Intervención y familias migrantes: análisis crítico de la «vulnerabilidad¼ desde los/las profesionales / Intervention and migrant families: critical analysis of "vulnerability" from professionals / Intervenção e famílias migrantes: análise crítica da "vulnerabilidade" dos profissionais

Resumen (analítico) Se indagan los significados que adquiere la noción de vulnerabilidad en la intervención social con familias migrantes en Santiago de Chile en relación con el sistema de xenofobia y racismo imperante. Se llevó a cabo una investigación cualitativa usando entrevistas semiestructuradas y un análisis de contenido, en una muestra de diez profesionales del ámbito psicosocial que trabajan con población migrante en la región metropolitana de Chile. Los resultados revelan cómo desde la intervención social se construye una noción de sujeto migrante asociado a la vulnerabilidad, en donde la matriz xenófoba y racista agudiza las dinámicas de exclusión. Asimismo, se desprenden valoraciones moralistas negativas sobre el ejercicio parental, una sobreculturalización de sus prácticas de cuidados y la verificación de formas sutiles de control, disciplinamiento y normalización de las familias migrantes.

Abstract (analytical) This paper analyzes the meanings that the notion of vulnerability acquires in social interventions with migrant families in Santiago de Chile in relation to a system that has high levels of xenophobia and racism. Qualitative research was carried out using semi-structured interviews and content analysis in a sample consisting of 10 professionals from the psychosocial field who work with the migrant population in the Metropolitan Region of Chile. The results reveal how the social intervention constructs a notion of a migrant subject strongly associated with vulnerability in which the xenophobic and racist matrix exacerbates the dynamics of exclusion. In addition, negative evaluations are expressed by participants in the study about parental practices, an over-culturalization of their care practices and the verification of subtle forms of control, discipline and normalization of migrant families.

Resumo (analítico) O artigo investiga os sentidos adquiridos pela noção de vulnerabilidade na intervenção social com famílias migrantes em Santiago do Chile em relação ao sistema vigente de xenofobia e racismo. Realizou-se uma pesquisa qualitativa por meio de entrevistas semiestruturadas e análise de conteúdo, em uma amostra composta por 10 profissionais da área psicossocial que atuam com a população migrante na Região Metropolitana do Chile. Os resultados revelam como, a partir da intervenção social, se constrói uma noção de sujeito migrante irredutivelmente associado à vulnerabilidade, onde a matriz xenófoba e racista exacerba a dinâmica da exclusão. Além disso. avaliações moralistas negativas são emitidas sobre o exercício parental, uma superculturalização de suas práticas de cuidado e a verificação de formas sutis de cuidar. derivado, controle, disciplina e normalização das famílias migrantes.

Structural gender inequalities and symptoms of postpartum depression in 40 countries.

BACKGROUND: The role of structural gender inequality in macro-level differences in women's perinatal mental health remains largely unexplored. This short communication explores structural gender inequalities and their potential as a macro-level, upstream social determinant of postpartum depression (PPD). METHODS: We compiled meta-analytically derived national-level prevalence estimates of PPD symptoms - based on the Edinburgh Postnatal Depression Scale - with economic (e.g., income inequality), health (e.g., infant mortality rate), sociodemographic (e.g., urban population), and structural gender inequality variables (e.g., abortion policies) for 40 countries. Meta-regression techniques and traditional p-value based stepwise procedures, complemented with a Bayesian model averaging approach, were used for a robust selection of variables associated with national-level PPD symptom prevalence. RESULTS: Income inequality (ß = 0.04, 95% CI = 0.02 to 0.07) and abortion policies (ß = 0.02, 95% CI = 0.00 to 0.03) were the only variables selected in the final, adjusted model, accounting for 60.7% of cross-national variations in PPD symptoms. LIMITATIONS: Study quality of primary studies was not assessed and some national-level meta-analytical estimates were based on few primary studies. A fifth of world countries and territories could be included, with high-income regions overrepresented. High rate of missing national-level data for potential predictors of PPD. Cross-sectional analyses precludes causal inferences. CONCLUSIONS: Abortion policies are a significant macro-level social determinant of PPD, and its liberalization might be associated with women's mental health at a population level. Our findings should be a relevant argument for clinicians to advocate for changing discriminatory social norms against women.

Health outcomes of unpaid caregivers in low- and middle-income countries: A systematic review and meta-analysis.

AIMS AND OBJECTIVES: To explore differences in health outcomes between unpaid caregivers and noncaregivers living in low- and middle-income countries (LMICs). BACKGROUND: Previous meta-analyses found worse health outcomes for unpaid caregivers in high-income nations. However, no meta-analysis has considered unpaid caregivers from LMICs. A systematic integration of this topic may contribute to nursing care for unpaid caregivers in LMICs. DESIGN: Systematic review and meta-analysis of observational studies. METHODS: Following PRISMA statement, studies were searched for using the CINAHL, PubMed and SciELO databases, limited to publications until 31 December 2019. Random- and fixed-effects meta-analyses were used for data synthesis. RESULTS: Fourteen studies from Africa, Asia and South America were included. Unpaid caregivers of people with ill-health were more anxious and depressed than noncaregivers. Studies conducted in Asia and South America reported poorer health outcomes for unpaid caregivers than noncaregivers, whereas the trend for African studies was the opposite. Unpaid caregivers of healthy individuals may have better health status than noncaregivers, particularly those caring between 1-14 hr per week. Of the six studies which examined gender differences, two studies informed worse health outcomes for women, one presented the opposite effect, and three found no differences. CONCLUSIONS: Individual, social, cultural and systemic factors play an important role in the health outcomes of unpaid caregivers in LMICs. More evidence is needed from LMICs. As unpaid caregivers are predominantly female, urgent attention to the health outcomes of female unpaid caregivers is required. RELEVANCE TO CLINICAL PRACTICE: The management of mental health problems, particularly anxiety and depression, should be an integral part of nursing care for unpaid caregivers living in LMICs. To further promote the health of unpaid caregivers in developing countries, stakeholders should consider launching educational campaigns that assist caregivers in finding ways to meet their cultural obligations while also reinforcing caregiver self-care.

Development and validation of a three-item version of the Edinburgh Postnatal Depression Scale.

OBJECTIVE: To develop and validate a brief screening instrument for postpartum depression in resource-constrained primary care settings. METHOD: Secondary data analysis of a cohort of 305 mothers (Mdnage = 26) attending well-child check-ups in six primary care centers in Santiago, Chile, answered the Edinburgh Postnatal Depression Scale (EPDS), the 36-Item Short Form Health Survey, and the Mini International Neuropsychiatric Interview depression module. A predictive model for postpartum depression was built using logistic and least absolute shrinkage and selection operator regressions, with bootstrap validation. RESULTS: A three-item version of the EPDS exhibited excellent discriminative capacity (c statistic = 0.95) and showed no significant differences versus the full version of the EPDS (χ2 (1) = 1.75, p = .187). The best trade-off between sensitivity (92.86%) and specificity (86.70%) was achieved at a cut-off score of 8/9. CONCLUSIONS: The three-item version of the EPDS can save clinicians valuable time, which might potentially improve communication of results to patients.

Health outcomes of unpaid care workers in low-income and middle-income countries: a protocol for a systematic review.

INTRODUCTION: The literature on health outcomes of unpaid care work has included studies coming from high-income countries, and has reported gender inequalities that make caregiving women more vulnerable to physical and mental health problems. The impact of unpaid care work on the health of those living in low-income and middle-income countries, where women's autonomy is more limited, is unknown. METHODS AND ANALYSIS: We will conduct a systematic review of observational studies on health outcomes according to unpaid caregiving status and sex of people living in low-income and middle-income countries. Cumulative Index to Nursing and Allied Health Literature, PubMed and Scientific Electronic Library Online Citation Index will be searched for reports in English or Spanish with published results from inception to 1 June 2017. We expect the studies to have recruited individuals in low-income and middle-income countries, including exposed and non-exposed groups to participation in unpaid care to members if their households or community reporting either physical and/or mental health problems, self-reported health-related quality of life, self-care skills/behaviours or use of any healthcare services in the participants. Data extraction, the assessment of risk of bias and confounding, and qualitative synthesis will be carried out by two independent reviewers with the assistance of a third party. DISSEMINATION: Results are expected to be published in peer-reviewed journals from the field of health and gender, or health and inequality. PROSPERO REGISTRATION NUMBER: CRD42017071785.

Análisis etnográfico en salas de espera de centros de salud primaria: implicancias para la detección y tratamiento de la depresión posparto / Ethnographic analysis at general practice waiting rooms: implications for postpartum depression detection and treatment

Chile cuenta con tamizaje y acceso universal para el tratamiento de la depresión posparto, no obstante, ésta es una patología sub-detectada y sub-tratada. Con el objetivo de describir y analizar las barreras de acceso para la detección y tratamiento de la depresión posparto implicadas en la producción de cuidados materno-infantiles en las salas de espera de consultorios, se llevó a cabo un estudio etnográfico en seis centros de salud primaria Santiago de Chile. La maternidad, como objeto de discursos y prácticas reproducidos en los espacios comunes del consultorio, se constituye en una condición conflictiva para las puérperas, implicando una sobrecarga diferencial de trabajo doméstico y de cuidados, exigiendo su movilización entre instancias formales e informales del cuidado de la salud. Se problematiza en torno al grado de integración entre trabajo remunerado y el cuidado de la salud en las mujeres.

In Chile, universal screening and treatment for postpartum depression has been implemented at a national level, however it remains under-detected and under-treated. To describe and analyze barriers to postpartum depression detection and treatment implied in maternal-infant health care production at general practice waiting rooms, an ethnographic study was carried out at six primary care clinics belonging to the Metropolitan Area of Santiago, Chile. Discourses and practices on maternity enacted at waiting room, reveals a conflicting condition for postpartum women, implying a differential overburden with domestic work and care tasks, demanding constant mobilization between formal and informal health care sources. The grade of integration between remunerated work and women's self-care is debated.

Abuso sexual infantil (ASI): comprensiones y representaciones clínicas desde las prácticas de salud mental / Sexual child abuse: understanding and representing clinical practices within mental health practices

Este artículo presenta una investigación, realizada en dos etapas, que estudia al Abuso Sexual Infantil (ASI) como fenómeno clínico, enmarcada en sus expresiones representacionales, conceptuales y culturales. Interroga a profesionales de instituciones que trabajan con abuso, trazando un itinerario analítico comprensivo de abordajes tanto clínicos, como de políticas de intervención desarrolladas. Metodológicamente realizamos un estudio observacional, analítico y longitudinal ambispectivo, con diseño cualitativo, aplicado en dos cohortes de tiempo (2005-2006 y 2011-2012), para profundizar el conocimiento de comprensiones y estrategias clínicas que profesional e institucionalmente han abordado al ASI. Sus resultados destacan: sobrejudicialización y sobrepatologización del ASI, necesidad de profundizar el trabajo interdisciplinario, dificultades del abordaje individual de reparación y prevención, desasosiego y malestar subjetivo de los profesionales, presencia social y mantención de situaciones de abuso con patrones de género predominantemente autoritarios, y devastador daño psíquico de víctimas directas e indirectas.

This study investigates Sexual Child Abuse (SCA) in its clinical context, including its representational, conceptual, and cultural expressions. Working with professionals of institutions, following an analytic yet understanding method, this study traces their approaches at the clinical level as well as intervention policies. Methodologically, the investigation is observational, analytic, and longitudinal, and qualitative design study, including two temporal cohorts (2005-2006 and 2011-2012). These methods were chosen to acquire better knowledge regarding the strategies used in clinics. Relevant results include: excessive tendencies to treat the matter as a juridical case and as pathology; the need for interdisciplinary work; the difficulty of repairing and preventing; the presence of discontent and unease in professionals related to their work; social relations in the presence of SCA of an authoritarian type; and the devastating psychic damage, both direct and indirect, in its victims.

Diversidad familiar, relaciones de género y producción de cuidados en salud en el modelo de salud familiar: análisis de caso en un CESFAM de la Región Metropolitana, Chile / Family diversity, gender relations and health care in the familiy health approach: case study in CESFAM in the Chilean Metropolitan Area

Por medio de este estudio se analiza el papel de las mujeres y de las familias en la producción de los cuidados en salud desde los discursos que producen los equipos de salud y el análisis de las fichas familiares en un CESFAM de una localidad urbano-rural de la Región Metropolitana. Se concluye que a pesar de las reformas modernizadoras impulsadas por el Estado en el sector salud, se perpetúa el lugar tradicional de las mujeres y su condición de género, así como un ideario de familia sustentado en la clásica división sexual del trabajo. Asimismo se aprecia que a pesar de la centralidad del papel de las mujeres en la producción de la salud familiar, este permanece invisibilizado y sólo se transparenta con relación a la responsabilidad de estas en las problemáticas familiares.

We have analyzed the role of women and their families regarding the health group speeches and the analysis of the family records from CESFAM in an urban rural place in the Metropolitan region. It is concluded that in spite of the modern reforms boosted by the state health department the traditional role of women and their genre condition remains the same as well as their way of living supported by the classical sex division in their jobs. At the same time it is observed that in spite of the central role of women in maintaining the family health, this remains unseen and it is only observed in their responsibilities in the family circumstances.

Mujeres en la historia de la Psicología: autorías y paradojas / Women in the history of psychology: autorships and paradoxes

La reconstrucción histórica del desarrollo de las distintas ciencias ha adquirido una creciente relevancia en las últimas décadas. En este trabajo se estudia la percepción de estudiantes respecto de la influencia de las variables género y poder en el registro histórico de la psicología, presentando resultados parciales de una investigación mayor. Se reporta los resultados de un estudio cuantitativo en que se aplicó una encuesta a estudiantes de psicología de universidades chilenas (n=484, 99 hombres y 385 mujeres). Se utilizó como instrumento una encuesta construída ad hoc, evaluada en un estudio piloto, que contiene 2 preguntas cerradas, 2 preguntas abiertas y una escala Likert con 25 itemes. Los resultados fueron analizados en frecuencias, porcentajes y análisis de significación (chi-cuadrado) comparando las submuestras de hombres y mujeres. Se encontró que los estudiantes: asignan gran importancia al estudio de la historia de la disciplina (ausente de las mallas curriculares chilenas como asignatura especifica) y al análisis del lugar de la mujer en ésta; recuerdan principalmente los aportes realizados por psicólogos hombres, desconociendo las contribuciones femeninas, valoran el aporte teórico como requisito para ser incluido en los registros históricos y muestran contradicciones frente a la influencia del género como causa de la ausencia femenina en la memoria colectiva de la disciplina.