[Operational domains of healthy aging: a qualitative description in older adults in Peru]. / Dominios operativos del envejecimiento saludable: una descripción cualitativa en personas adultas mayores de Perú.

BACKGROUND AND OBJECTIVE: Understanding the domains of healthy aging (HA) through the perceptions of older adults is important for the multidimensional determination of the construct according to the culture of Peru and for the development of plans that promote the health, well-being, resources and strengths of older adults. The purpose of this study is to qualitatively explore the operational domains of HA in Peruvian older adults. METHOD: The approach adopted was fundamental qualitative descriptive. A purposive sampling was used and 26 participants attending senior centers belonging to the municipal commune of Lima were recruited (Medad=67.9; SD=6.64). Semi-structured interviews were conducted and the content analysis was carried out using an inductive method identifying the units of meaning of the HA. RESULTS: The content analysis showed 11 sub-themes and 4 main themes. The identified themes were as follows: "functional health", "psychological well-being", "active engagement with life" and "religion". Given this, the results demonstrate the multidimensionality of HA in Peruvian older adults. CONCLUSION: The operational domains of HA indicate the importance of individual perceptions considering functional health, psychological well-being, active engagement with life, and religion. This perspective supports the multidimensional concept of HA. This can be implemented as a guide for government entities working with PAMs. In addition, to formulate new public policies focusing on the domains of HA.

Estigma y salud mental en pacientes con diagnóstico de cáncer / Stigma and mental health in patients with a cancer diagnosis

Objetivo: Determinar la relación entre el estigma y la salud mental en pacientes diagnosticados con cáncer. Material y Método: Estudio correlacional con una muestra no probabilística de 250 pacientes diagnosticados con cáncer, entre 26 y 72 años (85,2% mujeres y 14,8% varones). La recolección de datos se llevó a cabo en un centro de salud privado mediante el Cuestionario de estigma percibido, experimentado e internalizado, el Cuestionario de Salud del Paciente-4 (PHQ-4), y una ficha de características sociodemográficas. El análisis de datos se realizó con el coeficiente de correlación de Pearson, y se analizó la magnitud de los efectos con los criterios deGignac y Szodorai. Resultados: Se identificaron asociaciones inversas de efecto grande entre la salud mental y el estigma percibido (r = -0,362), el estigma experimentado (r = -0,413) y el estigma internalizado (r = -0,479). Conclusiones: Los resultados respaldan que, a mayor estigma percibido, experimentado e internalizado, son menores las puntuaciones en la salud mental de los pacientes con diagnóstico de cáncer (AU)

Objective: To determine the relationship between stigma and mental health in patients diagnosed with cancer. Material and Methods: Correlational study with a non-probabilistic sample of 250 patients diagnosed with cancer, between 26 and 72 years of age (85.2% women and 14.8% men). Data collection was carried out in a private health center using the Perceived, Experienced and Internalized Stigma Questionnaire, the Patient Health Questionnaire-4 (PHQ-4), and a sociodemographic characteristics form. Data analysis was performed using Pearson's correlation coefficient, and the magnitude of the effects was analyzed using the Gignac and Szodorai criteria. Results: Large effect inverse associations were identified between mental health and perceived stigma (r = -0.362), experienced stigma (r = -0.413) and internalized stigma (r = -0.479). Conclusions: The results support that the higher the perceived, experienced, and internalized stigma, the lower the mental health scores of patients with a cancer diagnosisObjective: To determine the relationship between stigma and mental health in patients diagnosed with cancer. Material and Methods: Correlational study with a non-probabilistic sample of 250 patients diagnosed with cancer, between 26 and 72 years of age (85.2% women and 14.8% men). Data collection was carried out in a private health center using the Perceived, Experienced and Internalized Stigma Questionnaire, the Patient Health Questionnaire-4 (PHQ-4), and a sociodemographic characteristics form. Data analysis was performed using Pearson's correlation coefficient, and the magnitude of the effects was analyzed using the Gignac and Szodorai criteria. Results: Large effect inverse associations were identified between mental health and perceived stigma (r = -0.362), experienced stigma (r = -0.413) and internalized stigma (r = -0.479) (AU)

Zarit Caregiver Burden Interview: Psychometric Properties in Family Caregivers of People with Intellectual Disabilities.

Caregivers of people with intellectual disabilities may feel overburdened in their work and experience negative psychological consequences. The purpose of this instrumental study was to determine the evidence of internal structure and reliability of the Zarit Caregiver Burden Interview scale. A total of 398 family caregivers, including women and men, participated (M = 47.33, SD = 10.44). The structure of the scale was evaluated by factor analysis and the McDonald Omega coefficient was used to estimate reliability. Sixteen models of the scale were tested, differing in number of items and factor structures. A model of 15 items and 4 dimensions (overload, competence, social relationship, and interpersonal relationship) obtained acceptable fit (χ2 = 184.72; p < 0.001; CFI = 0.95; TLI = 0.94; RMSEA = 0.055; SRMR = 0.05) and reliability coefficients above 0.70 in their dimensions. It is concluded that the Zarit scale is valid and reliable for use in caregivers of people with intellectual disabilities.

Internal Structure of the Work-Family Conflict Questionnaire (WFCQ) in Teacher Teleworking.

The interference between family and work roles has led to the development of scales for their measurement. However, instrumental studies of work-family conflict have not been conducted in the context of teacher teleworking during the COVID-19 pandemic. For this reason, the objectives of this study were set to obtain evidence of the internal structure and fairness of the Blanch and Aluja Work-Family Conflict Questionnaire, as well as its association with job satisfaction and other sociodemographic variables. A total of 235 Peruvian school teachers between the ages of 24 and 72 years (M = 43.79 and SD = 9.67) responded to the scale using the online form. The analysis employed the non-parametric item response theory modeling (Mokken scaling analysis). The structure of two correlated factors was confirmed: work conflict in the family (WCF) and family conflict in the work (FCW). Both dimensions were invariant with respect to sex group and educational level. The association of both dimensions with job satisfaction was theoretically convergent, and the gender of the teachers slightly moderated this relationship. The reliability was adequate for group research. Finally, the instrument can be useful in the organizational context of teachers who telework.

Moral Disengagement, Dark Triad and Face Mask Wearing during the COVID-19 Pandemic.

Not wearing a face mask, despite the sanitary recommendation, represented a public health risk during the COVID-19 pandemic. For this reason, the aim of the study was to determine the mediating role of moral disengagement in the relationship between the dark triad and face mask wearing during the second wave of the pandemic. We worked with a sample made up of 534 adults, who were administered the Dirty Dozen Dark test, the Moral Disengagement Mechanisms Scale and a questionnaire on the frequency of use of face masks. The results showed that moral disengagement mediates the effect of each trait of the dark triad (Machiavellianism, psychopathy and narcissism) on the use of face masks. It is concluded that those who possess any of the dark personality traits morally disengage in order not to use a face mask, exercising a reckless behavior of the possible contagion of COVID-19 to others.

Traducción y validez de la Escala de creencias sobre el uso de mascarillas para prevenir el contagio de la COVID-19 / Translation and validity of the Scale of beliefs about the use of masks to prevent the spread of COVID-19

RESUMEN Introducción: El uso de la mascarilla es indispensable para reducir la propagación de la COVID-19, pero, un porcentaje importante de personas se rehúsan a su uso. Es posible que las creencias jueguen un rol sustancial en la aceptación o rechazo de su uso. Sin embargo, se carece de una escala para evaluar las creencias sobre el uso de mascarillas para prevenir el contagio de la COVID-19. Objetivo: Traducir y determinar las evidencias de validez, de estructura interna y confiabilidad del autoinforme de creencias sobre el uso de las mascarillas. Métodos: El autoinforme de creencias sobre el uso de las mascarillas fue administrado a 1 218 personas de diferentes provincias del Perú (Medad = 27,4 años, DE = 12,6), elegidas de forma no probabilística. El instrumento fue sometido a un proceso de doble traducción del inglés al español y viceversa; además, mediante el programa Proyecto Jamovi versión 1.6, se determinó la estructura interna con análisis factorial (exploratorio y confirmatorio) y finalmente se estimó la confiabilidad. Resultados: El análisis factorial exploratorio identificó cuatro factores emergentes que explicaron el 53,7 % de la varianza. El modelo fue verificado y obtuvo índices de ajuste aceptables (χ² = 154 gl = 46; p < 0,01; CFI = 0,96; TLI = 0,942; RMSEA = 0,602). Además, se apreciaron cargas factoriales estandarizadas mayores a 0,30. Conclusión: La versión en español del autoinforme de creencias sobre el uso de las mascarillas muestra evidencias de validez, de estructura y confiabilidad por consistencia interna adecuadas.

ABSTRACT Introduction: The use of a mask is essential to reduce the spread of COVID-19, however, a significant percentage of people refuse to use it. Beliefs may play an important role in accepting or rejecting their use. Objective: To translate and determine the evidence of validity of internal structure and reliability of the self-report of beliefs about the use of masks. Methods: The self-report of beliefs about the use of masks was administered to 1218 people from different provinces of Peru (M age = 27,4 years, SD = 12,6), chosen in a non-probabilistic way. The instrument was subjected to a process of double translation from English to Spanish and vice versa; In addition, using the Jamovi Project version 1.6 program, the internal structure was determined with factor analysis (exploratory and confirmatory), and finally reliability was estimated. Results: The exploratory factor analysis identified four emerging factors that explained 53.7% of the variance. The model was verified and obtained acceptable fit indices (χ² = 154 gl = 46; p < 0,01; CFI = 0,96; TLI = 0,942; RMSEA = 0,602). In addition, standardized factor loadings greater than 0,30 were observed. Conclusions: The Spanish version of the self-report of beliefs about the use of masks shows evidence of validity of structure and reliability due to adequate internal consistency.

Relación entre síntomas psicopatológicos y funcionamiento familiar en adultos mayores víctimas de violencia familiar / Relationship between Psychopathological Symptoms and Family Functioning in Older Adults Victims of Family Violence

Introducción: Las familias son un soporte social importante para el bienestar de sus miembros, sobre todo los adultos mayores, quienes resultan vulnerables al maltrato intrafamiliar que pueden afectar su calidad de vida y generar síntomas psicopatológicos; sin embargo, existe poca evidencia científica de esta relación. Objetivo: Analizar la relación entre síntomas psicopatológicos y funcionamiento familiar en adultos mayores, víctimas de violencia familiar. Métodos: Estudio transversal, correlacional, en hospital distrital de La Esperanza, Trujillo, Perú, entre junio-octubre 2019. Población 170 adultos mayores asistidos en consulta psicológica, muestra por conveniencia de 151 adultos mayores: 84 víctimas y 67 no víctimas de maltrato. Los instrumentos empleados fueron cuestionario SCL-90 y APGAR familiar. Se procesaron los datos con el Coeficiente de correlaciones de Spearman, la fórmula de transformación de Rupinski y Dunlap y la q de Cohen. Resultados: El funcionamiento familiar tiene relación inversa con la somatización y depresión, en víctimas (r = -0,481; -0,536) y no víctimas de violencia familiar (r = -0,329; -0,387); las víctimas presentaron relaciones negativas del funcionamiento familiar con la obsesión-compulsión (r = -0,336), sensibilidad interpersonal (r = -0,314), ansiedad (r = -0,355), hostilidad (r = -0,435) e ideación paranoide (r = -0,511); la proporción de las diferencias entre las correlaciones de muestras arrojan un tamaño de efecto grande entre funcionamiento familiar e ideación paranoide y mediano entre hostilidad y funcionamiento familiar. Conclusiones: Existe correlación entre los síntomas psicopatológicos y funcionamiento familiar en adultos mayores víctimas y no víctimas de violencia familiar, con diferencias entre correlaciones de ambas muestras en la relación del funcionamiento familiar con la hostilidad y la ideación paranoide(AU)

Introduction: Families are an important social support for the welfare of their members, especially older adults, who are vulnerable to familial mistreatment, which can affect their quality of life and produce psychopathological symptoms; however, there is little scientific evidence about this relationship. Objective: To analyze the relationship between psychopathological symptoms and family functioning in older adults who are victims of family violence. Methods: Cross-sectional and correlational study carried out in La Esperanza district hospital, in Trujillo, Peru, between June and October 2019. The population was made up of 170 older adults attended in the psychological consultation. A convenience sample of 151 older adults was chosen: 84 victims and 67 non-victims of mistreatment. The instruments used were the Symptom Checklist-90 (SCL-90) and the Apgar-family questionnaires. Data were processed with Spearman's coefficient of correlation, Rupinski and Dunlap's transformation formula, and Cohen's q. Results: Family functioning showed inverse relationships with somatization and depression in victims (r=-0.481; -0.536) and non-victims of family violence (r=-0.329; -0.387). Victims presented negative relationships of family functioning with obsession-compulsion (r=-0.336), interpersonal sensitivity (r=-0.314), anxiety (r=-0.355), hostility (r=-0.435) and paranoid ideation (r=-0.511). The proportion of differences between sample correlations yielded a large effect size between family functioning and paranoid ideation, while it is average between hostility and family functioning. Conclusions: There is correlation between psychopathological symptoms and family functioning in older adult who are victims and non-victims of family violence, with differences between correlations of both samples in the relationship of family functioning with hostility and paranoid ideation, respectively(AU)

El miedo al contagio de covid-19, como mediador entre la exposición a las noticias y la salud mental, en población peruana / Fear of COVID-19 infection, as a mediator between exposure to news and mental health, in the Peruvian population

Objetivo: Determinar la relación entre el nivel de estrés y las estrategias de afrontamiento utilizadas por estudiantes de la Licenciatura en Enfermería en Instituciones de Educación Superior (IES) de Ciudad Obregón, Sonora.Metodología: Estudio no experimental y correlacional; se empleó un muestreo probabilístico estratificado de 250 estudiantes, con edades entre los 18 y 46 años de edad. Los datos fueron recabados mediante un cuestionario de características sociodemográficas, el instrumento del nivel de estrés percibido y para medir afrontamiento el Brief COPE Inventory.Resultados: El 74.4% de la muestra fueron mujeres y el 25.6% hombres, ambos géneros exhibieron nivel de estrés moderado (78%), la estrategia de afrontamiento reportada con mayor frecuencia fue afrontamiento activo emocional. Se empleó la prueba no paramétrica chi-cuadrada de Pearson (χ2) para probar la existencia de asociación entre el nivel de estrés y las estrategias de afrontamiento (p= 0.67). Con base a los resultados de χ2 (p=.067) se realizó un análisis adicional separando las categorías de cada una de las variables de estudio, se utilizó la prueba de Pearson con la cual se encontró correlación significativa entre el nivel de estrés bajo y la estrategia afrontamiento activo emocional, (p=0.27) y entre nivel de estrés alto y estrategia de afrontamiento emocional por evitación (p=-.01).Conclusiones: Los niveles más altos de estrés lo manifiestan estudiantes que cursan solo materias teóricas. Se sugiere la implementación de intervenciones relacionadas al manejo adecuado del estrés (AU)

Objective: Determine the relationship between the stress level and the coping strategies used by students of the Bachelor’s Degree of Nursing in institutions of higher education of Ciudad Obregón, Sonora.Methodology: Descriptive and correlational study; the population was comprised by 250 students whose age ranged from 18 and 46 years. Data was collected through a questionnaire of sociodemographic characteristics, the perceived stress level instrument, and the Brief COPE questionnaire.Results: 74.4% of the sample was comprised by women and 25.6% by men. It was found that both genders had a moderate level of stress (78%), in terms of the coping strategies most frequently used by the students, the emotional active coping was the one found. The correlation analysis was performed using Pearson's chi-square non-parametric test (x2) to probe the existence of relationship between the stress level and coping strategies (p=0.67). Based on the results of x2 (p=0.067), an additional analysis was carried out separating the categories of each one of the variables of study; Pearson’s test was used to find a significant correlation between low stress level and active emotional coping strategy (p=0.27) and between high stress level and avoidance emotional coping strategy (p=-0.01).Conclusions: The highest levels of stress are manifested by students who study only theoretical subjects. It is suggested the implementation of interventions related to the adequate management of stress (AU)

Factores relacionados con el estrés postraumático en pacientes con alta médica por la COVID-19 / Factors related to post-traumatic stress in patients with medical discharge due to COVID-19

RESUMEN Introducción: La hospitalización a causa de la COVID-19 puede predisponer a la aparición de posibles secuelas psicológicas a largo plazo. Objetivo: Determinar la relación entre los factores hospitalarios y no hospitalarios con el estrés postraumático en pacientes con alta médica por la COVID-19. Métodos: Estudio de corte transversal y diseño correlacional. La muestra no probabilística estuvo compuesta por 126 participantes con la COVID-19, evaluados mediante un cuestionario autoadministrado y la Escala de Trauma de Davidson. Para el procesamiento de datos se aplicó la prueba ji cuadrado y la V de Cramer como medida de magnitud de efecto. Resultados: El trastorno por estrés postraumático presenta asociaciones moderadas con los factores hospitalarios: tiempo de hospitalización (p< 0,001) (V de Cramer= 0,33), tipo clínico de COVID-19 (p< 0,001) (V de Cramer= 0,49) y soporte ventilatorio invasivo (p< 0,001) (V de Cramer= 0,39); y con los factores no hospitalarios: oxigenoterapia en rehabilitación (p< 0,001) (V de Cramer= 0,33), secuelas neurológicas (p< 0,001) (V de Cramer= 0,41), dificultad respiratoria (p< 0,001) (V de Cramer= 0,53), percepción de discriminación social (p< 0,05) (V de Cramer= 0,29), dificultad para reincorporarse a las actividades diarias (p< 0,001) (V de Cramer= 0,40) y familiares infectados con la COVID-19 (p< 0,001) (V de Cramer= 0,30). Conclusiones: Existen factores, tanto intra como extrahospitalarios, que se relacionan con el trastorno por estrés postraumático luego del alta médica por la COVID-19.

ABSTRACT Introduction: Hospitalization due to COVID-19 can predispose to the appearance of possible long-term psychological sequelae. Objective: To determine the relationship between hospital and non-hospital factors with post-traumatic stress in patients discharged for COVID-19 from a hospital in Peru. Methods: Cross-sectional study and correlational design. The non-probabilistic sample consisted of 126 participants, evaluated through a self-administered questionnaire and the Davidson Trauma Scale. For data processing, the chi-square test and Cramer's V were used as measures of the magnitude of effect. Results: Post-traumatic stress disorder presents moderate associations with hospital factors: hospitalization time (p<0.001) (Cramer's V = 0.33), clinical type of COVID-19 (p<0.001) (Cramer's V = 0 .49) and invasive ventilatory support (p<0.001) (Cramer's V = 0.39); and with non-hospital factors: oxygen therapy in rehabilitation (p<0.001) (Cramer's V = 0.33), neurological sequelae (p<0.001) (Cramer's V = 0.41), respiratory distress (p<0.001) (Cramer's V = 0.53), perception of social discrimination (p<0.05) (Cramer's V = 0.29), difficulty returning to daily activities (p<0.001) (Cramer's V = 0.40) and family members infected with COVID-19 (p<0.001) (Cramer's V = 0.30). Conclusions: There are both in-hospital and out-of-hospital factors associated with post-traumatic stress disorder following discharge from COVID-19.

Factores de riesgo asociados al embarazo en adolescentes / Risk factors associated with pregnancy in adolescents

OBJETIVO: Evaluar los factores de riesgo para el embarazo en adolescentes. MÉTODO: Estudio retrospectivo de casos y controles con una muestra no probabilística por conveniencia de 180 adolescentes: 60 gestantes (casos) y 120 no gestantes (controles). La recolección de datos se realizó entre los meses de setiembre y octubre del 2019 en un centro de salud público de Trujillo, mediante el FACES-III y una ficha de identificación de datos sociodemográficos y familiares. Para el análisis de datos se determinó el Odds ratio, se calcularon los intervalos de confianza (IC) y se procedió a estimar la magnitud de efecto. RESULTADOS: Tanto la exposición a la violencia (OR: 5.82), la funcionalidad familiar (OR: 3.87), la edad del primer embarazo de la madre (OR: 4.07) y la situación sentimental de los padres (OR: 4.24), actuaron como factores de riesgo con una magnitud de efecto moderada; en tanto que el grado de instrucción de la madre (OR: 2.03) se mostró como un factor de riesgo con magnitud de efecto pequeña y el grado de instrucción del padre (OR: 1.37) insignificante. CONCLUSIONES: La exposición a la violencia, la funcionalidad familiar, la edad del primer embarazo de la madre, la situación sentimental y el grado de instrucción de los padres actuaron como factores de riesgo para el embarazo en adolescentes

OBJECTIVE: To assess the risk factors for pregnancy in adolescents. METHOD: Retrospective case-control study with a non-probability sample for convenience of 180 adolescents: 60 pregnant women (cases) and 120 non pregnant women (controls) Data collection was carried out between September and October, 2019 in a public health center in Trujillo, using FACES-III and a card identifying sociodemographic and family data. For the data analysis the Odds ratio was determined, the confidence intervals (CI) were calculated and the magnitude of effect was estimated. RESULTS: Exposure to violence (OR: 5.82), family functionality (OR: 3.87), age of mother's first pregnancy (OR: 4.07), and parents' emotional situation (OR: 4.24) were risk factors with a moderate magnitude of effect, whereas mother's education (OR: 2.03) was a risk factor with a small magnitude of effect and father's education (OR: 1.37) was insignificant. CONCLUSIONS: Exposure to violence, family functionality, age of mother's first pregnancy, emotional situation and parents' level of education all acted as risk factors for adolescent pregnancy

A multifaceted intervention to increase prophylactic oxytocin use during the third stage of labor and to reduce routine episiotomies in Nicaragua.

OBJECTIVE: To assess the effect of a multifaceted intervention among skilled birth attendants on the use of oxytocin during the third stage of labor, the active management of the third stage of labor (AMTSL), and the rate of routine episiotomy during vaginal births in two health districts in Nicaragua. METHODS: An uncontrolled before-and-after study design was used. The rates of oxytocin use in the third stage of labor, AMTSL, and episiotomy were measured for vaginal births occurring in eight hospitals and health centers during 2011-2012, before and after implementation of a multifaceted facility-based intervention. The intervention involved the use of opinion leaders, interactive workshops to develop and implement evidence-based guidelines, academic detailing, the use of reminders, and feedback on the rates of oxytocin use and episiotomy. RESULTS: Oxytocin use during the third stage of labor increased significantly from 95.3% to 97.4% (P=0.003). The episiotomy rate dropped significantly from 31.2% to 21.2% overall, and from 59.6% to 40.5% in primiparous women (P<0.001 for both comparisons). CONCLUSION: The multifaceted intervention improved the targeted care practices during childbirth. However, a further decrease in the routine use of episiotomy would be desirable.

Stakeholder perceptions of a total market approach to family planning in Nicaragua.

OBJECTIVE: To assess private-sector stakeholders' and donors' perceptions of a total market approach (TMA) to family planning in Nicaragua in the context of decreased funding; to build evidence for potential strategies and mechanisms for TMA implementation (including public-private partnerships (PPPs)); and to identify information gaps and future priorities for related research and advocacy. METHODS: A descriptive exploratory study was conducted in various locations in Nicaragua from March to April 2010. A total of 24 key private-sector stakeholders and donors were interviewed and their responses analyzed using two questionnaires and a stakeholder analysis tool (PolicyMakerTM software). RESULTS: All survey participants supported a TMA, and public-private collaboration, in family planning in Nicaragua. Based on the survey responses, opportunities for further developing PPPs for family planning include building on and expanding existing governmental frameworks, such as Nicaragua's current coordination mechanism for contraceptive security. Obstacles include the lack of ongoing government engagement with the commercial (for-profit) sector and confusion about regulations for its involvement in family planning. Strategies for strengthening existing PPPs include establishing a coordination mechanism specifically for the commercial sector and collecting and disseminating evidence supporting public-private collaboration in family planning. CONCLUSIONS: There was no formal or absolute opposition to a TMA or PPPs in family planning in Nicaragua among a group of diverse nongovernmental stakeholders and donors. This type of study can help identify strategies to mobilize existing and potential advocates in achieving articulated policy goals, including diversification of funding sources for family planning to achieve contraceptive security.

Stakeholder perceptions of a total market approach to family planning in Nicaragua / Percepciones de grupos interesados sobre la aplicación de un enfoque de mercado total a la planificación familiar en Nicaragua

OBJECTIVE: To assess private-sector stakeholders' and donors' perceptions of a total market approach (TMA) to family planning in Nicaragua in the context of decreased funding; to build evidence for potential strategies and mechanisms for TMA implementation (including public-private partnerships (PPPs)); and to identify information gaps and future priorities for related research and advocacy. METHODS: A descriptive exploratory study was conducted in various locations in Nicaragua from March to April 2010. A total of 24 key private-sector stakeholders and donors were interviewed and their responses analyzed using two questionnaires and a stakeholder analysis tool (PolicyMakerTM software). RESULTS: All survey participants supported a TMA, and public-private collaboration, in family planning in Nicaragua. Based on the survey responses, opportunities for further developing PPPs for family planning include building on and expanding existing governmental frameworks, such as Nicaragua's current coordination mechanism for contraceptive security. Obstacles include the lack of ongoing government engagement with the commercial (for-profit) sector and confusion about regulations for its involvement in family planning. Strategies for strengthening existing PPPs include establishing a coordination mechanism specifically for the commercial sector and collecting and disseminating evidence supporting public-private collaboration in family planning. CONCLUSIONS: There was no formal or absolute opposition to a TMA or PPPs in family planning in Nicaragua among a group of diverse nongovernmental stakeholders and donors. This type of study can help identify strategies to mobilize existing and potential advocates in achieving articulated policy goals, including diversification of funding sources for family planning to achieve contraceptive security.

OBJETIVO: Evaluar las percepciones de los grupos interesados y de los donantes del sector privado sobre la aplicación de un enfoque de mercado total a la planificación familiar en Nicaragua en el contexto de una reducción del financiamiento; establecer datos científicos que avalen posibles estrategias y mecanismos para ejecutar este tipo de enfoque (lo que incluye alianzas entre los sectores público y privado); y determinar las brechas de información y las prioridades futuras en la investigación y la promoción de este enfoque. MÉTODOS: Entre marzo y abril del 2010 se llevó a cabo un estudio exploratorio descriptivo en varios lugares de Nicaragua. Se entrevistaron 24 personas de varios grupos interesados y de donantes clave del sector privado y se analizaron sus respuestas mediante dos cuestionarios y una herramienta de análisis específica (programa informático PolicyMakerTM). RESULTADOS: Todos los encuestados respaldaron la aplicación de un enfoque de mercado total y la colaboración entre los sectores público y privado respecto de la planificación familiar en Nicaragua. Según las respuestas obtenidas en la encuesta, las oportunidades para desarrollar alianzas adicionales entre los dos sectores respecto de la planificación familiar incluyen mejorar y ampliar los marcos gubernamentales existentes, como el actual mecanismo de coordinación de Nicaragua para la seguridad anticonceptiva. Los obstáculos son la falta de colaboración actual del gobierno con el sector comercial (con fines de lucro) y la confusión acerca de la reglamentación para participar en la planificación familiar. Las estrategias para fortalecer las alianzas existentes entre los sectores público y privado comprenden el establecimiento de un mecanismo de coordinación específico para el sector comercial, y la recolección y difusión de datos que avalen la colaboración entre los dos sectores respecto de la planificación familiar. CONCLUSIONES: En la evaluación de varios grupos interesados y de donantes del sector no gubernamental no se encontró ninguna oposición formal o absoluta a un enfoque de mercado total o a la conformación de alianzas entre los sectores público y privado respecto de la planificación familiar en Nicaragua. Este tipo de estudio puede ayudar a identificar estrategias que motiven a los promotores de la causa actuales y potenciales a alcanzar las metas políticas enunciadas, lo que incluye la diversificación de las fuentes de financiamiento para la planificación familiar a fin de alcanzar la seguridad anticonceptiva.

[The contribution of violence to maternal mortality in Morelos, Mexico]. / La contribución de la violencia a la mortalidad materna en Morelos, México.

OBJECTIVE: To document the under-registration of violent deaths related to pregnancy and the importance of considering these violent deaths within the definition of maternal mortality. MATERIAL AND METHODS: The study was carried out in the state of Morelos, based on the review of all death certificates (394) of reproductive aged women (12-49 years) who died during 2001. Based on a list of diagnostic criteria we eliminated 167 certificates that were neither violent deaths nor maternal deaths. The remaining 227 certificates were further evaluated through verbal autopsy and/or review of medical charts. RESULTS: Fifty-one violent deaths were found. Eighteen maternal deaths were officially reported in 2001, however, our study identified 23 direct maternal deaths and four violent deaths during pregnancy and the post-partum period. We found that this reproductive event was the direct trigger for the homicide or suicide of these four women, and only one of these cases was documented officially. CONCLUSIONS: Violent deaths related to pregnancy should be included in official maternal mortality statistics as indirect causes of maternal deaths. This would allow for a greater and more accurate understanding of violent maternal deaths and guide appropriate prevention and care policies, programs and services. Verbal autopsy is a useful technique for identifying cases of violent maternal deaths.

La contribución de la violencia a la mortalidad materna en Morelos, México / The contribution of violence to maternal mortality in Morelos, Mexico

OBJETIVO: Documentar el subregistro de muertes violentas relacionadas con el embarazo y la importancia de considerar, dentro de la definición de mortalidad materna, aquellas muertes producidas también por causas relacionadas con violencia. MATERIAL Y MÉTODOS: El estudio se realizó en el estado de Morelos, a partir de 394 certificados de defunción de mujeres entre 12 y 49 años de edad que murieron a lo largo del año 2001. Con base en una lista de diagnósticos de los certificados de defunción, se excluyeron 167 casos que, por las causas de muerte determinadas en el certificado de defunción, no se consideraron que podrían haber sido muertes maternas ni muertes violentas. Posteriormente se realizó el análisis de los 227 certificados restantes a través de la revisión de expedientes clínicos y/o autopsias verbales. RESULTADOS: Se encontraron 51 muertes violentas. Las estadísticas oficiales señalan que en 2001 hubo 18 muertes maternas, mientras que este estudio identificó 23 muertas maternas directas más cuatro muertas violentas durante el embarazo y el posparto. Es decir, se encontró que el evento reproductivo fue el factor que desencadenó el homicidio o suicidio de cuatro mujeres. Excepto en un caso, este hecho no está señalado ni relacionado en los registros oficiales. CONCLUSIONES: Se recomienda la inclusión de la violencia relacionada con la reproducción en los registros oficiales de mortalidad materna como una causa indirecta. Esto permitiría profundizar la comprensión de las causas de la mortalidad materna y orientaría la elaboración de políticas, programas y servicios de prevención y atención. La autopsia verbal (AV) es una técnica que ayuda a la identificación de casos de embarazo y muertes maternas violentas.

OBJECTIVE: To document the under-registration of violent deaths related to pregnancy and the importance of considering these violent deaths within the definition of maternal mortality. MATERIAL AND METHODS: The study was carried out in the state of Morelos, based on the review of all death certificates (394) of reproductive aged women (12-49 years) who died during 2001. Based on a list of diagnostic criteria we eliminated 167 certificates that were neither violent deaths nor maternal deaths. The remaining 227 certificates were further evaluated through verbal autopsy and/or review of medical charts. RESULTS: Fifty-one violent deaths were found. Eighteen maternal deaths were officially reported in 2001, however, our study identified 23 direct maternal deaths and four violent deaths during pregnancy and the post-partum period. We found that this reproductive event was the direct trigger for the homicide or suicide of these four women, and only one of these cases was documented officially. CONCLUSIONS: Violent deaths related to pregnancy should be included in official maternal mortality statistics as indirect causes of maternal deaths. This would allow for a greater and more accurate understanding of violent maternal deaths and guide appropriate prevention and care policies, programs and services. Verbal autopsy is a useful technique for identifying cases of violent maternal deaths.