health facility environment encountered in Norway regarding check-ups, diagnosis tests, childbirth preparation courses, and health facilities. Informants perceived that the maternity care practices of the host country were underpinned by the health care providers' cultural understandings of labor and pregnancy. Particularly, they experienced a less interventionist approach towards pregnancy and childbirth. CONCLUSIONS: The experiences of immigrant parents provide relevant information to improve reproductive health services in a cross-cultural context. Inmigration brings new challenges that must be addressed from a perspective of cultural competence. These services should acknowledge diversity in cultural beliefs around childrearing and involve both fathers and mothers in decision-making.

Asset map in a Chilean Health Promoting University: 'a strategy for revitalization'.

Health Promoting Universities (HPUs) are more likely to perform actions intended to change habits and increase personal empowerment, than they are to develop community actions. The objective of this research is to create an asset map to visualize collective actions in a Chilean HPU. A qualitative study, based on the ABCD model was conducted. There were 149 people, distributed into 48 semi-structured interviews and 14 focus groups, who participated in this study (students, employees, ex-students and retirees). An asset map was elaborated, identifying the contributions of residents, associations and organizations, local institutions, physical resources, economic assets and local culture and with a new category, 'connecting assets'. These categories show the range of resources in a university. According to the participants, the questions on asset identification were a tool for reflection, and by giving their opinions and discovering or drawing attention to new resources, they gained a better understanding of the assets in the university. Several participants stated that these talks could generate a positive emotional environment, which boosted their wellbeing. There were gender- and group-based differences in how the assets were valued. Students stressed assets related to services and benefits from the institution, green areas, and collective spaces. Employees, retirees and ex-students emphasized assets related to belonging, identity and traditions. Men appreciated openness and privacy in physical spaces. Women highlighted assets related to the institution. The resulting map, displays a range of resources that can help the university develop new possibilities for comprehensive and collective actions that would revitalize the HPU strategy.

Psychometric properties of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) on Chilean women / Propiedades psicométricas del instrumento Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) en mujeres chilenas

Abstract Introduction: Pelvic floor dysfunctions have an impact on women's sexual function. A Chilean study found that 74% of women have pelvic floor dysfunctions, but there is no validated tool for them. Objective: To evaluate the psychometric properties of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) for assessing sexual function in Chilean women with pelvic floor dysfunctions. Methods: Cross-sectional study of psychometrics in 217 women with pelvic floor dysfunction, age 18 or older, and sexually active (last 6 months). Non-probability, convenience sampling. Tool: PISQ-12. Experts checked content validity, construct validity with confirmatory factor analysis, reliability with Cronbach's alpha, and discriminating capacity with Pearson and McDonald's omega. Results: Population is mainly perimenopausal, highly educated with no income and with urinary incontinence (89.4%). Psychometric analysis supports a three-factor structure: sexual response, female sexual problems, and male sexual problems, with a good (α= 0.85), acceptable (α= 0.73), and poor (α= 0.63) reliability, respectively, but McDonald's omega was acceptable for all three. These were related to age (rs: -0.33), education (rs: 0.36), number of pregnancies (rs: -0.18) and vaginal births (rs: -0.25). Conclusions: PISQ-12 is valid and reliable for measuring sexual dimension and problems. Age, education, and number of pregnancies and vaginal births are moderately correlated to sexual response.

Resumen Introducción: Las disfunciones del piso pélvico impactan la función sexual de mujeres que la padecen. En un estudio chileno un 74% de las mujeres presentó disfunción sexual sin tener un instrumento validado para esta población. Objetivo: Evaluar las propiedades psicométricas del Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire (PISQ-12) para medir la función sexual en mujeres chilenas con disfunciones del piso pélvico. Métodos: Estudio transversal psicométrico de 217 mujeres con disfunción del piso pélvico, igual /mayor a 18 años, sexualmente activas (últimos 6 meses). Muestreo no probabilístico de conveniencia. Cuestionario: PISQ-12. Se realizó juicio de expertos para validez de contenido, análisis factorial confirmatorio para validez de constructo y el α de Cronbach para confiabilidad y capacidad discriminativa con Pearson y ω de McDonald. Resultados: Población principalmente perimenopáusica, alta escolaridad sin ingresos y con Incontinencia Urinaria (89.4%). El análisis psicométrico apoyó una estructura de tres factores: respuesta sexual, limitaciones sexuales femeninas y limitaciones sexuales masculinas, con confiabilidad buena (α= 0.85) aceptable (α= 0.73) y pobre (α= 0.63), respectivamente, aunque el ω de McDonald mostró valores aceptables para los tres. Éstos se relacionaron con edad (rs: -0.33), escolaridad (0.36), número de embarazos (-0.18) y partos vaginales (-0.25). Conclusiones: El PISQ-12 es válido y confiable, midiendo la dimensión sexual y limitaciones sexuales. La edad, escolaridad, número de embarazos y partos vaginales se correlaciona con la respuesta sexual en intensidad moderada.

Caracterización del cáncer de mama de un servicio de salud pública del sur de Chile según edad, período 2005-2015 / Characterization of breast cancer of a public health service in southern Chile according to age, period 2005-2015

INTRODUCCIÓN: En Chile ha aumentado la morbilidad y mortalidad por el cáncer de mama (CaMa), y el Servicio de Salud de Talcahuano (SST) ha realizado acciones para pesquisarlo precozmente y cumplir con las garantías explícitas en salud (GES) OBJETIVO: Caracterizar los ingresos por CaMa del SST en el período 2005-2015. MÉTODO: Estudio transversal de 1.077 mujeres diagnosticadas con CaMa en la Unidad de Patología Mamaria (UPM) del SST. Variables: edad, tipo histológico, etapificación, tratamiento y cumplimiento de las GES. Análisis univariado y bivariado con suite estadística SPSS v25. RESULTADOS: Los casos aumentaron en todo el período de estudio, excepto en 2011. Concentrando el 35,5% en mujeres de ≥65 años. El carcinoma ductal invasor ascendió al 73,5% de los tipos histológicos, y 41,9% tenía un tamaño tumoral entre 2 y 5 cms. Las mujeres de 65 y más años presentan los porcentajes más altos en frecuencia y tamaño de tumor. El 78,6% ingresó en etapa 0 a IIB. Los tratamientos más frecuentes fueron: hormonoterapia (81,4%), radioterapia (80,1%), mastectomía parcial (69,4%), quimioterapia (56,3%) y disección axilar (55,7%). El cumplimiento de las garantías GES, es mayor en la confirmación diagnóstica (87%) que en el inicio de tratamiento (77,3%). CONCLUSIÓN: Ascendió sostenidamente el CaMa en el SST, excepto en 2011, quizás condicionado por el terremoto del año 2010. La mayoría de los ingresos lo hacen en etapas tempranas, en mujeres ≥50 años (especialmente en ≥65 más) y con tratamientos más conservadores. Existe un alto cumplimiento de las GES del CaMa en el SST.

INTRODUCTION: Breast cancer morbidity and mortality has increased in Chile, and the Talcahuano Health Service (THS) has taken measures for an early detection and complying with the country's Explicit Health Guarantees program (GES in Spanish). OBJECTIVE: To characterize admissions to the THS for breast cancer between 2005 and 2015. Methods: Cross-sectional study, consisting of 1077 women who had been diagnosed with breast cancer in the Mammary Pathologies Unit of the THS. Variables: age, histological type, staging, treatment, and GES compliance. Univariate and bivariate analysis, using SPSS v25. RESULTS: Cases increased every year but on 2011, with 35.5% of them being women aged 65 or older. Invasive ductal carcinoma accounted for 73.5% of the histological types, while 41.9% presented a tumor size of 2-5 cm. Women aged 65 and older showed the highest percentages in frequency and tumor size. 78.6% of cases were admitted while on stages 0 to IIB. Most frequent treatments were hormone therapy (81.4%), radiotherapy (80.1%), partial mastectomy (69.4%), chemotherapy (56.3%), and axillary dissection (55.7%). GES compliance was higher in the diagnosis stage (87.0%) than at the start of treatment (77.3%). CONCLUSION: Breast cancer rates have steadily increased in the THS but on 2011, which could be due to the 2010 Chile earthquake. Most admissions are women aged 50 or more (especially ≥ 65), on early stages, and under more traditional treatments. There is a high rate of GES compliance in this health service.

Impact of the Covid-19 pandemic on perinatal mental health (Riseup-PPD-COVID-19): protocol for an international prospective cohort study.

BACKGROUND: Corona Virus Disease 19 (COVID-19) is a new pandemic, declared a public health emergency by the World Health Organization, which could have negative consequences for pregnant and postpartum women. The scarce evidence published to date suggests that perinatal mental health has deteriorated since the COVID-19 outbreak. However, the few studies published so far have some limitations, such as a cross-sectional design and the omission of important factors for the understanding of perinatal mental health, including governmental restriction measures and healthcare practices implemented at the maternity hospitals. Within the Riseup-PPD COST Action, a study is underway to assess the impact of COVID-19 in perinatal mental health. The primary objectives are to (1) evaluate changes in perinatal mental health outcomes; and (2) determine the risk and protective factors for perinatal mental health during the COVID-19 pandemic. Additionally, we will compare the results between the countries participating in the study. METHODS: This is an international prospective cohort study, with a baseline and three follow-up assessments over a six-month period. It is being carried out in 11 European countries (Albania, Bulgaria, Cyprus, France, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom), Argentina, Brazil and Chile. The sample consists of adult pregnant and postpartum women (with infants up to 6 months of age). The assessment includes measures on COVID-19 epidemiology and public health measures (Oxford COVID-19 Government Response Tracker dataset), Coronavirus Perinatal Experiences (COPE questionnaires), psychological distress (BSI-18), depression (EPDS), anxiety (GAD-7) and post-traumatic stress symptoms (PTSD checklist for DSM-V). DISCUSSION: This study will provide important information for understanding the impact of the COVID-19 pandemic on perinatal mental health and well-being, including the identification of potential risk and protective factors by implementing predictive models using machine learning techniques. The findings will help policymakers develop suitable guidelines and prevention strategies for perinatal mental health and contribute to designing tailored mental health interventions. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04595123 .

Psychometric properties of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) on Chilean women.

Introduction: Pelvic floor dysfunctions have an impact on women's sexual function. A Chilean study found that 74% of women have pelvic floor dysfunctions, but there is no validated tool for them. Objective: To evaluate the psychometric properties of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) for assessing sexual function in Chilean women with pelvic floor dysfunctions. Methods: Cross-sectional study of psychometrics in 217 women with pelvic floor dysfunction, age 18 or older, and sexually active (last 6 months). Non-probability, convenience sampling. Tool: PISQ-12. Experts checked content validity, construct validity with confirmatory factor analysis, reliability with Cronbach's alpha, and discriminating capacity with Pearson and McDonald's omega. Results: Population is mainly perimenopausal, highly educated with no income and with urinary incontinence (89.4%). Psychometric analysis supports a three-factor structure: sexual response, female sexual problems, and male sexual problems, with a good (α= 0.85), acceptable (α= 0.73), and poor (α= 0.63) reliability, respectively, but McDonald's omega was acceptable for all three. These were related to age (rs: -0.33), education (rs: 0.36), number of pregnancies (rs: -0.18) and vaginal births (rs: -0.25). Conclusions: PISQ-12 is valid and reliable for measuring sexual dimension and problems. Age, education, and number of pregnancies and vaginal births are moderately correlated to sexual response.

Introducción: Las disfunciones del piso pélvico impactan la función sexual de mujeres que la padecen. En un estudio chileno un 74% de las mujeres presentó disfunción sexual sin tener un instrumento validado para esta población. Objetivo: Evaluar las propiedades psicométricas del Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire (PISQ-12) para medir la función sexual en mujeres chilenas con disfunciones del piso pélvico. Métodos: Estudio transversal psicométrico de 217 mujeres con disfunción del piso pélvico, igual /mayor a 18 años, sexualmente activas (últimos 6 meses). Muestreo no probabilístico de conveniencia. Cuestionario: PISQ-12. Se realizó juicio de expertos para validez de contenido, análisis factorial confirmatorio para validez de constructo y el α de Cronbach para confiabilidad y capacidad discriminativa con Pearson y ω de McDonald. Resultados: Población principalmente perimenopáusica, alta escolaridad sin ingresos y con Incontinencia Urinaria (89.4%). El análisis psicométrico apoyó una estructura de tres factores: respuesta sexual, limitaciones sexuales femeninas y limitaciones sexuales masculinas, con confiabilidad buena (α= 0.85) aceptable (α= 0.73) y pobre (α= 0.63), respectivamente, aunque el ω de McDonald mostró valores aceptables para los tres. Éstos se relacionaron con edad (rs: -0.33), escolaridad (0.36), número de embarazos (-0.18) y partos vaginales (-0.25). Conclusiones: El PISQ-12 es válido y confiable, midiendo la dimensión sexual y limitaciones sexuales. La edad, escolaridad, número de embarazos y partos vaginales se correlaciona con la respuesta sexual en intensidad moderada.

Impacto de las políticas de educación sexual en la salud sexual y reproductiva adolescente en el sur de chile, período 2010 - 2017 / Impact of sexual education policies on adolescent sexual and reproductive health in southern Chile, period 2010 - 2017

RESUMEN Antecedentes: Desde los años 2001 y 2012 se incorporan contenidos sobre sexualidad en el currículum de 6º/7º básico y 2º/3o medio. A partir del año 2010 se legaliza que la población adolescente debe recibir educación sexual. Se propusieron siete programas en esta materia para establecimientos educacionales. Su implementación y sus resultados no han sido evaluados. Objetivo: Evaluar el impacto de las políticas de educación sexual implementadas en Chile, en la salud sexual y reproductiva de la población adolescente de la comuna de Concepción entre los años 2010 y 2017. Material y método: Estudio ecológico en establecimientos educacionales e indicadores de salud sexual y reproductiva en adolescentes. Incluyó 51 establecimientos y estadísticas de embarazo, uso de métodos anticonceptivos (MAC), casos de infecciones de transmisión sexual (ITS) y violencia sexual. Resultados: El 43% de éstos implementaron algún programa de educación sexual; El 80% ha incorporado los contenidos curriculares, y la misma cifra ha ejecutado iniciativas propias de sexualidad y asesorías externas con un alcance del 84%. Se observa un descenso del embarazo adolescente, aumento del uso de MAC, pero disminuyó el uso de condón masculino, y un aumento de los casos de gonorrea y VIH, así como las cifras de violencia sexual hacia adolescentes. Conclusiones: A pesar del descenso de algunos indicadores de salud sexual y reproductiva en adolescentes, es preocupante el aumento de las ITS y la disminución del uso de métodos que previenen su contagio, así como la violencia sexual que también es un riesgo para adquirir ITS.

ABSTRACT Background: In 2001 and 2012, contents on sexuality were added to the curriculum of the 6th and 7th grades of primary school, and to the 2nd and 3rd grades of secondary school. In 2010, sex education became compulsory for adolescents. There are seven sex education programs for schools, but their implementation and results have not been evaluated. Objective: To evaluate the impact of Chilean sex education policies on the sexual and reproductive health of teenagers from the commune of Concepción between 2010 and 2017. Material and methods: Ecological study, using schools and teenagers' sexual and reproductive health indicators. 51 schools were included in this study, and the indicators used were pregnancy statistics, use of contraceptives, cases of sexually-transmitted diseases (STDs), and sexual violence. Results: 43% of schools have implemented a sex education program. 80% have included the curriculum content. The same percentage of schools has implemented their own initiatives on the topic, while an 84% has asked for external counsel. Teenage pregnancy rates have decreased and the use of contraceptives has increased, but we also observed a decrease in the use of male condom and a higher rate of gonorrhea and HIV cases. The cases of sexual violence against adolescents have increased as well. Conclusions: Despite the decrease seen in some indicators, the higher rate of STDs and the lower use of methods to prevent them are alarming. The higher rate of sexual violence is worrying as well, as it is associated with STDs.

Determinants in the process of seeking help for urinary incontinence in the Chilean health system.

OBJECTIVE: To analyze via the Andersen model what leads women with urinary incontinence (UI) to seek help and remain in the healthcare system. METHODS: An interpretative phenomenologic study enrolling women aged 18 years or older who were diagnosed with UI at a tertiary care hospital in Chile between January and March 2016. Data were collected by semi-structured interview. The categories explored experience with UI and reasons for seeking health care, and included the dimensions of the Andersen model. RESULTS: Ten women were enrolled. Characteristics that eased or hindered healthcare seeking were identified to come from the women (frequency and quantity of symptoms, coping strategies, and beliefs about its causes) and from their environment (reaction of partner, family, or coworkers to her condition). Some were associated with primary care (human and/or technical resources) and some with secondary care (pelvic floor units). CONCLUSION: The results reflect the complexities of asking for health care for women with UI, especially in a country such as Chile with different healthcare levels. Raising awareness of this complexity and developing an approach that includes all stakeholders (institution, community, and family) is crucial for professionals who want to offer both medical therapy and wellness-focused healthcare.

Fortalecimiento de la musculatura del piso pélvico en gestantes en control en un centro de salud familiar: un estudio experimental / Strengthening of the pelvic floor muscles in control pregnant women in a family health center: an experimental study

ANTECEDENTES: Aunque la presencia de disfunciones del piso pélvico es más prevalente en mujeres adultas de avanzada edad, durante el embarazo o post parto se puede presentar incontinencia urinaria (IU), siendo la de esfuerzo (IUE) la más común en este período. OBJETIVO: Evaluar el efecto del entrenamiento de la musculatura del piso pélvico (EMPP) en gestantes controladas en el Centro de Salud Familiar de la comuna de Yerbas Buenas, durante el año 2016. MATERIAL Y MÉTODO: Estudio piloto cuasi-experimental en gestantes entre 20 y 40 anos, atendidas en Atención Primaria de Salud. Muestra piloto: 20 gestantes (20 a 28 semanas de gestación). Se les evaluó la fuerza de la musculatura pélvica (FMP) mediante Escala de Oxford Modificada al inicio y luego de 8 semanas de EMPP, además se midieron las características socio-bio-demográficas, antecedentes mórbidos y obstétricos, hábitos y la sintomatología urinaria, lo que fue medido utilizando el International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF). RESULTADOS: El 50% de las gestantes refirió IU durante el embarazo, siendo en el 95% IUE. No se relacionó la paridad, tipo de parto y EN con menor FMP. El EMPP mejoró significativamente la FMP de las gestantes (p<0,05) CONCLUSIONES: La IUE fue la DPP más prevalente en las gestantes. Es posible mejorar la FMP en gestantes con el EMPP, por tanto, se debería considerar su incorporación a las prestaciones del sistema público de salud como una acción de promoción de la salud sexual y reproductiva, ya que es una intervención de bajo costo y baja complejidad.

BACKGROUND: Although pelvic floor dysfunctions are more prevalent in older adult women, urinary incontinence may be present during pregnancy or postpartum, with stress incontinence (SUI) being the most common in this period. OBJECTIVE: To evaluate the effect of pelvic floor muscle training on pregnant women attended in a family health center in Yerbas Buenas, Chile, in 2016. MATERIAL AND METHOD: Pilot quasi-experimental study in pregnant women, aged between 20 and 40, attending a primary health care center. Pilot sample: 20 pregnant women (20 to 28 weeks). Pelvic muscle strength was assessed by Modified Oxford Scale at the beginning of the study and then after 8 weeks of exercising. Socio-and bio-demographic characteristics, morbidity and obstetric history, habits, and urinary symptoms were assessed using the International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF). RESULTS: 50% of the women presented urinary incontinence during pregnancy, with 95% of them suffering from stress incontinence. Parity, type of delivery and nutritional status did not relate to lower pelvic musculature strength. Pelvic floor muscle training significantly improved the women's pelvic muscle strength (p <0.05). CONCLUSIONS: Stress urinary incontinence was the most prevalent pelvic floor dysfunction in pregnant women. It is possible to improve pelvic muscle strength in pregnant women through pelvic floor muscle training; therefore, their inclusion into the public health system should be considered as an action to promote sexual and reproductive health, since it is a low-cost and low-complexity intervention.