Typologies of Intimate Partner Violence Against Women in Five Latin-American Countries: A Latent Class Analysis.

Objectives: To estimate typologies of Intimate Partner Violence against women in some Latin-American countries. Methods: Multistage sampling survey included women aged 15 to 49 (n = 63,321). Latent class analysis was estimated, including psychological, physical, and sexual violence and control. Results: The three-class model had a better fit. 1) The high-level IPV class (23%) comprised those suffering high levels of violence. They had higher education and wealth index, lived in urban settings, and their husbands used alcohol more. 2) The middle-level IPV class (45%) suffered high levels of control but low levels of other violence. They justified IPV more than other classes and this group had a high proportion of women without education. 3) Women in the non-IPV class (32%) did not report IPV. Conclusion: Three typologies of IPV were found: high-level, middle-level, and non-IPV. Policies should create screening, early prevention strategies, and programs based on these typologies. The high-level IPV group can benefit from intense legal and mental health interventions, including alcohol reduction and women's empowerment. The middle-level IPV group could benefit from interventions to reduce violence justification and increase women's education.

The Impact of the COVID-19 Pandemic on the Mental Health of Healthcare Workers in Italy: Analyzing the Role of Individual and Workplace-Level Factors in the Reopening Phase After Lockdown.

Introduction: Italy is one of the high-income countries hit hardest by Covid-19. During the first months of the pandemic, Italian healthcare workers were praised by media and the public for their efforts to face the emergency, although with limited knowledge and resources. However, healthcare workers soon had to face new challenges at a time when the national health system was working hard to recover. This study focuses on this difficult period to assess the impact of the COVID-19 pandemic on the mental health of Italian healthcare workers. Materials and Methods: Healthcare workers from all Italian regions [n = 5,502] completed an online questionnaire during the reopening phase after the first wave lockdown. We assessed a set of individual-level factors (e.g., stigma and violence against HCWs) and a set of workplace-level factors (e.g., trust in the workplace capacity to handle COVID-19) that were especially relevant in this context. The primary outcomes assessed were score ≥15 on the Patient Health Questionnaire-9 and score ≥4 on the General Health Questionnaire-12, indicators of clinically significant depressive symptoms and psychological distress, respectively. Logistic regression analyses were performed on depressive symptoms and psychological distress for each individual- and workplace-level factor adjusting for gender, age, and profession. Results: Clinically significant depressive symptoms were observed in 7.5% and psychological distress in 37.9% of HCWs. 30.5% of healthcare workers reported having felt stigmatized or discriminated, while 5.7% reported having experienced violence. Feeling stigmatized or discriminated and experiencing violence due to being a healthcare worker were strongly associated with clinically significant depressive symptoms [OR 2.98, 95%CI 2.36-3.77 and OR 4.72 95%CI 3.41-6.54] and psychological distress [OR 2.30, 95%CI 2.01-2.64 and OR 2.85 95%CI 2.16-3.75]. Numerous workplace-level factors, e.g., trust in the workplace capacity to handle COVID-19 [OR 2.43, 95%CI 1.92-3.07] and close contact with a co-worker who died of COVID-19 [OR 2.05, 95%CI 1.56-2.70] were also associated with clinically significant depressive symptoms. Similar results were found for psychological distress. Conclusions: Our study emphasizes the need to address discrimination and violence against healthcare professionals and improve healthcare work environments to strengthen the national health system's capacity to manage future emergencies.

Prospectiva estratégica para fortalecer un convenio docenciaservicio de enfermería / Strategic Prospective in an Education and Health Care Service Agreement / Prospetiva estratégica para fortalecer um convênio docência - serviço de enfermagem

Objetivo: Implementar y evaluar la utilidad de la metodología prospectiva estratégica para respaldar el desarrollo de un convenio docencia-servicio entre el Instituto Nacional de Cancerología (INC) ESE y la Facultad de Enfermería de la Universidad Nacional de Colombia. Método: Ejercicio prospectivo estratégico con seguimiento de un año desarrollado como parte de un programa más amplio y que se desarrolló en tres fases: 1) análisis sobre la situación de enfermería en el INC; 2) desarrollo de un taller para determinar el papel del Departamento de Enfermería dentro del INC, y 3) seguimiento de los resultados del taller por un año (24 de septiembre de 2012 a 24 de septiembre de 2013) para evaluar la utilidad de la metodología prospectiva estratégica como elemento de trabajo conjunto en el marco del convenio docencia-servicio. Resultados: Enfermería quiere un cambio que fortalezca su capacidad de cuidado dentro del INC. La prospectiva facilitó la identificación de siete elementos estratégicos que incluyen el cuidado, la educación, la investigación, la sistematización, el modelo de gestión, el desarrollo del talento humano y la proyección social que, en conjunto, permitieron determinar el papel del Departamento de Enfermería dentro del INC, como se puede evidenciar en el seguimiento del convenio docente asistencial durante un año. Conclusiones: La metodología de prospectiva estratégica demostró ser un mecanismo útil, novedoso e importante para respaldar el convenio docencia-servicio. La revisión de logros y limitaciones permite avanzar en un trabajo conjunto con una visión compartida que fortalece a las partes interactuantes

Objective: To implement and evaluate the utility of the Strategic prospective methodology to support the development of an education and health care service agreement between an Institution of the higher complexity level and a University School of Nursing. Method: Longitudinal exercise of Strategic Prospective developed in three phases: First, analysis of the nursing context and status in the Health Institution. Second, development of a prospective workshop to determine the Nursing Department's role in developing the Institution. Third, follow up of the workshop results for one year (September 24, 2012, to September 24, 2013) in order to evaluate the utility of the methodology for strengthening the education and health care service agreement between the Health Institution and the University ­ School of Nursing. Results: In the Instituto Nacional de Cancerología (INC), Nursing want a change that will strengthen their ability to care. The Strategic prospective methodology facilitated the identification of seven strategic elements including care, education, research, systematization, management model, the development of human talent and social projection. These elements allowed us to determine the role of the Nursing Department within the INC as it was evidenced in the development of the teaching care agreement during a one year follow up. Conclusions: The Strategic prospective methodology proved to be useful, innovative and important to the development of a health care service agreement between the Health Institute on and the University School of Nursing, by working together with a shared vision that strengthens the interacting parties.

Objetivo: Implementar e avaliar a utilidade da metodologia prospetiva estratégica para apoiar o desenvolvimento de convênio docência-serviço entre o Instituto Nacional de Cancerologia (INC) ESE e a Faculdade de Enfermagem da Universidade Nacional da Colômbia. Método: Exercício prospetivo estratégico com seguimento de um ano desenvolvido como parte de um programa mais amplo que foi desenvolvido em três fases: 1) análise da situação da enfermagem no INC; 2) desenvolvimento de uma oficina para determinar o papel do Departamento de Enfermagem dentro do INC, e 3) seguimento dos resultados da oficina por um ano (24 de setembro de 2012 a 24 de setembro de 2013) para avaliar a utilidade da metodologia prospetiva estratégica como elemento de trabalho conjunto no marco do convenio docência-serviço. Resultados: Enfermagem quer uma mudança que fortaleza sua capacidade de cuidado dentro do INC. A prospetiva facilitou a identificação de sete elementos estratégicos que incluem o cuidado, a educação, a pesquisa, a sistematização, o modelo de gestão, o desenvolvimento do talento humano e a projeção social que, em conjunto, permitiram determinar o papel do Departamento de Enfermagem dentro do INC, como foi possível evidenciar no seguimento do convenio docente assistencial durante um ano. Conclusões: A metodologia da prospetiva estratégica mostrou ser mecanismo útil, inovador e importante para apoiar o convenio docência-serviço. A revisão de realizações e restrições permite avançar em um trabalho conjunto com visão compartilhada que fortalece às partes que interagem.

Tobacco use among school enrolled and no enrolled adolescent in Medellin, Colombia. A population survey.

BACKGROUND: Tobacco use among adolescents is a problematic risk behavior with early age of onset and consequences in health outcomes in adulthood. OBJECTIVES: Estimate the prevalence of tobacco use among adolescents at school and off school. METHODS: A community-base cross sectional study was conducted during 2007 to estimate the prevalence of tobacco consumption in adolescents aged 12-15 (n=1.998), school and off school. A multistage probability sampling was conducted. RESULTS: Life prevalence of tobacco consumption was 26.8% and currently use tobacco was 6%, the age onset was 11 years; non-enrolled in school adolescents had higher smoking rates. Majority of current smokers were able to buy cigarettes. CONCLUSION: Non-enrolled adolescents have more risk to tobacco use. Public policies should generate strategies to intervene this population. It is important to conduct the Global Youth Tobacco Survey in a national sample of adolescents including of school adolescents and establish an epidemiological surveillance system of risk behaviors based on surveys conducted periodically.

Diseño y características de los participantes de un programa para el desarrollo positivo de escolares (Medellín, Colombia) / Design of a program for the positive development of schoolchildren and characteristics of participants (Medellin, Colombia)

El diseño del Programa para la promoción de potencialidades personales y prevención de conductas de riesgo para la salud en escolares, PILAS! mejores adultos, mejor infancia, se realizó basándose en evidencia local e internacional sobre programas de prevención de violencia basados en la escuela. El programa ofrece formación a padres, madres, maestros y maestras, por medio de metodologías activas, y asesoría durante 10 meses sobre temas que conducen al desarrollo personal de niños/as y a la deslegitimación de la violencia en las interacciones cotidianas. Se beneficiaron 306 maestros y maestras, 800 padres y madres, y 12.800 niños y niñas. La medición inicial a 1751 infantes, según sus cuidadores/as, mostró una media de 80, en una escala de 0 a 100, en competencias sociales, pero una alta frecuencia de agresión. En padres y madres, fallas en la comunicación y supervisión, y uso de castigos con agresión psicológica y física; además, una baja cohesión social en el barrio (AU)

The design of the program for the promotion of personal potential and prevention of risky health behaviors in school-aged children, PILAS! Better Adults, Better Kids, was based on local and international evidence on programs for the prevention of school-based violence. The program offers a training process for parents and teachers through active methodologies and advice (provided for 10 months) based on topics that encourage individual child development and the delegitimization of violence in everyday interactions. A total of 306 teachers, 800 parents and 12,800 children benefited from the program. An initial measurement was conducted using a scale ranging from 0 to 100 in a sample of 1751 children. The results showed an average of 80 in the children's social skills, but caregivers reported high levels of aggression. Communication and supervision failures were found among parents, as well as punishment practices through psychological and physical aggression. Another finding was low social cohesion in the neighborhood (AU)

[Design of a program for the positive development of schoolchildren and characteristics of participants (Medellin, Colombia)]. / Diseño y características de los participantes de un programa para el desarrollo positivo de escolares (Medellín, Colombia).

The design of the program for the promotion of personal potential and prevention of risky health behaviors in school-aged children, PILAS! Better Adults, Better Kids, was based on local and international evidence on programs for the prevention of school-based violence. The program offers a training process for parents and teachers through active methodologies and advice (provided for 10 months) based on topics that encourage individual child development and the delegitimization of violence in everyday interactions. A total of 306 teachers, 800 parents and 12,800 children benefited from the program. An initial measurement was conducted using a scale ranging from 0 to 100 in a sample of 1751 children. The results showed an average of 80 in the children's social skills, but caregivers reported high levels of aggression. Communication and supervision failures were found among parents, as well as punishment practices through psychological and physical aggression. Another finding was low social cohesion in the neighborhood.

Aggressors and resilient youths in Medellin, Colombia: the need for a paradigm shift in order to overcome violence.

The objective of this study was to estimate the ratio of resilient youth and compare this to youth with aggressive behavior, and to youth who also exhibit sexually risky behavior and drug use. A cross-section study of a representative sample of people between aged between 12 and 60 who are residents of Medellin, Colombia, and its metropolitan area (N = 4,654) was employed using probabilistic multi-stage sampling. Youth between 14 and 26 years old were selected for the present analysis (n = 1,780). The proportion of resilient youth is 22.9%, of aggressors is 11.3%, and that of youth with other risky conduct is 65.8%. The high ratio of resilient youth calls for a reorientation of public policy toward prevention and control of violence, prioritizing the promotion of resilient behavior instead of continuing with tertiary prevention actions.

Aggressors and resilient youths in Medellin, Colombia: the need for a paradigm shift in order to overcome violence / Agresores y resilientes en Medellín, Colombia: necesidad de un cambio de paradigma para superar la violencia / Agressores e resilientes em Medellín, Colômbia: necessidade de uma mudança de paradigma, a fim de superar a violência

The objective of this study was to estimate the ratio of resilient youth and compare this to youth with aggressive behavior, and to youth who also exhibit sexually risky behavior and drug use. A cross-section study of a representative sample of people between aged between 12 and 60 who are residents of Medellin, Colombia, and its metropolitan area (N = 4,654) was employed using probabilistic multi-stage sampling. Youth between 14 and 26 years old were selected for the present analysis (n = 1,780). The proportion of resilient youth is 22.9%, of aggressors is 11.3%, and that of youth with other risky conduct is 65.8%. The high ratio of resilient youth calls for a reorientation of public policy toward prevention and control of violence, prioritizing the promotion of resilient behavior instead of continuing with tertiary prevention actions.

Los objetivos fueron estimar la proporción de jóvenes resilientes y comparar dicha proporción con la de jóvenes con conductas agresivas y con otras conductas de riesgo. Estudio transversal en una muestra representativa de personas entre los 12 a 60 años, habitantes de Medellín, Colombia, y el área metropolitana (N = 4.654). Muestreo probabilístico polietápico. Se seleccionaron los jóvenes entre 14-26 años para el presente análisis (n = 1.780). La proporción de jóvenes resilientes es de un 22,9%, la de agresores un 11,3%, la de jóvenes con otras conductas de riesgo es de un 65,8%. La alta proporción de jóvenes resilientes obliga a reorientar las políticas públicas de la prevención terciaria y el control de la violencia a la promoción de las conductas resilientes y al desarrollo positivo de los niños y jóvenes en la sociedad.

Os objetivos foram estimar a proporção de jovens resistentes e compará-la com jovens com condutas agressivas, e jovens que também apresentam comportamento sexual de risco e uso de drogas. Estudo transversal de uma amostra representativa de pessoas com idades entre 12 e 60 anos, habitantes de Medellín e sua área metropolitana, na Colômbia (N = 4.654), foi utilizado a partir de amostragem probabilística multiestágio. Jovens entre 14 e 26 anos foram selecionados para a presente análise (n = 1.780). A proporção de jovens resistentes foi de 22,9%, de agressores 11,3%, e de jovens com conduta de risco foi de 65,8%. A alta proporção de jovens resistentes força uma reorientação das políticas públicas para a prevenção e controle da violência, privilegiando a promoção de condutas de resistência ao invés de continuar com ações de prevenção terciária.

Reducing violence by transforming neighborhoods: a natural experiment in Medellín, Colombia.

Neighborhood-level interventions provide an opportunity to better understand the impact that neighborhoods have on health. In 2004, municipal authorities in Medellín, Colombia, built a public transit system to connect isolated low-income neighborhoods to the city's urban center. Transit-oriented development was accompanied by municipal investment in neighborhood infrastructure. In this study, the authors examined the effects of this exogenous change in the built environment on violence. Neighborhood conditions and violence were assessed in intervention neighborhoods (n = 25) and comparable control neighborhoods (n = 23) before (2003) and after (2008) completion of the transit project, using a longitudinal sample of 466 residents and homicide records from the Office of the Public Prosecutor. Baseline differences between these groups were of the same magnitude as random assignment of neighborhoods would have generated, and differences that remained after propensity score matching closely resembled imbalances produced by paired randomization. Permutation tests were used to estimate differential change in the outcomes of interest in intervention neighborhoods versus control neighborhoods. The decline in the homicide rate was 66% greater in intervention neighborhoods than in control neighborhoods (rate ratio = 0.33, 95% confidence interval: 0.18, 0.61), and resident reports of violence decreased 75% more in intervention neighborhoods (odds ratio = 0.25, 95% confidence interval 0.11, 0.67). These results show that interventions in neighborhood physical infrastructure can reduce violence.

Predicting resilient adolescents and youths: validation of a screening test in Colombia.

BACKGROUND: This article presents the validation of the Child and Youth Resilience Measure-58 (CYRM-58) in the Colombian context and in Spanish language. METHODS: CYRM-58 has 58 questions and was developed by an international team of researchers coordinated by the Resilience Research Centre (Dalhousie University, Canada). Simplified CYRM Colombia is a test that uses 7 questions of CYRM-58; for its validation we tested reproducibility in 22 persons aged 14 to 23 years. RESULTS: We validated content and internal consistency in 39 resilients, 43 youth with deviant behaviors, and 66 controls matched by age and sex. We estimated internal consistency by non-parametric factorial analysis, and we assessed content validity by means of the Mann-Whitney test, bootstrap regression and logistic regression. The reproducibility was found to be in the range of 75-86%. Correlation between measurements was 75%. CONCLUSION: The best predictive model or Simplified CYRM Colombia was found to have seven questions (sensitivity = 96%, specificity = 76%, power = 80%).

Violence witnessing, perpetrating and victimization in Medellín, Colombia: a random population survey.

BACKGROUND: The burden of injury from violence and the costs attributable to violence are extremely high in Colombia. Despite a dramatic decline in homicides over the last ten years, homicide rate in Medellin, Colombia second largest city continues to rank among the highest of cities in Latin America. This study aims to estimate the prevalence and distribution of witnesses, victims and perpetrators of different forms of interpersonal violence in a representative sample of the general population in Medellin in 2007. METHODS: A face-to-face survey was carried out on a random selected, non-institutionalized population aged 12 to 60 years, with a response rate of 91% yielding 2,095 interview responses. RESULTS: We present the rates of prevalence for having been a witness, victim, or perpetrator for different forms of violence standardized using the WHO truncated population pyramid to allow for cross-national comparison. We also present data on verbal aggression, fraud and deception, yelling and heavy pranks, unarmed aggression during last year, and armed threat, other severe threats, robbery, armed physical aggression, and sexual aggression during the lifetime, by age, sex, marital and socioeconomic status, and education. Men reported the highest prevalence of being victims, perpetrators and witnesses in all forms of violence, except for robbery and sexual violence. The number of victims per perpetrator was positively correlated with the severity of the type of violence. The highest victimization proportions over the previous twelve months occurred among minors. Perpetrators are typically young unmarried males from lower socio-economic strata. CONCLUSIONS: Due to very low proportion of victimization report to authorities, periodic surveys should be included in systems for epidemiological monitoring of violence, not only of victimization but also for perpetrators. Victimization information allows quantifying the magnitude of different forms of violence, while data on factors associated with aggression and perpetrators are necessary to estimate risk and protective factors that are essential to sound policies for violence prevention formulation.

Morbilidad asociada al soporte transfusional en pacientes pediátricos con leucemia aguda en el Instituto Nacional de Cancerología / Support blood transfusion

La leucemia aguda representa el cáncer más común en pediatría los tratamientos actuales hacen necesario un soporte hemetológico constante que incrementa los riesgos de complicaciones como fiebre, reacciones alérgicas, reacciones inmunológicas, infecciones y reacción injerto contra huésped. El objetivo del presnet trabajo se realizó con el objeto de determinar la morbilidad asociada con el soporte transfusional en pacientes pediátricos con leucemia aguda, para lo cual se realizó un estudio retrospectivo en pacientes transfundidos menores de 15 años con diagnóstico de leucemia aguda linfoblástica y mieloblástica entre enero de 1999 y julio de 2000. Se analizaron 75 pacientes se administraron en total 468 transfusiones: 218 (46,6 por ciento) unidades de glóbulos rojos empacados y 250 (53,4) unidades de plaquetas; se trataron 257 (54,9por ciento) unidades ya fuera con irradiación, filtro deleucocitador o técnica de aféresis. Las complicaciones derivadas de la transfusión fueron escasas (1,92 por ciento)tres relacionadas con la administración de glóbulos rojos; fiebre, exantema y hemólisis; y seis relacionadas con la transfusión de plaquetas: urticaria, refractariedad plaquetaria y anafilaxis. Conclusión: En la población pediátrica con diagnóstico de leucemia aguad en INC la morbilidad asociada a las transfusiones durante el año y medio del estudio fue baja y no se pudo establecer su relación con el tratamiento que se da a los productos transfundidos.