[Health consequences of violence against women by the couple]. / Consecuencias para la salud de la violencia contra la mujer por la pareja.

Intimate partner violence against women (IPV) has devastating effects on the healthcare and well-being of women and their children. Physical, psychological, and social consequences, a worse perception of their own health, and loss of quality of life are well-documented, while aftereffects persist in time even after the end of abuse. Psychological consequences of abuse last longer and are more serious. IPV also affects sons and daughters, disabled people, family, and the attacker himself. Many health problems, both physical and mental, that lead women to go to healthcare services in search of help have an origin in the violence they experience. Treatment of the symptoms without awareness of its relation to such violence favours medicalization, iatrogenesis, and chronification. Psychological violence poses a threat that is invisible, subtle, cumulative, and difficult to detect; it is, however, the most destructive.

Eliminating morbidity caused by neglected tropical diseases by 2030.

The objective of this manuscript is to provide selective examples of the work of the Pan American Health Organization/World Health Organization (PAHO/WHO) Collaborating Centre for Research and Training in Parasite Epidemiology and Control which contribute to the WHO goal of eliminating neglected tropical diseases by 2030. This PAHO/WHO CC specifically aligns its activities with the Sustainable Development Goals and with the goals outlined in the WHO Road Map for Neglected Tropical Diseases 2021-2030. Its role is to contribute to advancing global action on NTDs, primarily through policy development and knowledge translation. Three important projects have recently been completed: 1. Finalizing the Monitoring and Evaluation Framework for the NTD Road Map (published May 2021; this PAHO/WHO CC was a member of the working group); 2. Developing new guidelines for the preventive chemotherapy of Taenia solium taeniasis (published September 2021; this PAHO/WHO CC was co-Chair; and 3. Formulating a policy brief on deworming for adolescent girls and women of reproductive age (published January 2022; this PAHO/WHO CC is co-lead). These projects are the result of the integration of expertise and experience from multiple partners, including from PAHO and WHO (where both organizations provided key leadership), this PAHO/WHO CC, government ministries, civil society organizations and universities, among others. In conclusion, this PAHO/WHO CC contributes timely guidance to country-led evidence-informed public health policy, to cost-effective program implementation and to the identification of priority research topics - all focused, ultimately, on eliminating NTD-attributable morbidity by 2030.

El objetivo de este artículo es proporcionar ejemplos seleccionados de la labor del centro colaborador de investigación y capacitación en epidemiología y control de parásitos de la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS), que contribuye al objetivo de la OMS de eliminar las enfermedades tropicales desatendidas para el 2030. Este centro colaborador de la OPS/OMS alinea sus actividades específicamente con los Objetivos de Desarrollo Sostenible y con los objetivos descritos en la Hoja de ruta sobre enfermedades tropicales desatendidas 2021-2030 de la OMS. Su función es contribuir al avance de las medidas mundiales sobre las enfermedades tropicales desatendidas, principalmente mediante la elaboración de políticas y la traducción de conocimiento. Recientemente se han completado tres proyectos importantes: 1) finalización del marco de seguimiento y evaluación de la Hoja de ruta sobre enfermedades tropicales desatendidas (publicado en mayo del 2021; este centro colaborador de la OPS/OMS formó parte del grupo de trabajo); 2) elaboración de nuevas directrices para la quimioterapia preventiva de la teniasis por Taenia solium (publicado en septiembre del 2021; este centro colaborador fue copresidente); y 3) formulación de un informe de políticas sobre la desparasitación de las adolescentes y las mujeres en edad reproductiva (publicado en enero del 2022; este centro colaborador fue coautor). Estos proyectos son el resultado de la integración del conocimiento y la experiencia de múltiples asociados, como la OPS y la OMS (ambas organizaciones ofrecieron un liderazgo clave), este centro colaborador de la OPS/OMS, así como varios ministerios gubernamentales, organizaciones de la sociedad civil y universidades, entre otros. En conclusión, este centro colaborador de la OPS/OMS ofrece orientaciones oportunas para las políticas de salud pública basadas en la evidencia lideradas por los países, la ejecución de programas costo-efectivos y la determinación de los temas de investigación prioritarios, todo ello destinado, en última instancia, a eliminar la morbilidad atribuible a las enfermedades tropicales desatendidas para el 2030.

O objetivo deste manuscrito é fornecer exemplos seletivos do trabalho do Centro Colaborador de Pesquisa e Treinamento em Epidemiologia e Controle de Parasitos da Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS) que contribuem para a meta da OMS de eliminar até 2030 as doenças tropicais negligenciadas. Este CC da OPAS/OMS alinha especificamente suas atividades com os Objetivos de Desenvolvimento Sustentável e com as metas delineadas no Roteiro da OMS para Doenças Tropicais Negligenciadas 2021-2030. Seu papel é contribuir para o avanço da ação global contra doenças tropicais negligenciadas, principalmente por meio do desenvolvimento de políticas e da tradução de conhecimentos. Três importantes projetos foram concluídos recentemente: 1. Finalização da Estrutura de Monitoramento e Avaliação do Roteiro para as DTN (publicada em maio de 2021 ­ este CC da OPAS/OMS foi membro do grupo de trabalho); 2. Desenvolvimento de novas diretrizes para a quimioprofilaxia da teníase por Taenia solium (publicado em setembro de 2021 ­ este CC da OPAS/OMS foi copresidente); e 3. Formulação de orientação para políticas de desparasitação para adolescentes e mulheres em idade reprodutiva (publicado em janeiro de 2022 ­ este CC da OPAS/OMS foi cogestor). Esses projetos são o resultado da integração de conhecimentos e experiência de múltiplos parceiros, incluindo a OPAS e a OMS (onde ambas as organizações forneceram liderança essencial), este CC da OPAS/OMS, ministérios governamentais, organizações da sociedade civil e universidades, entre outros. Em suma, este CC da OPAS/OMS contribui com orientações oportunas para uma política de saúde pública liderada pelos países e informada com base em evidências, para a implementação de programas com boa relação custo-benefício e para a identificação de tópicos prioritários de pesquisa ­ todos focados, em última análise, na eliminação da morbidade atribuível às DTN até 2030.

[Evaluation of a community-based intervention to increase influenza vaccination coverage in pregnant women]. / Evaluación de una intervención comunitaria para incrementar la cobertura vacunal de la gripe en mujeres embarazadas.

OBJECTIVE: To know the impact of the educational intervention carried out on the professionals of a basic health area and their community participation group, which make up the intervention group (IG), and to analyze its repercussion on the vaccination coverage achieved for influenza in the risk group (pregnant and puerperal women) comparing it with its neighboring basic zone, which makes up the control group (CG), during the 2019/20 vaccination season. DESIGN: Quasi-experimental study of community intervention. SITE: Two basic health zones belonging to the Elche-Crevillente health department, Spain. PARTICIPANTS: Pregnant and postpartum women from 2 basic health areas and the community participation group. Health professionals directly related to the flu vaccination campaign. INTERVENTIONS: Training session for the IG prior to the 2019/20 flu campaign. MAIN MEASUREMENTS: Attitudes towards influenza vaccination in health professionals through the validated CAPSVA questionnaire and the vaccination coverage of pregnant and postpartum women through the Nominal Vaccine Registry and their acceptance of the vaccine in the midwife's office. RESULTS: The influenza vaccination coverage data recorded in Nominal Vaccine Registry for pregnant and puerperal women was 26.4% (n=207) in the IG and 19.7% (n=144) in the CG (p=0.001), with an incidence ratio of 1.34, thus achieving 34% more vaccination in the IG. Acceptance for vaccination in the midwife's office was also high, with 96.5% immunization in IG vs. 89.0% in CG, with a RR=1.09 (95% CI 1.01-1.62). CONCLUSIONS: Joint training strategies for professionals and community assets improve the results of vaccination coverage.

[Considerations for the design and implementation of interventions for the cessation of tobacco, alcohol and cannabis use in pregnancy: A qualitative study]. / Consideraciones para el diseño e implementación de las intervenciones para la cesación de consumo de tabaco, alcohol y cannabis en el embarazo. Un estudio cualitativo.

OBJECTIVE: To explore the opinion of different key stakeholders regarding the requirements that tobacco, alcohol and/or cannabis cessation interventions should meet to be implemented and to be acceptable and useful during pregnancy. DESIGN: A qualitative study with phenomenological approach. SITE: The study was conducted in Spain in 2022. PARTICIPANTS: Decision makers, health professionals, pregnant women using tobacco, alcohol and/or cannabis and their partners who are also users. METHODS: Data were collected through focus groups and in-depth interviews, until discourse saturation was reached and accurately transcribed. Exploratory analysis and inductive open coding were conducted, codes were merged into categories and subcategories were identified. RESULTS: Four categories and 18 subcategories were identified. The results suggest that interventions should be multicomponent. Among the interventions most accepted by pregnant women and their partners were specific cessation consultations, information, peer support (although they did not specify how) and financial incentives. Among other options to consider, co-oximetry, proposed by managers to obtain an objective register. CONCLUSIONS: The conclusion is that this intervention should be carried out at the level of prenatal care in primary care. There are doubts regarding the frequency, purpose, and follow-up of this multicomponent intervention, as well as the possibility of incorporating couples.

Síndrome de Wiskott-Aldrich en España: incidencia, mortalidad y sesgo de género durante 21 años.

Antecedentes: El síndrome de Wiskott-Aldrich (SWA) es un raro trastorno ligado al cromosoma X que se considera que afecta predominantemente a varones. Objetivo: El objetivo de este estudio consistía en investigar la incidencia y la mortalidad intrahospitalaria del SWA en España, así como el sesgo de género. Métodos: Se llevó a cabo un estudio epidemiológico retrospectivo poblacional en 97 pacientes con SWA diagnosticados en hospitales españoles entre 1997 y 2017, utilizando para ello datos del Sistema Nacional de Vigilancia de Datos Hospitalarios. Resultados: Nuestros resultados revelaron que la incidencia anual media del SAW en España fue de 1,1 caso por cada 10 millones de habitantes (IC del 95 %, 0,45-2,33). El riesgo relativo fue mayor en los varones que en las mujeres (2,42). El diagnóstico de SWA se establece a una edad más avanzada en las mujeres (mediana de 47 años) que en los varones (mediana de 5,5 años). Únicamente los varones ingresaron en el hospital en al menos 10 ocasiones diferentes y todas las muertes se detectaron en varones. La tasa de mortalidad intrahospitalaria fue del 9,28 % en el SAW y la mayoría de las muertes se asociaron a hemorragia cerebral o infección. Conclusiones: El SWA, una enfermedad rara, se diagnostica a una edad más avanzada en las mujeres y la mortalidad se observó exclusivamente en varones, asociada en la mayoría de los casos a hemorragia cerebral e infección.

Epistemologies of love and desire: Chicana Lesbians: The Girls Our Mothers Warned Us About.

This article provides a context for the publication of Chicana Lesbians: The Girls Our Mothers Warned Us About (1991). As Chicana literature and feminism flourished, the visibility of Chicanas increased dramatically, and at the same it became noticeable that Chicana lesbian representations lacked considerably. During this time roughly from the 1980s through 2000, the focus on Chicana lesbian representation reached a new level of awareness which ultimately led to an increase in demand for publications by and about Chicana lesbians. However, this new visibility did not materialize so easily and there were still resistances in the academy and at national conferences that led to major, well-documented confrontations. This was a dramatic and momentous period for the establishment of a public discourse about Chicana lesbians within Chicana/o studies that still continues today. Arguably, contributions by Chicana lesbians provided many foundational theories critical to the development of Chicana feminist thought and Chicana Studies that merits recognition. Published by Third Woman Press in 1991 and edited by Carla Trujillo, this book collection signaled a turn in perceptions of Chicana/o gays and lesbians across communities and in academic circles. This article argues that the publication of Chicana Lesbians: The Girls Our Mother Warned Us About was made possible by a confluence of social, cultural, and literary engagements with other publications that arose from a politics of love and desire. As a result, love and desire are epistemic expressions that shape the collective voices in Chicana Lesbians.

Iranian Women's Divorce Style: A Qualitative Study.

Divorce has received scant attention in Iran, despite the problems that arise for individuals and families and in social life. The present study aimed to find the divorce process of the Iranian couples among whom the woman was the divorce initiator. For this purpose, interviews were conducted, using the grounded theory method, with 34 Iranian divorcing men and women (women initiating a divorce and their spouses) to investigate their divorce experience. The results revealed that the psychological, communication, cultural, and social factors involved in the divorce phenomenon were observed in five stages: (1) emergence of thinking about divorce, (2) hesitation on stay, (3) difficult decision-making, (4) separation, and (5) legal action. Despite more restrictive laws and more complicated social conditions for women initiating divorce than men, the number of women initiating the divorce is increasing in the changing cultural context of Iran. Therefore, we hope that our results on the divorce process help couples, families, and especially professionals plan preventive measures and develop clinical interventions targeting marriage and marital relationships.

El divorcio ha recibido escasa atención en Irán a pesar de los problemas que plantea para las personas, las familias y la vida social. El presente estudio tuvo como finalidad estudiar el proceso de divorcio de parejas iraníes entre las cuales la mujer fue la iniciadora del divorcio. Con este fin, se realizaron entrevistas usando el método de teoría fundamentada con 34 hombres y mujeres iraníes que se estaban divorciando (mujeres que iniciaron el divorcio y sus cónyuges) para investigar su experiencia de divorcio. Los resultados revelaron que los factores psicológicos, comunicativos, culturales y sociales implicados en el fenómeno de divorcio se observaron en cinco etapas: 1) aparición del pensamiento de divorcio, 2) duda sobre si aplazarlo, 3) toma de decisión difícil, 4) separación y 5) acciones legales. A pesar de que las leyes son más restrictivas y las condiciones sociales son más complicadas para las mujeres que inician el divorcio que para los hombres, el número de mujeres que inician el divorcio está aumentando en el contexto cultural cambiante Irán. Por lo tanto, esperamos que nuestros resultados sobre el proceso de divorcio ayuden a las parejas, a las familias y especialmente a los profesionales a planificar medidas preventivas y a diseñar intervenciones clínicas orientadas al matrimonio y a las relaciones conyugales.

[Health professionals' perception about the socio-educational group intervention with women who present somatic symptoms without organic cause]. / Percepción de profesionales de la salud sobre la intervención grupal socioeducativa con mujeres que presentan síntomas somáticos sin causa orgánica.

OBJECTIVE: To know the perception and opinion of primary care health professionals on the impact of non-medicalizing group educational intervention (GRUSE) with women who present somatic symptoms without organic cause. DESIGN: Qualitative phenomenological study. SETTING: Primary care health centers in Andalusia, during 2017 and 2018. PARTICIPANTS AND/OR CONTEXTS: Twenty-four health professionals, selected according to their level of involvement in the GRUSE strategy (socio-educational groups). METHOD: A qualitative methodology is applied, through the phenomenological method. The technique used to collect the information is the discussion group, and a content analysis is carried out on it. The software Atlas.ti 8.0 is used as a support resource for the analysis. RESULTS: Health professionals highlight group work as a means of achieving change, and point to the importance of intervention as a non-medicalizing strategy. They perceive that the participants obtain some benefits: the improvement of their personal well-being, the increase of their self-esteem and self-determination, and the generation of social networks, benefits that also affect their immediate surroundings. CONCLUSIONS: In the opinion of the professionals, the strategy has positive effects on women and does not mean an increase in resources for the health system. In addition, they express the importance of provide women with tools to cope with daily life problems derivates mostly from gender mandates of a patriarchal society.

Lower Sexual Satisfaction and Function Mediate the Association of Assault Military Sexual Trauma and Relationship Satisfaction in Partnered Female Service Members/Veterans.

Little is known about the association of military sexual trauma (MST) and relationship satisfaction among partnered female service members/veterans (SM/Vs). Extant civilian literature shows a strong association between sexual trauma and poorer relationship outcomes, and theory suggests that sexual function and satisfaction may mediate this association. Given that as many as 40% of female SM/Vs report MST and roughly half of female veterans are partnered and in their peak sexual years, it is critical to understand the association of MST, relationship satisfaction, sexual function, and sexual satisfaction in this population. Female SM/Vs (N = 817) completed a demographic inventory, self-report measures of MST, relationship satisfaction, sexual function, and sexual satisfaction. One hundred fifty-one (18.48%) participants did not experience MST. Three hundred eighty-eight (47.49%) reported that they experienced harassment-only MST, and 278 (34.03%) reported assault MST. At the bivariate level, lower relationship satisfaction was associated with lower sexual function and satisfaction with large effect sizes. Assault MST was associated with lower relationship satisfaction and sexual function and satisfaction with small-to-medium effect sizes. No differences in relationship satisfaction, sexual satisfaction, and function between those with harassment-only and no MST were observed. Mediation analyses demonstrated that lower sexual function and satisfaction mediated the association of assault MST and relationship satisfaction. Couples' therapy offered to SM/Vs with MST should screen for type of MST, sexual function, and satisfaction. Addressing the sequelae of MST and increasing sexual function and satisfaction in these partnerships may be critical treatment targets.

Se sabe muy poco acerca de la asociación del trauma sexual militar (TSM) y la satisfacción con la relación entre las mujeres militares/veteranas en pareja. La bibliografía existente sobre los civiles indica una asociación fuerte entre el trauma sexual y malos resultados en las relaciones, en consecuencia, la teoría sugiere que la disfunción sexual y la insatisfacción sexual pueden mediar esta asociación. Teniendo en cuenta que hasta el 40% de las mujeres veteranas informan TSM y que aproximadamente la mitad de las mujeres veteranas está en pareja y en el pico de sus años sexuales, es fundamental comprender la asociación del TSM, la satisfacción con la relación, la disfunción sexual y la insatisfacción sexual en esta población. Un grupo de mujeres militares/veteranas (N = 817) completaron una encuesta sobre datos demográficos, mediciones autoinformadas de TSM, satisfacción con la relación, función sexual y satisfacción sexual. Ciento cincuenta y una (18.48%) participantes no sufrieron TSM. Trescientas ochenta y ocho (47.49%) informaron que sufrieron TSM por acoso solamente, y 278 (34.03%) informaron TSM por agresión sexual. A nivel bivariado, una menor satisfacción con la relación estuvo asociada con una menor función y satisfacción sexual con mayores tamaños del efecto. El TSM por agresión sexual estuvo asociado con una menor satisfacción con la relación y la función y la satisfacción sexual con tamaños del efecto entre pequeños y medianos. No se observaron diferencias en la satisfacción con la relación, la satisfacción sexual y la función sexual entre aquellas con acoso solamente y ningún TSM. Los análisis de mediación demostraron que una menor función sexual y una menor satisfacción sexual mediaron la asociación del TSM por agresión sexual y la satisfacción con la relación. La terapia de pareja ofrecida a las veteranas con TSM debería detectar el tipo de TSM, la función sexual y la satisfacción sexual. Abordar las secuelas del TSM y reducir la disfunción y la insatisfacción sexual en estas asociaciones pueden ser objetivos fundamentales de tratamiento.

Violence against women in Primary Health Care: Potentialities and limitations to identification.

OBJECTIVE: To determine the potential and limitations of Primary Health Care professionals to identify situations of violence against women. LOCATION: A municipality of Rio Grande do Sul, Brazil. DESIGN: Descriptive and exploratory study with a qualitative approach. PARTICIPANTS: Twenty-one health professionals of three Family Health Strategy units, as well as one Basic Health Unit. The inclusion criterion consisted of being a health worker in these services. The exclusion criterion was to be absent from work by any kind type license during the period of data production. METHOD: The technique used to produce data was individual, semi-structured, interviews in order to collect sociodemographic data and the monitoring by professionals related to the potentials and limitations to identify violence situations. The data collection was suspended based on the saturation criterion. The data were systematized and analyzed by the content analysis technique, according to the analytical categories of health care network and gender. RESULTS: The potential to identify themes were: professional experience, receptive atmosphere, bonding, and listening to the reports of women, children and/or neighbors and observing their behavior; to identify the lesions; prenatal consultations; and home visits. As to the limitations: silence, denial/non-recognition of violence, lack of complaints by women; fear and guilt; flaws and unpreparedness of the health team; and fear due to the presence of aggressor. CONCLUSIONS: It is urgent to recognize the potential of Primary Care and to promote the qualification of professionals in order to identify the situation among visible and invisible complaints, leading to the confrontation of violence.

Demand for obstetric care and density of health resources for childbearing age Mexican women.

INTRODUCTION: In Mexico, there is an increase recorded in the number of C-sections, as well as inequity and inequality in the distribution of resources for obstetric care. OBJECTIVE: To identify the states and municipalities in Mexico that concentrate the demand for obstetric care and the C-section rates and their relationship with health resources and women of childbearing age (WCBA). METHOD: Births of the 2008-2017 period were recorded, grouped into five municipal strata, as well as 2017 health resources and WCBA. RESULTS: The 2008-2017 national rate of C-sections was 45.3/100 births; 95 and 97 % of births and C-sections were concentrated in the "very high" stratum, where 80 % or more of health resources were used, with overuse standing out. The density of health resources assigned to WCBAs reflected inequity and inequality. CONCLUSIONS: The high concentration of obstetric demand and health resources supply could entail a higher recurrence of C-sections. Policies for C-section reduction should consider proper organization and administration of health resources.

INTRODUCCIÓN: México registra aumento de las cesáreas e inequidad y desigualdad en la distribución de recursos para la atención obstétrica. OBJETIVO: Identificar las entidades y municipios en México que concentran la demanda de atención obstétrica y tasas de cesáreas y su relación con los recursos en salud y mujeres en edad fértil (MEF). MÉTODO: Se registraron los nacimientos del periodo 2008-2017, agrupados en cinco estratos municipales, y los recursos en salud y MEF de 2017. RESULTADOS: La tasa nacional de cesáreas 2008-2017 fue de 45.3/100 nacimientos; 95 y 97 % de los nacimientos y cesáreas se concentraron en el estrato "muy alto", en el cual se utilizó 80 % o más de los recursos en salud y destacó la sobreutilización. La densidad de recursos en salud destinados a las MEF reflejó inequidad y desigualdad. CONCLUSIONES: La alta concentración de la demanda obstétrica y oferta de los recursos en salud pudiera conllevar mayor recurrencia a la cesárea. En las políticas de reducción de cesáreas es necesario considerar la organización y administración adecuadas de los recursos en salud.

Reproductive justice for incarcerated mothers and advocacy for their infants and young children.

The United States has seen unprecedented growth in the number of incarcerated women, most of whom are mothers with minor children. Major public health concerns relate to the reproductive health of women in prisons and jails and the well-being of their infants and young children. In the current article, we use a reproductive justice framework to examine the intersection of incarceration and maternal and child health. We review (a) current research on the reproductive health of incarcerated women, (b) characteristics and experiences of pregnant incarcerated women, (c) outcomes of infants and young children with incarcerated parents, (d) implications of research findings for policy and practice, and (e) the need for increased research, public education, and advocacy. We strongly recommend that correctional policies and practices be updated to address the common misconceptions and biases as well as the unique vulnerabilities and health needs of incarcerated women and their young children.

Estados Unidos ha visto un crecimiento sin precedentes en el número de mujeres encarceladas, la mayoría de las cuales son madres con niños menores. Mayores preocupaciones de salud pública conciernen a la salud reproductiva de mujeres en prisiones y cárceles y el bienestar de sus infantes y niños pequeños. En el presente artículo, usamos un marco de trabajo de justicia reproductiva para examinar la intersección del encarcelamiento y la salud materno-infantil. Revisamos 1) la investigación actual sobre la salud reproductiva de mujeres encarceladas, 2) las características y experiencias de mujeres embarazadas encarceladas, 3) lo que resulta de infantes y niños pequeños con progenitores encarcelados, 4) las implicaciones de los resultados de la investigación en cuanto a políticas y prácticas, y 5) la necesidad de aumentar la investigación, la educación pública y la defensoría. Recomendamos fuertemente que se actualicen las políticas y prácticas correccionales para incluir los conceptos erróneos y prejuicios acerca de mujeres encarceladas y sus niños pequeños, así como también sus distintivas vulnerabilidades y necesidades de salud.

Les Etats-Unis d'Amérique ont été les témoins d'une augmentation sans précédent dans le nombre de femmes incarcérées, la plupart étant des mères avec des enfants mineurs. De grands problèmes de santé publique sont liés à la santé reproductive des femmes en prison et au bien-être de leurs nourrissons et de leurs jeunes enfants. Dans cet article nous utilisons une structure de justice reproductive afin d'examiner l'intersection de l'incarcération et de la santé maternelle et de l'enfant. Nous passons en revue: 1) les recherches actuelles sur la santé reproductive des femmes incarcérées, 2) les caractéristiques et les expériences de femmes incarcérées enceintes, 3) les résultats de nourrissons et de jeunes enfants avec des parents incarcérés, 4) les implications des résulats de recherche pour les lois et la pratique, et 5) le besoin de plus de recherches, plus d'éducation publique, plus de promotion et défense. Nous recommandons fortement que les lois correctionnelles et les pratiques correctionnelles soient mises à jour afin de traiter et de faire face aux conceptions erronées et à la partialité communes, ainsi qu'aux vulnérabilités uniques et aux besoins de santé des femmes incarcérées et de leurs jeunes enfants.

[Moderate exercise and intake of either high or low glycemic index carbohydrates in sedentary women]. / Ejercicio moderado y consumo de alimentos de alto y bajo índice glucémico en mujeres sedentarias.

OBJECTIVE: To analyze changes in blood glucose, insulin and triglyceride concentrations in relation to a moderate aerobic exercise in sedentary women of different body weight, exposed to either a high or low glycemic index carbohydrates diet. DISEñO: Cross-over type. SITE: Research was performed in the Exercise Physiology Laboratory at Facultad de Ciencias de la Cultura Física, Universidad Autónoma de Chihuahua, México. PARTICIPANTS: Twenty-six young sedentary women who did not exercise in the last year participated in the study. Four of adequate weight (AW) and 2 with obesity (OB) were excluded for not consuming the suggested carbohydrates (1gr/kg of weight) nor completed the programed exercise. There were n=10 in each group (AW/OB). INTERVENTION: Two treatments of 55minutes of aerobic exercise each were applied one day after consuming either high or low glycemic index carbohydrates. MAIN MEASUREMENTS: Plasmatic glucose, insulin, and triglycerides were determined before and after the scheduled exercise. RESULTS: Glucose, insulin, and triglycerides were higher in OB than in AW at baseline. Glucose was normalized in OB from 5.8±0.35 to 5.3±0.23 mmol/L (P=.001), only by eating foods with low glycemic index; triglycerides increased from 139.5±66.0 to 150.8±67.2mg/dl (P=.004) at the end of the exercise, after consumption of low glycemic index carbohydrates. CONCLUSION: Elevation of triglycerides secondary to exercise after consumption of low glycemic index seems to indicate an increase of lipid oxidation in OB.

ON BEING MOTHER AND PATIENT: DIALECTICAL STRUGGLES DURING MEDICALLY HIGH-RISK PREGNANCY.

Medically high-risk pregnancy (MHRP) affects 3 to 10% (diagnosis-dependent) of pregnant women in the United States (National Institute of Child Health Development, 2015), threatening maternal and fetal well-being. Although mothers' prenatal distress and mother-infant attachment after birth have been quantitatively researched, little research has examined women's lived experiences of MHRP in the United States. We examined 16 women's experiences of MHRP during hospitalization at an urban, Northeastern U.S. hospital using an interpretive phenomenological approach. Our qualitative findings provide new understanding of how women expend tremendous energy simultaneously navigating new roles of mother and patient. While negotiating these roles, they experienced dialectical struggles and uncertainty relating to emotion management, locus of control, appraisals of self/others, and relational self. Women managed these conflicts within the contexts of their emerging maternal identity, patient-provider relationships, and social relationships. Women struggled as they managed emotion, determined their level of responsibility for fetal outcomes, appraised others and themselves, and worried about how they were perceived. This amplified distress and contributed to women's emotional exhaustion, sense of being overwhelmed, and stress burden. New explication of these energy-depleting dynamic processes underlying women's experiences of MHRP and their impact on the future mother-infant relationship is considered, and strategies for psychosocial support are identified.

IS REFLECTIVE SUPERVISION ENOUGH? AN EXPLORATION OF WORKFORCE PERSPECTIVES.

Infant mental health practice requires the performance of intense emotional labor. Professionals comprising the infant mental health (IMH) field are largely women at seminal points in adult life-span development. The purpose of this article is to explore the day-to-day challenges faced by clinical infant mental health professionals and their perspectives on the supports available for effective job performance. We review reflective supervision as a long-cherished professional support in the IMH field designed to hold the practitioner's fears, worries, and ambivalence, so that she may return to the work fortified to remain in therapeutic alliance with families despite unsolvable problems and an unknowable future (Weatherston, D., 2009). Yet, we propose that reflective supervision alone may not be an adequate protective measure for a workforce performing intensive emotional labor for extended periods and therefore at potentially increased risk for burnout and high turnover (Hochschild, A.R. ; C. Maslach, , C.M. Brotheridge & A.A. Grandey, 2009; A.S. Wharton, ). We suggest that structural factors concerning organizational culture, flexibility in scheduling, and professional growth and versatility bear deeper examination for their merits in supporting the IMH workforce. Finally, we contend that the overrepresentation of women in practitioner positions in IMH leaves an empirical gap where little is known about the experience of male IMH practitioners and the ramifications of their performance of emotional labor.

Prevalence of Trichomonas vaginalis and Human papillomavirus in female sex workers in Central Veracruz, Mexico.

Female sex workers (FSWs) have been considered a key population for sexually transmitted infections (STIs); therefore, they are periodically screened as a requirement to obtain a work card. However, there is insufficient epidemiological data on STIs among FSWs in Mexico. The detection of Trichomonas vaginalis is limited to microscopic studies and the molecular screening of Human papillomavirus (HPV) is only done to women 35 years of age and older. The objective of this study was to determine the prevalence of T. vaginalis and HPV infections in FSWs in the city of Orizaba, Veracruz, Mexico. Samples from 105 FSWs were obtained by cervical swab and analyzed. The identification of T. vaginalis and HPV was performed by molecular methods. HPV DNA was identified in 5.71% of the samples with the presence of HPV16, HPV18, and HPV58. A percentage of 25.7% samples were positive for T. vaginalis for optical microscopy and 23.8% for PCR. The results of the study indicate the need to incorporate more sensitive methods for the timely diagnosis of STIs as well as comprehensive health promotion programs directed to the most vulnerable groups among FSWs.

[How do immigrant women access health services in the Basque Country? Perceptions of health professionals]. / ¿Cómo acceden las mujeres inmigrantes a los servicios sanitarios en el País Vasco? Percepciones de profesionales sanitarias.

OBJECTIVE: To determine the perception of health professionals working in alternative health centres on the barriers and facilitators in the access by immigrant women to general public health services and sexual and reproductive health in the Basque Country. LOCATION: Basque Country. DESIGN: Analysis of qualitative content based on 11 individual interviews. PARTICIPANTS: Health professionals working in alternative health centres of Primary Care and sexual and reproductive health. METHOD: Data collection was performed between September and December 2015 in four alternative health centres. After transcription, the units of meaning, codes and categories were identified. RESULTS: Four categories emerged from the analysis, which represented how the characteristics of immigrant women (Tell me how you are and I will tell you how to access), the attitude of the administrative and health staff ("When they are already taken care of"), the functioning of the health system (Inflexible, passive and needs-responsive health system), and health policies ("If you do not meet the requirements, you do not go in. The law is the law") influence access to health services of immigrant women. CONCLUSIONS: This study shows that there are a considerable number of barriers and few facilitators to the access by immigrant women to public health and sexual and reproductive health services in the Basque Country. The alternative health centres were presented as favouring the improvement of the health of the immigrant population and in their access.

Prevalence of intimate partner violence in Spain: A national cross-sectional survey in primary care.

OBJECTIVES: (1) To analyze the prevalence of Intimate Partner Violence by types. (2) To examine the relationship between sociodemographic characteristics and Intimate Partner Violence. DESIGN: Cross-sectional study using a self-administered questionnaire. SETTING: Primary Healthcare centers in Spain. PARTICIPANTS: 10,322 women (18-70 years) attending Primary Healthcare centers. MAIN MEASUREMENTS: A compound index was calculated based on frequency, types, and duration of Intimate Partner Violence. Multivariable adjusted logistic regression models were used to identify the sociodemographic factors, which were independently associated with each Intimate Partner Violence category. RESULTS: The prevalence of Intimate Partner Violence was 24.8%. For the physical only category, no differences were observed regarding education or employment status, and women with the highest income have less risk. For the psychological only category, no differences were observed according to the income level. The risk increases as the education level decreases, and the greatest frequency of only psychological Intimate Partner Violence was observed in women who were unemployed or students. For both the physical and psychological category of Intimate Partner Violence, a clear risk increase is observed as income and education levels decrease. Retired women showed the highest frequency of this violence category. CONCLUSION: The results show that Intimate Partner Violence affects women of all social strata, but the frequency and Intimate Partner Violence category will vary according to the socio-economic.

Physicians' experiences and views on the role of obstetric ultrasound in rural and urban Rwanda: a qualitative study.

OBJECTIVE: To explore Rwandan physicians' experiences and views on the role of obstetric ultrasound in clinical management of pregnancy, and in situations where maternal and fetal health interests conflict. METHODS: Physicians (n = 19) in public and private health facilities in urban and rural Rwanda were interviewed in 2015 as part of the CROss-Country Ultrasound Study (CROCUS). Data were analysed qualitatively. RESULTS: Ultrasound was described as an important tool in maternity care. Availability and quality of equipment varied across sites, and considerable disparities in obstetric ultrasound utilisation between rural and urban areas were described. The physicians wanted more ultrasound training and saw the potential for midwives to perform basic scans. Information about fetal sex and well-being was described as women's main expectations of ultrasound. Although women's right to autonomy in pregnancy was supported in principle by participating physicians, fetal rights were sometimes seen as needing physician 'protection'. CONCLUSIONS: There appears to be increasing use and demand for obstetric ultrasound in Rwanda, particularly in urban areas. It seems important to monitor this development closely to secure wise and fair allocation of scarce obstetric expertise and resources and to prevent overuse or misuse of ultrasound. Raising awareness about the benefits of all aspects of antenatal care, including ultrasound may be an important step to improve pregnant women's uptake of services. Increased opportunities for formal ultrasound training, including the training of midwives to perform basic scans, seem warranted. Moreover, in parallel with the transition to more medico-technical maternity care, a dialogue about maternal rights to autonomy in pregnancy and childbirth is imperative.

HIV-free survival at 12-24 months in breastfed infants of HIV-infected women on antiretroviral treatment.

OBJECTIVE: To provide estimates of HIV-free survival at 12-24 months in breastfed children by maternal ART (6 months or lifelong) to inform WHO HIV and Infant Feeding guidelines. METHODS: Eighteen studies published 2005-2015 were included in a systematic literature review (1295 papers identified, 156 abstracts screened, 55 full texts); papers were analysed by narrative synthesis and meta-analysis of HIV-free survival by maternal ART regimen in a random effects model. We also grouped studies by feeding modality. Study quality was assessed using a modified Newcastle-Ottawa Scale (NOS) and GRADE. RESULTS: The pooled estimates for 12-month HIV-free survival were 89.8% (95% confidence interval, CI: 86.5%, 93.2%) for infants of mothers on ART for 6 months post-natally (six studies) and 91.4% (95% CI 87.5%, 95.4%) for infants of mothers on lifelong ART (three studies). Eighteen-month HIV-free survival estimates were 89.0% (95% CI 83.9%, 94.2%) with 6 months ART (five studies) and 96.1% (95% CI 92.8%, 99.0%) with lifelong ART (three studies). Twenty-four-month HIV-free survival for infants whose mothers were on ART to 6 months post-natally (two studies) was 89.2% (95% CI 79.9%, 98.5%). Heterogeneity was considerable throughout. In four studies, HIV-free survival in breastfed infants ranged from 87% (95% CI 78%, 92%) to 96% (95% CI 91%, 98%) and in formula-fed infants from 67% (95% CI 35.5%, 87.9%) to 97.6% (95% CI 93.0%, 98.2%). CONCLUSION: Our results highlight the importance of breastfeeding for infant survival and of ART in reducing the risk of mother-to-child HIV transmission and support the WHO recommendation to initiate ART for life immediately after HIV diagnosis.