Cyber sexual harassment against women and impact on health. A cross-sectional study in a representative population sample

BACKGROUND

This study focuses on the frequency of cyber sexual harassment (CSH) and examines its link with five health impact indicators (self-perceived health, medication, suicidal ideation, suicide attempts and use of health services).

METHODS

Analyzing the data provided by the 2019 Macro-survey on violence against women in Spain, two items of which refer to CSH. It was conducted in Spain on a representative sample of 9568 women aged over 16 years old.

RESULTS

A total of 9.15% of the women surveyed had experienced CSH at some point in their lives. Being under 25 years old, having higher education, not being in a relationship, having no religious beliefs and having a certified disability are sociodemographic characteristics associated with a higher risk of CSH. Women who have experienced other forms of gender-based violence also show an increased risk. Female victims of CSH reported higher rates of suicidal ideation (20% versus 9.79% in non-victims of CSH) and suicidal attempts (7.20% versus 1.74% in non-victims of CSH).

CONCLUSIONS

These findings have significant implications for the design of preventive health polices, which should incorporate strategies to address CSH as part of the continuum of multiple interrelated forms of gender violence that affect women and girls throughout their lives.

[Barriers and proposals for a health care approach to trafficking for sexual exploitation]

OBJECTIVE

To examine the perception of the trafficking in women for sexual exploitation, identify the difficulties and collect the proposals of professionals in direct contact with the victims of trafficking in women for sexual exploitation in Andalusia (Spain).

METHOD

Qualitative study based on interviews with 10 key informants, selected from organizations providing support and care to victims of trafficking in women for sexual exploitation in 2021. Two researchers carried out a thematic categorical content analysis, integrative and relational analysis. Three themes with different sub-themes were analyzed.

RESULTS

Difficulties have been identified in relation to women (delay in recognizing themselves as victims, cultural differences, distrust of the system), traffickers (modification of strategies), health professionals (lack of sensitivity and lack of homogeneity in actions) and the health system (lack of cultural intermediation, administrative complexity). The key informants propose more training for professionals, the use of effective action protocols and better coordination between institutions.

CONCLUSIONS

The health sector faces a number of challenges in responding comprehensively and effectively to trafficking in women for sexual exploitation. Improvements are needed in raising awareness among health professionals, the development of standardized protocols, greater collaboration between sectors, the provision of specialized mental health services and effective cultural mediation.

Characteristics and effectiveness of interventions to reduce cyberbullying: a systematic review

Background

This paper presents the results from a systematic review on the effectiveness of interventions to reduce Cyberbullying (CB) as a function of their outcomes and main characteristics; and an analysis of the level of completeness to which the characteristics of these interventions are described.

Methods

Systematic searches were conducted in PubMed, Scopus, ERIC and Psycinfo databases on February 14, 2022. In addition, relevant publications were hand searched for relevant studies. We considered interventions that provided data on CB prevalence changes in populations between primary school and college age.

Results

In total, 111 studies were retained for further screening from 3,477 results. Following rigorous screening, 43 reports including 46 studies and information from 36 different interventions were included in our systematic review. Results shows that most of the interventions measuring reductions in global CB, cyberperpetration/victimization, cybervictimization and cyberperpetration were effective or partially effective. While the interventions measuring reductions in cyber-bystanding were not effective. Multicomponent interventions showed higher effectiveness than single-component interventions. After completion of the TIDieR check-list, included interventions were considered to offer an insufficient level of detail for a number of the analyzed items in relation to "how well planned," "intervention modifications" and "tailoring."

Conclusion

Given the aforementioned, it is critical to increase the number of studies and the quality of interventions targeting CB and the level of detail of its description in order to obtain more robust outcomes about how to reduce its prevalence and facilitate the replication of the effective interventions.

Systematic review registration

https://archive.org/details/osf-registrations-wn5u4-v1, Identifer DOI: 10.17605/OSF.IO/WN5U4.

Relationship between Sexual Violence and the Health of Spanish Women-A National Population-Based Study

BACKGROUND

Health consequences are likely to be different when sexual violence is analysed independently from other types of violence. It is also likely that different health consequences will result in the cases of partner or ex-partner sexual violence, non-partner sexual violence and sexual harassment.

METHODS

This study is based on the 2019 Macro-survey of Violence against Women conducted by the Spanish Ministry of Equality on a sample of 9568 women aged 16 years or older. Odds ratios were calculated, and multinomial logistic regression analyses were performed.

RESULTS

The present study estimates that 4 out of 10 surveyed women had experienced some form of sexual violence in their lifetime. Sexual harassment is the most frequently reported form of this violence, while intimate partner sexual violence is the form with the most unfavourable sociodemographic characteristics and the worst health impact indicators, such as a greater likelihood of suicidal behaviour.

CONCLUSIONS

Sexual violence is a widespread, under-studied problem with negative health impacts. Women exposed to intimate partner violence are the most vulnerable and at risk. It is advised that responses and comprehensive care plans be developed that place special emphasis on the protection of victims' mental health.

The prevalence of intimate partner violence against women with disabilities: a systematic review of the literature

PURPOSE

Although systematic reviews have already been conducted on violence and disability, the evidence is not conclusive in Intimate Partner Violence (IPV). This study examined the prevalence of IPV in women with disabilities, taking account of the different types of violence and disability.

METHODS

We performed a search in five databases. We included observational studies that analysed the frequency of IPV in women with disabilities compared to women without. Two independent reviewers selected and assessed studies. We made a qualitative synthesis according to the type of IPV analysed in relation to disability.

RESULTS

We identified 26 articles. The frequency and risk of IPV were greater in women with disabilities than in those without. All of the articles that studied financial violence, 81.3% of those that studied physical violence, 78.5% of those that studied psychological violence, 75% of those that studied physical/sexual violence, 73.3% of those that studied sexual violence and 50% of those that studied any type of violence found a significant association whit disability.

CONCLUSIONS

Women with disabilities are at higher risk of IPV. Rehabilitation centers and its professionals must have a leading role in the identification of these situations and this should be considered in IPV prevention plans.Implications for rehabilitationPeople with disabilities are at higher risk of multiple types of violence.Violence against women with disabilities therefore involves two public health issues interacting simultaneously.Rehabilitation centers and its professionals should have a leading role in the identification of IPV in women with disabilities.IPV prevention plans should consider rehabilitation centers and its professionals as a main component of interventions in women with disabilities.

Characterization of Cyberbullying Victimization and Perpetration Before and During the COVID-19 Pandemic in Spain

Cyberbullying is an extremely damaging form of interpersonal violence. Little is yet known about cyberbullying behaviors in the child and youth population during the COVID-19 pandemic and what effect this reduction in face-to-face social interactions has had on an increase in socialization via the Internet and cyberbullying. The present study is a cross-sectional descriptive study conducted in young people between the ages of 12 and 27 years attending two secondary schools in southern Spain (N = 733) to examine differences regarding sociodemographic characteristics, academic performance, and digital device use (independent variables) in the experiences of cybervictimization, cyberperpetration, and adverse psychological effects (dependent variables). Logistic regression models were constructed for each of the dependent variables including the independent variables mentioned above. More than 50 percent of the sample were victims of cyberbullying. Females and the LGBTIQ+ Community were at greater risk of being cybervictims and suffer adverse psychological effects. A total of 22.8 percent of the students reported having been victims and 26.5 percent perpetrators of cyberbullying for the first time during the COVID-19 pandemic, but no other major differences were observed. These findings point out that cyberbullying must be prioritized in public policy as part of an overall strategy for combating violence in childhood and adolescence, as well as gender-based and discriminatory violence.

Impact of socioeconomic and health-related factors on consumption of homeopathic and natural remedies in Spain in 2006, 2011 and 2017

OBJECTIVE

Complementary and alternative medicine use and type of use may be influenced by sociodemographic and economic determinants through which we could identify characteristics of patients with greater trend to use it. This paper aims to describe the changes in the consumption of homeopathic and natural remedies in Spain for three time points in order to discern changes in rate of consumption, associated factors and whether their use has been affected by a period of economic recession.

METHODS

This study utilized 2006, 2011 and 2017 cross-sectional data from the Spanish National Health Survey, a nationally representative survey of the population aged more than 15 years old and resident in Spain. Independent bivariate and multivariate descriptive analyses for each of the 3 years studied were performed.

RESULTS

The rate of consumption of both homeopathic and natural remedies has decreased over the periods studied. In spite of this decrease, the consumer profile appears to remain stable over the three periods. The sociodemographic factors associated with their consumption were being female, being 30-64 years old, being separated/divorced, having higher education qualifications, being employed and belonging to a higher social class. Psychiatric morbidity, chronic health problems such as pain, mental health problems or malignant tumors, and absence of major cardiovascular events were the clinical factors associated.

CONCLUSION

It can be concluded that beyond the economic situation, the use of homeopathic and natural remedies obeys to the needs of the patients related to their state of health and the response they receive from the health system. It may be that women have different needs and expectations of the healthcare system and, given this breach of expectations, seek remedy to alleviate their needs outside the system and conventional medicine.

A Mobile Phone-Based Intervention to Reduce Mental Health Problems in Health Care Workers During the COVID-19 Pandemic (PsyCovidApp): Randomized Controlled Trial

BACKGROUND

The global health emergency generated by the COVID-19 pandemic is posing an unprecedented challenge to health care workers, who are facing heavy workloads under psychologically difficult situations. Mental mobile Health (mHealth) interventions are now being widely deployed due to their attractive implementation features, despite the lack of evidence about their efficacy in this specific population and context.

OBJECTIVE

The aim of this trial is to evaluate the effectiveness of a psychoeducational, mindfulness-based mHealth intervention to reduce mental health problems in health care workers during the COVID-19 pandemic.

METHODS

We conducted a blinded, parallel-group, controlled trial in Spain. Health care workers providing face-to-face health care to patients with COVID-19 were randomly assigned (1:1) to receive the PsyCovidApp intervention (an app targeting emotional skills, healthy lifestyle behavior, burnout, and social support) or a control app (general recommendations about mental health care) for 2 weeks. The participants were blinded to their group allocation. Data were collected telephonically at baseline and after 2 weeks by trained health psychologists. The primary outcome was a composite of depression, anxiety, and stress (overall score on the Depression Anxiety Stress Scale-21 [DASS-21]). Secondary outcomes were insomnia (Insomnia Severity Index), burnout (Maslach Burnout Inventory Human Services Survey), posttraumatic stress (Davidson Trauma Scale), self-efficacy (General Self-Efficacy Scale), and DASS-21 individual scale scores. Differences between groups were analyzed using general linear modeling according to an intention-to-treat protocol. Additionally, we measured the usability of the PsyCovidApp (System Usability Scale). The outcome data collectors and trial statisticians were unaware of the treatment allocation.

RESULTS

Between May 14 and July 25, 2020, 482 health care workers were recruited and randomly assigned to PsyCovidApp (n=248) or the control app (n=234). At 2 weeks, complete outcome data were available for 436/482 participants (90.5%). No significant differences were observed between the groups at 2 weeks in the primary outcome (standardized mean difference -0.04; 95% CI -0.11 to 0.04; P=.15) or in the other outcomes. In our prespecified subgroup analyses, we observed significant improvements among health care workers consuming psychotropic medications (n=79) in the primary outcome (-0.29; 95% CI -0.48 to -0.09; P=.004), and in posttraumatic stress, insomnia, anxiety, and stress. Similarly, among health care workers receiving psychotherapy (n=43), we observed improvements in the primary outcome (-0.25; 95% CI -0.49 to -0.02; P=.02), and in insomnia, anxiety, and stress. The mean usability score of PsyCovidApp was high (87.21/100, SD 12.65). After the trial, 208/221 participants in the intervention group (94.1%) asked to regain access to PsyCovidApp, indicating high acceptability.

CONCLUSIONS

In health care workers assisting patients with COVID-19 in Spain, PsyCovidApp, compared with a control app, reduced mental health problems at 2 weeks only among health care workers receiving psychotherapy or psychotropic medications.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04393818; https://clinicaltrials.gov/ct2/show/NCT04393818.

Gender-based differences in perceptions about sexual violence, equality and drug‑facilitated sexual assaults in nightlife contexts

Sexual violence, including drug-facilitated sexual assaults, is a serious issue that is becoming increasingly common in leisure nightlife contexts. This study provides information about the attitudes and perceptions of Spanish youths towards sexual violence within that setting. The participants were recruited by a snowball sampling scheme. A bivariate analysis was performed to identify possible sociodemographic and nightlife recreational habit factors related to gender. The statistical significance of the differences between the studied variables was assessed using the chi-squared and Fisher's exact tests. Women perceived a low level of personal security, as well as the existence of social perceptions penalizing female more than male drug use, and blaming women for the sexual violence they suffer. Women also recognised less explicit violent behaviours as violence significantly more than men did. Men were more willing to have sexual intercourse with someone unable to express consent because of drugs. In addition, they believed more strongly that sexual assaults take place because of the victim's use of alcohol or other drugs. In a leisure nightlife context, women are prone to perceive a lack of social support for themselves and the feeling of impunity for the perpetrators. Furthermore, numerous misconceptions surround drug-facilitated sexual assaults, with the majority of respondents believing that assaults happen after the surreptitious administration of substances to the victim by an unknown assailant. Moreover, the involvement of alcohol was underestimated. Our findings are useful for designing prevention efforts, demystifying the drug-facilitated sexual assaults and enhancing social support for victims.

Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review and meta-analysis

BACKGROUND

This study aimed at examining the impact of providing healthcare during health emergencies caused by viral epidemic outbreaks on healthcare workers' (HCWs) mental health; to identify factors associated with worse impact, and; to assess the available evidence base regarding interventions to reduce such impact.

METHOD

Rapid systematic review. We searched MEDLINE, Embase, and PsycINFO (inception to August 2020). We pooled data using random-effects meta-analyses to estimate the prevalence of specific mental health problems, and used GRADE to ascertain the certainty of evidence.

RESULTS

We included 117 studies. The pooled prevalence was higher for acute stress disorder (40% (95%CI 39 to 41%)), followed by anxiety (30%, (30 to 31%)), burnout (28% (26 to 31%)), depression (24% (24 to 25%)), and post-traumatic stress disorder (13% (13 to 14%)). We identified factors associated with the likelihood of developing those problems, including sociodemographic (younger age and female gender), social (lack of social support, stigmatization), and occupational (working in a high-risk environment, specific occupational roles, and lower levels of specialised training and job experience) factors. Four studies reported interventions for frontline HCW: two educational interventions increased confidence in pandemic self-efficacy and in interpersonal problems solving (very low certainty), whereas one multifaceted intervention improved anxiety, depression, and sleep quality (very low certainty).

LIMITATIONS

We only searched three databases, and the initial screening was undertaken by a single reviewer.

CONCLUSION

Given the very limited evidence regarding the impact of interventions to tackle mental health problems in HCWs, the risk factors identified represent important targets for future interventions.

Intimate partner violence during pregnancy and risk of fetal and neonatal death: a meta-analysis with socioeconomic context indicators

OBJECTIVE

The objective of the study was to summarize the results from observational studies examining the risk of fetal and neonatal death (perinatal death) as a function of the experience of intimate partner violence during pregnancy and examine the influence of socioeconomic context indicators on this association.

DATA SOURCES

Bibliographic searches were conducted in PubMed, EMBASE, CINAHL, and LILACS until March 2019.

STUDY ELIGIBILITY CRITERIA

We considered observational studies that provided data on the association between intimate partner violence during pregnancy and perinatal death.

STUDY APPRAISAL AND SYNTHESIS METHODS

Information collected included study characteristics, type, and prevalence of intimate partner violence and the reported association between intimate partner violence and perinatal death. Quality of the included studies was assessed using the Newcastle-Ottawa scale. Two reviewers independently conducted all review procedures; disagreements were resolved by a third reviewer. Meta-analyses were conducted based on the specific type of intimate partner violence (physical, psychological, sexual, unspecified) and also based on any type of intimate partner violence, considering 1 effect size per study, regardless of the type of intimate partner violence analyzed. Meta-regression analyses were performed to assess the possible effects of socioeconomic context. The proportion of deaths attributable to the exposure of intimate partner violence based on the crude data from the 3 cohort studies available also was calculated.

RESULTS

Seventeen studies were included. The random-effects model showed a statistically significant increase in the odds of perinatal death among women exposed to unspecified intimate partner violence (odds ratio, 3.18; 95% confidence interval, 1.88-5.38), physical intimate partner violence (odds ratio, 2.46; 95% confidence interval, 1.76-3.44), and any type of intimate partner violence during pregnancy (odds ratio, 2.89; 95% confidence interval, 2.03-4.10). Meta-regression analysis showed stronger associations in countries with higher gross domestic product (odds ratio, 1.03; 95% confidence interval, 1.02-1.04) and a higher percentage of health expenditure (odds ratio, 1.27; 95% confidence interval, 1.09-1.46). The proportion of deaths attributable to exposure to intimate partner violence in cohort studies was attributable proportion, 60%; 95% confidence interval, 15-81%.

CONCLUSION

Pregnant women who experience intimate partner violence during pregnancy may be about 3 times more likely to suffer perinatal death compared with women who do not experience intimate partner violence. It should be a priority to include intimate partner violence screenings or other detection strategies in pregnancy monitoring or family-planning programs because these could help avoid preventable perinatal deaths.

Intimate partner violence and perinatal health: a systematic review

BACKGROUND

Physical, psychological and sexual intimate partner violence (IPV) has been described in the literature as different types of IPV experienced by women during pregnancy all over the world.

OBJECTIVES

To review and summarise systematically the empirical evidence on the links between IPV during pregnancy and the perinatal health of mothers and fetuses/neonates.

SEARCH STRATEGY

MEDLINE (Ovid), CINAHL, Embase, Nursing@ovid (Ovid) and LILACS were searched (2008-2018).

SELECTION CRITERIA

Observational studies that examined perinatal health outcomes (i.e. pre-term birth, low birthweight, miscarriage, perinatal death and premature rupture of membranes) in pregnant women exposed to IPV.

DATA COLLECTION AND ANALYSIS

Information on study characteristics, type of IPV measured, study design, methodological quality and outcome variable extracted.

RESULTS

Fifty studies were included. Twenty-nine analysed undifferentiated IPV (n = 25 489), 34 included physical IPV (n = 7333), 22 analysed psychological IPV (n = 7833) and 18 examined sexual IPV (n = 2388). Fifteen studies were from Asia, 12 from North America and Oceania, and 12 from Central and South America. The studies examined the association between IPV and 39 different perinatal health outcomes. The most frequent outcomes reported were pre-term birth (50%), low birthweight (46%), miscarriage (30%), perinatal death (20%) and premature rupture of membranes (20%). A significant association with perinatal health outcomes was reported by 12 of the studies analysing undifferentiated IPV, 18 physical IPV, six psychological IPV and two sexual IPV.

CONCLUSIONS

The relation between IPV and perinatal health outcomes can be seen in different epidemiological designs and countries. In all, 39 different outcomes were identified and 29 were associated with IPV.

TWEETABLE ABSTRACT

A variety of poor perinatal health outcomes are associated with psychological, physical and sexual IPV.

Childhood chromium exposure and neuropsychological development in children living in two polluted areas in southern Spain

This study aimed to assess the association between exposure to chromium and neuropsychological development among children. A cross-sectional study was conducted with 393 children aged 6-11 years old randomly selected from State-funded schools in two provinces in Southern Spain (Almeria and Huelva), in 2010 and 2012. Chromium levels in urine and hair samples were analyzed by inductively coupled plasma mass spectrometry with an octopole reaction system. Neuropsychological development was evaluated using the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) and three computerized tests from the Behavioural Assessment and Research System (BARS): Reaction Time Test (RTT), Continuous Performance Test (CPT) and Selective Attention Test (SAT). Multivariable linear regression models adjusted for potential confounders, including heavy metals, were applied to examine the association between chromium levels and neuropsychological outcomes. A 10-fold increase in urine chromium levels was associated with a decrease of 5.99 points on the WISC-IV Full-Scale IQ (95% CI: 11.98 to -0.02). Likewise, a 10-fold increase in urine chromium levels in boys was associated with a decrease of 0.03 points in the percentage of omissions (95% CI: 0.0 to 0.05) in the SAT, with an increase of 68.35 points in latency (95% CI: 6.60 to 130.12) in the RTT, and with an increase in the number of trials with latencies > 1000 ms (β = 37.92; 95% CI: 2.73 to 73.12) in the RTT. An inverse significant association was detected between chromium levels in hair and latency in the SAT in boys (β = -50.53; 95% CI: 86.86 to -14.22) and girls (β = -55.95; 95% CI: 78.93 to -32.97). Excluding trials with latencies >1000 ms in the RTT increased latency scores by 29.36 points in boys (95% CI: 0.17 to 58.57), and 39.91 points in girls (95% CI: 21.25 to 58.59). This study is the first to show the detrimental effects of postnatal chromium exposure on neuropsychological development in school-aged children.

[Indirect methods to estimate hidden population: Second part]

"Hidden populations" are difficult to identify because they have stigmatizing or illegal characteristics. For that reason, determining their size or prevalence in certain contexts is complicated. In those populations, traditional or direct methods, as population surveys, do not usually serve for this purpose, but indirect methods, based on incomplete data sources, can be useful.This work completes the original article published in Revista Española de Salud Pública in 2017: "Indirect methods to estimate hidden populations". Different methods are exposed, showing their indications and bias. To make an estimation as real as possible it is necessary to evaluate carefully the data available and analyze the risk of bias.

Effectiveness of interventions to improve cardiovascular healthcare in rural areas: a systematic literature review of clinical trials

The objective of this systematic literature review is to examine the impact of interventions to improve cardiovascular disease healthcare provided to people living in rural areas. Systematic electronic searches were conducted in Medline, CINAHL, Embase, Scopus, and Web of Knowledge in July 2018. We included clinical trials assessing the effectiveness of interventions to improve cardiovascular disease healthcare in rural areas. Study eligibility assessment, data extraction, and critical appraisal were undertaken by two reviewers independently. We identified 18 trials (18 interventions). They targeted myocardial infarction (five interventions), stroke (eight), and heart failure (five). All the interventions for myocardial infarction were based on organizational changes (e.g. implementation of mobile coronary units). They consistently reduced time to treatment and decreased mortality. All the interventions for heart failure were based on the provision of patient education. They consistently improved patient knowledge and self-care behaviour, but mortality reductions were reported in only some of the trials. Among the interventions for stroke, those based on the implementation of telemedicine (tele-stroke systems or tele-consultations) improved monitoring of stroke survivors; those based on new or enhanced rehabilitation services did not consistently improve mortality or physical function; whereas educational interventions effectively improved patient knowledge and behavioural outcomes. In conclusion, a number of different strategies (based on enhancing structures and providing patient education) have been proposed to improve cardiovascular disease healthcare in rural areas. Although available evidence show that these interventions can improve healthcare processes, their impact on mortality and other important health outcomes still remains to be established.

Effectiveness of interventions to improve cancer treatment and follow-up care in socially disadvantaged groups

OBJECTIVE

To identify and characterize the interventions that aimed to improve cancer treatment and follow-up care in socially disadvantaged groups. To summarize the state of the art for clinicians and researchers.

METHODS

We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies were randomized controlled trials and quasi-experimental studies with a control group (usual care or enhanced usual care) conducted in Organization for Economic Co-operation and Development (OECD) member countries and published until 2016.

RESULTS

Thirty-one interventions were identified, the majority of which were conducted in the United States in patients with breast cancer. Most interventions aimed to decrease social inequalities based on ethnicity/race and/or socioeconomic level, with fewer interventions targeting inequalities based on geographical area. The most frequently assessed outcomes were quality of life (n = 20) and psychosocial factors (n = 20), followed by treatment adherence or satisfaction (n = 12,), knowledge (n = 11), pain management (n = 10), and lifestyle habits (n = 3).

CONCLUSIONS

The impact of interventions designed to improve cancer treatment and follow-up care in socially disadvantages groups is multifactorial. Multicomponent-intervention approaches and cultural adaptations are common, and their effectiveness should be evaluated in the populations of interest. More interventions are needed from outside the Unite States and in patients with cancers other than breast cancer, targeting gender or geographical inequalities and addressing key outcomes such as treatment adherence or symptom management.

Socio-economic factors linked with mental health during the recession: a multilevel analysis

BACKGROUND

Periods of financial crisis are associated with higher psychological stress among the population and greater use of mental health services. The objective is to analyse contextual factors associated with mental health among the Spanish population during the recession.

METHODOLOGY

Cross-sectional, descriptive study of two periods: before the recession (2006) and after therecession (2011-2012). The study population comprised individuals aged 16+ years old, polled for the National Health Survey. There were 25,234 subjects (2006) and 20,754 subjects (2012). The dependent variable was psychic morbidity.

INDEPENDENT VARIABLES

1) socio-demographic (age, socio-professional class, level of education, nationality, employment situation, marital status), 2) psycho-social (social support) and 3) financial (GDP per capita, risk of poverty, income per capita per household), public welfare services (health spending per capita), labour market (employment and unemployment rates, percentage of temporary workers). Multilevel logistic regression models with mixed effects were constructed to determine change in psychic morbidity according to the variables studied.

RESULTS

The macroeconomic variables associated with worse mental health for both males and females were lower health spending per capita and percentage of temporary workers. Among women, the risk of poor mental health increased 6% for each 100€ decrease in healthcare spending per capita. Among men, the risk of poor mental health decreased 8% for each 5-percentage point increase in temporary workers.

CONCLUSIONS

Higher rates of precarious employment in a region have a negative effect on people's mental health; likewise lower health spending per capita. Policies during periods of recession should focus on support and improved conditions for vulnerable groups such as temporary workers. Healthcare cutbacks should be avoided in order to prevent increased prevalence of poor mental health.

Intimate partner violence in women with disabilities: perception of healthcare and attitudes of health professionals

PURPOSE

Intimate partner violence (IPV) is a major social problem and public health issue, but we still have a relatively small amount of data about partner violence in women with disabilities. The main objective of this study was to understand the experiences of women with disabilities who are or have been abused by their partners and to explore the knowledge, views and training requirements of primary care professionals.

METHOD

Qualitative study using semi-structured interviews with women with disabilities who had experienced IPV (n = 14), and focus groups with healthcare professionals (n = 16).

RESULTS

Women with disabilities suffer specific forms of abuse. Because they depend on the people around them to take action, they are subordinate and this can prolong the abuse. The healthcare staff frequently mentioned that it is often difficult to notice that women with disabilities are being abused. Their lack of training about disabilities and gender-based violence makes them less sure of their ability to identify and deal with any possible cases of abuse.

CONCLUSIONS

The difficulties described by the women interviewed are broadly speaking the same as those described by the healthcare professionals consulted. A number of suggestions for improvements are provided based on the results found. Implications for Rehabilitation The rehabilitation of abused disabled women implies that women perceive the health system as a resource to resolve their situation. Healthcare professionals should be trained on how to detect, treat and communicate with disabled women who experience partner violence. Is needed to establish a comprehensive system of coordination between services involved in caring for abused women and with disabilities.

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.

Validity and Reliability of the Spanish Version of the "Abuse Assessment Screen" among Pregnant Women

OBJECTIVE

To assess the reliability, accuracy, and construct validity of the Spanish Abuse Assessment Screen (AAS) among pregnant women using the Spanish version of Index of Spouse Abuse (ISA) as a reference standard.

DESIGN AND SAMPLE

Cross-sectional survey. A total of 1,329 pregnant women were selected in nine primary care centers during 2008-2009.

MEASURES

The Spanish ISA was self-administered first, followed by the AAS, administered by the midwife. Sensitivity, specificity, and predictive values of the Spanish AAS were compared with the Spanish version of the ISA as a reference standard.

RESULTS

Percentage of agreement between initial and retest administration of the Spanish AAS was high, from 96.4% to 100%. Specificity was for all types of abuse above 97%, but sensitivity values were much lower (33.3%, 22.9%, 6.9%, for severe physical abuse, minor psychological abuse, and minor physical abuse, respectively). The sensitivity of severe psychological abuse was perfect. Construct validity was good.

CONCLUSION

The Spanish AAS has good test-retest reliability, specificity, and construct validity. The sensitivity was good for severe psychological abuse and moderate for severe physical abuse. Further formal psychometric evaluations, in other languages from countries with low prevalence of abuse, remains a priority for clinical and research efforts in pregnancy domestic violence screening.

How does intimate partner violence differ depending on level of rurality of residential area in Spain?

Intimate partner violence (IPV) is recognized as a worldwide public health problem. Most theories ascribe IPV to individual, family, or cultural factors. Authors analyzed different residential areas in Spain in terms of IPV frequency as well as its impact on health and the use of services. A standardized self-administered cross-sectional survey was administered to ever-partnered adult women ages 18 to 70 years receiving care at primary health care centers (N = 10,322). Logistic regression analyzed the association between the level of rurality and health indicators, IPV, and use of services. The lowest frequency of IPV among women is reflected in higher rurality. Women of medium and low rurality presented a poorer self-perceived health and more physical health problems. Women from medium and low rurality areas declared seeking health services more frequently. These results show the importance of the environment in health and indicate the need for research on urban-rural differences in health problems to develop specific public health programs for each country.

Characteristics and effectiveness of diabetes self-management educational programs targeted to racial/ethnic minority groups: a systematic review, meta-analysis and meta-regression

BACKGROUND

It is not clear to what extent educational programs aimed at promoting diabetes self-management in ethnic minority groups are effective. The aim of this work was to systematically review the effectiveness of educational programs to promote the self-management of racial/ethnic minority groups with type 2 diabetes, and to identify programs' characteristics associated with greater success.

METHODS

We undertook a systematic literature review. Specific searches were designed and implemented for Medline, EMBASE, CINAHL, ISI Web of Knowledge, Scirus, Current Contents and nine additional sources (from inception to October 2012). We included experimental and quasi-experimental studies assessing the impact of educational programs targeted to racial/ethnic minority groups with type 2 diabetes. We only included interventions conducted in countries members of the OECD. Two reviewers independently screened citations. Structured forms were used to extract information on intervention characteristics, effectiveness, and cost-effectiveness. When possible, we conducted random-effects meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals. Two reviewers independently extracted all the information and critically appraised the studies.

RESULTS

We identified thirty-seven studies reporting on thirty-nine educational programs. Most of them were conducted in the US, with African American or Latino participants. Most programs obtained some benefits over standard care in improving diabetes knowledge, self-management behaviors and clinical outcomes. A meta-analysis of 20 randomized controlled trials (3,094 patients) indicated that the programs produced a reduction in glycated hemoglobin of -0.31% (95% CI -0.48% to -0.14%). Diabetes knowledge and self-management measures were too heterogeneous to pool. Meta-regressions showed larger reduction in glycated hemoglobin in individual and face to face delivered interventions, as well as in those involving peer educators, including cognitive reframing techniques, and a lower number of teaching methods. The long-term effects remain unknown and cost-effectiveness was rarely estimated.

CONCLUSIONS

Diabetes self-management educational programs targeted to racial/ethnic minority groups can produce a positive effect on diabetes knowledge and on self-management behavior, ultimately improving glycemic control. Future programs should take into account the key characteristics identified in this review.

Intimate partner violence in older women in Spain: prevalence, health consequences, and service utilization

The purpose of this study is to estimate the prevalence of lifetime intimate partner violence (IPV) in older women and to analyze its effect on women's health and Healthcare Services utilization. Women aged 55 years and over (1,676) randomly sampled from Primary Healthcare Services around Spain were included. Lifetime IPV prevalence, types, and duration were calculated. Descriptive and multivariate procedures using logistic and multiple lineal regression models were used. Of the women studied, 29.4% experienced IPV with an average duration of 21 years. Regardless of the type of IPV experienced, abused women showed significantly poorer health and higher healthcare services utilization compared to women who had never been abused. The high prevalence detected long standing duration, negative health impact, and high healthcare services utilization, calling attention to a need for increased efforts aimed at addressing IPV in older women.

Effectiveness of two interventions based on improving patient-practitioner communication on diabetes self-management in patients with low educational level: study protocol of a clustered randomized trial in primary care

BACKGROUND

In the last decades the presence of social inequalities in diabetes care has been observed in multiple countries, including Spain. These inequalities have been at least partially attributed to differences in diabetes self-management behaviours. Communication problems during medical consultations occur more frequently to patients with a lower educational level. The purpose of this cluster randomized trial is to determine whether an intervention implemented in a General Surgery, based in improving patient-provider communication, results in a better diabetes self-management in patients with lower educational level. A secondary objective is to assess whether telephone reinforcement enhances the effect of such intervention. We report the design and implementation of this on-going study.

METHODS/DESIGN

The study is being conducted in a General Practice located in a deprived neighbourhood of Granada, Spain. Diabetic patients 18 years old or older with a low educational level and inadequate glycaemic control (HbA1c > 7%) were recruited. General Practitioners (GPs) were randomised to three groups: intervention A, intervention B and control group. GPs allocated to intervention groups A and B received training in communication skills and are providing graphic feedback about glycosylated haemoglobin levels. Patients whose GPs were allocated to group B are additionally receiving telephone reinforcement whereas patients from the control group are receiving usual care. The described interventions are being conducted during 7 consecutive medical visits which are scheduled every three months. The main outcome measure will be HbA1c; blood pressure, lipidemia, body mass index and waist circumference will be considered as secondary outcome measures. Statistical analysis to evaluate the effectiveness of the interventions will include multilevel regression analysis with three hierarchical levels: medical visit level, patient level and GP level.

DISCUSSION

The results of this study will provide new knowledge about possible strategies to promote a better diabetes self-management in a particularly vulnerable group. If effective, this low cost intervention will have the potential to be easily incorporated into routine clinical practice, contributing to decrease health inequalities in diabetic patients.

TRIAL REGISTRATION

Clinical Trials U.S. National Institutes of Health, NCT01849731.

Inhibiting and facilitating factors to end a violent relationship: patterns of behavior among women in Spain

The objective of this study are (a) to explore the factors, which facilitate or inhibit women's responses to intimate partner violence (IPV) and their ability to leave a violent relationship; (b) to identify patterns of behavior in abused women based on their perception of the violence and the actions they take to find help or a solution to the problems derived from IPV. Semistructured interviews were carried out. The critical path is defined as the sequence of decisions and actions taken by affected women to address the violence they experienced. Based on this concept, we identified several factors that affect women's responses to violence, and categorized them into inhibiting and facilitating factors. We also identified three patterns of behavior: the first one is theoretically as the ideal critical path, whereas in the third pattern the process is less like the ideal critical path.

Personal and psychosocial predictors of psychological abuse by partners during and after pregnancy: a longitudinal cohort study in a community sample

OBJECTIVE

To describe the incidence and risk factors of psychological intimate partner violence (IPV) during pregnancy and the first year after childbirth.

DESIGN

Longitudinal cohort study.

SETTING

Nine primary care centers in the Valencia Region (Spain).

POPULATION

A consecutive sample of 1400 women in the first trimester of pregnancy, attending the prenatal programme in the Valencia Region of Spain in 2008, with follow-up in the third trimester of pregnancy, and at 5 and 12 months postpartum. A total of 888 women (66.5%) participated in all four phases.

METHODS

A logistic regression model was fitted using generalised estimating equations to assess the effects of previous partner violence, consumption of alcohol or illicit drugs and social support on subsequent psychological partner violence.

MAIN OUTCOME MEASURE

Psychological IPV during follow-up.

RESULTS

We observed an increase in the incidence of psychological IPV after birth, particularly at 5 months postpartum. The strongest predictor of psychological IPV was having experienced abuse 12 months before pregnancy (OR 10.46, 95%CI 2.40-45.61). Other predictors were consumption of alcohol or illicit drugs by the partner or a family member (OR3.50, 95%CI 1.38-8.85) and lack of affective social support (OR2.83, 95%CI 1.31-6.11).

CONCLUSIONS

Previous abuse and psychosocial risk factors predict partner psychological abuse after birth. Monitoring psychological IPV and effective interventions are needed not only during pregnancy but also during the postpartum period.

The assessment of intimate partner violence in Spanish women: the index of spouse abuse

We aimed to analyze the internal consistency and construct validity of the Spanish version of the Index of Spouse Abuse (ISA) in a representative sample of 8,995 women attending general practice in Spain in 2006-2007. The factor structure analysis shows that the ISA measures four intimate partner violence (IPV) dimensions: emotional, physical, and sexual abuse, and controlling behavior. Cronbach alpha ranges from .82 (sexual factor) to .94 (emotional). Construct validity analysis shows that IPV is associated with poorer self-perceived health, higher psychological distress, and lower tangible social support. The ISA can help make more visible forms of gender violence in the intimate relationship that sometimes are not recognized as such, like sexual violence or controlling behavior. This can contribute to the development of specific interventions for women experiencing IPV, considering the specificities of the violent acts experienced.

Effect of exposure to p,p'-DDE on male hormone profile in Mexican flower growers

OBJECTIVES

p,p'-Dichlorodiphenyldichloroethene (p,p'-DDE) acts as an androgen receptor antagonist, however data regarding its hormonal effects in men are limited. The objective of this study was to evaluate the association between serum levels of p,p'-DDE and reproductive hormone profile in Mexican male flower growers.

METHODS

A longitudinal study was carried out in a population of men working in the production of flowers and ornamental plants in two Mexican states during July-October 2004 (rainy season) and December 2004-May 2005 (dry season). A questionnaire including information on socioeconomic characteristics, tobacco and alcohol use, presence of chronic and acute diseases, occupational history and anthropometry was used and blood and urine samples were obtained. Serum levels of p,p'-DDE were analysed by gas chromatography; FSH, LH, testosterone, oestradiol, inhibin B and prolactin levels were measured by enzymatic immunoassay. Urinary levels of dialkylphosphates (DAPs) were analysed by gas chromatography. Associations between serum levels of p,p'-DDE and male reproductive hormones (both transformed to their natural logarithm) were evaluated using multivariate generalised estimating equation (GEE) models.

RESULTS

Median p,p'-DDE levels were 677.2 ng/g lipid (range 9.4-12 696.5) during the rainy season and 626.7 ng/g lipid (range 9.4-13 668.1) during the dry season. After adjusting for potential confounders (age, body mass index, state of residence and DAPs), p,p'-DDE levels were negatively associated with prolactin (β=-0.04; 95% CI -0.07 to -0.008) and testosterone (β=0.04; 95% CI -0.08 to 0.005) and positively with inhibin B (β=0.11; 95% CI 0.02 to 0.21).

CONCLUSION

These results indicate that p,p'-DDE can affect hypothalamic-pituitary-gonadal axis function in humans.

Social determinants and health effects of low and high severity intimate partner violence

PURPOSE

We sought to analyze whether the sociodemographic profile of battered women varies according to the level of severity of intimate partner violence (IPV), and to identify possible associations between IPV and different health problems taking into account the severity of these acts.

METHODS

A cross-sectional study of 8,974 women (18-70 years) attending primary healthcare centers in Spain (2006-2007) was performed. A compound index was calculated based on frequency, types (physical, psychological, or both), and duration of IPV. Descriptive and multivariate procedures using logistic regression models were fitted.

RESULTS

Women affected by low severity IPV and those affected by high severity IPV were found to have a similar sociodemographic profile. However, divorced women (odds ratio [OR], 8.1; 95% confidence interval [CI], 3.2-20.3), those without tangible support (OR, 6.6; 95% CI, 3.3-13.2), and retired women (OR, 2.7; 95% CI, 1.2-6.0) were more likely to report high severity IPV. Women experiencing high severity IPV were also more likely to suffer from poor health than were those who experienced low severity IPV.

CONCLUSIONS

The distribution of low and high severity IPV seems to be influenced by the social characteristics of the women involved and may be an important indicator for estimating health effects. This evidence may contribute to the design of more effective interventions.

Do social inequalities exist in terms of the prevention, diagnosis, treatment, control and monitoring of diabetes? A systematic review

The major increase in the prevalence of diabetes mellitus (DM) has led to the study of social inequalities in health-care. The aim of this study is to establish the possible existence of social inequalities in the prevention, diagnosis, treatment, control and monitoring of diabetes in Organisation for Economic Co-operation and Development (OECD) countries which have universal healthcare systems. We searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews for all relevant articles published up to 15 December 2007. We included observational studies carried out in OECD countries with universal healthcare systems in place that investigate social inequalities in the provision of health-care to diabetes patients. Two independent reviewers carried out the critical assessment using the STROBE tool items considered most adequate for the evaluation of the methodological quality. We selected 41 articles from which we critically assessed 25 (18 cross-sectional, 6 cohorts, 1 case-control). Consistency among the article results was found regarding the existence of ethnic inequalities in treatment, metabolic control and use of healthcare services. Socioeconomic inequalities were also found in the diagnosis and control of the disease, but no evidence of any gender inequalities was found. In general, the methodological quality of the articles was moderate with insufficient information in the majority of cases to rule out bias. This review shows that even in countries with a significant level of economic development and which have universal healthcare systems in place which endeavour to provide medical care to the entire population, socioeconomic and ethnic inequalities can be identified in the provision of health-care to DM sufferers. However, higher quality and follow-up articles are needed to confirm these results.

Identifying sociodemographic differences in Intimate Partner Violence among immigrant and native women in Spain: a cross-sectional study

OBJECTIVES

To analyze whether sociodemographics and social support have a different or similar effect on the likelihood of Intimate Partner Violence in immigrants and natives, and to estimate prevalences and associations between different types of IPV depending on women's birthplace.

METHODS

Cross-sectional study of 10,048 women (18-70 years) attending primary healthcare in Spain (2006-2007).

OUTCOME

Current Intimate Partner Violence (psychological, physical and both). Sociodemographics and social support were considered first as explicative and later as control variables.

RESULTS

Similar Intimate Partner Violence sociodemographic and social support factors were observed among immigrants and natives. However, these associations were stronger among immigrants, except in the case of poor social support (adjusted odds ratio natives 4.36 and adjusted odds ratio immigrants 4.09). When these two groups were compared, immigrants showed a higher likelihood of IPV than natives (adjusted odds ratios 1.58).

CONCLUSION

Immigrant women are in a disadvantaged Intimate Partner Violence situation. It is necessary that interventions take these inequalities into account.

[Mental disease, existence of diagnostic, use of psychotropic medication: differences by autonomous communities under the national health survey 2006]

BACKGROUND

Most of the studies on psychological distress in Spain have been conducted in small geographical areas or specific population groups. However, there are no studies that provide representative data for each Autonomous Community (AC). The objectives of this paper are to determine, both in Spain and in the AC, the prevalence of psychological distress, diagnosis, use of psychoactive medication, social support and self-perceived health, as well as to study the association between psychological distress and the rest of the variables.

METHODS

Cross-sectional study, using data from the 2006 National Health Survey, that was completed by 29,478 persons.

VARIABLES STUDIED

sociodemographics, psychological distress (GHQ-12), self-perceived health, mental disorder diagnosis, functional social support (Duke) and use and prescription of psychoactive medication.

RESULTS

The prevalence of psychological distress in Spain was 20,1%; the highest prevalence was found in Canary Islands (28,2%) and the lowest in La Rioja (12,2%). Among those who presented psychological distress, 62,4% had never received a mental disorder diagnosis, and 71,6% had not used psychoactive medication in the last year. The highest prevalences of non-diagnosed cases (81,8%) and cases non-treated with psychoactive medication (83,1%) were found in La Rioja, whereas the lowest prevalences were found in Asturias. Eight percent of the persons who presented psychological distress had low social support and 63,8% reported bad self-perceived health.

CONCLUSIONS

Psychological distress is a prevalent phenomenon, and more than half of the persons who suffer it receive neither a diagnosis nor psychoactive medication. Moreover, there are considerable differences between the AC.

Biological, psychosocial, therapeutic and quality of life inequalities between HIV-positive men and women - a review from a gender perspective

The proportion of women infected with HIV worldwide has grown in recent years. From a transmission pattern that was once predominantly homosexual men and through intravenous use of drugs, the current pattern has become, to a large extent, heterosexual. Women are more vulnerable to be infected with HIV due to anatomical and psychosocial differences. In spite of this changing gender trend in the HIV pandemic, biological, psychosocial, therapeutic, and quality of life aspects have not been examined in detail in women. Moreover, this lack of investigation has relevance in terms of vertical transmission of the infection to newborns. Herein, we review gender differences in HIV, identifying from a gender perspective the biological and social factors with a greater influence on vulnerability to infection, and, on the other hand, examining gender differences with respect to the use of services, treatment, survival, and quality of life.

[Geographical variability in violence against women in Spain]

OBJECTIVES

To describe the prevalence of intimate partner violence and non-partner violence against women in Spain overall and by autonomous regions, as well as the characteristics of this violence, and to study the association between the prevalence of intimate partner violence and the frequency of formal complaints and deaths.

METHODS

A cross-sectional survey was performed through a self-administered questionnaire in 11,475 women attending primary care from 2006 to 2007. Multistage stratified sampling was carried out in a representative sample in each autonomous region. Data on intimate partner and non-intimate partner violence, formal complaints to the police and deaths due to intimate partner violence were gathered. A descriptive analysis was conducted. Correlations between the prevalence of intimate partner violence and police reports and deaths from this cause were determined through Pearson's correlation coefficient.

RESULTS

A total of 24.8% (23.4%-26.3%) of the sample reported having experienced intimate partner violence at some time. The highest prevalence of intimate partner violence was found in Ceuta and Melilla (40.2%) and the Balearic Islands (32.5%) and the lowest in Cantabria (18%). Fifteen percent of the sample reported having experienced non-partner violence at some time, and the most frequent type was that committed by a relative. Again, the highest prevalence of non-partner violence was found in Ceuta and Melilla and the Balearic Islands and the lowest in Cantabria. A significant positive linear correlation was found between intimate partner violence in the previous year and the rate of reports of intimate partner violence in the autonomous regions (r=0.398; p=0.005).

CONCLUSIONS

The prevalence of intimate partner violence varies from one autonomous region to another. The reasons for this variation should be further explored in future studies.

[Gender-based violence against immigrant and Spanish women: scale of the problem, responses and current policies]

OBJECTIVE

To compare the prevalence of gender-based violence among immigrant and Spanish women. To describe their responses to this problem and the possible differences. To identify specific interventions to deal with gender-based violence in immigrant women in Spain.

METHODS

We performed a cross-sectional survey through a self-administered questionnaire in 10,202 women attending primary care in Spain (2006-2007). A content analysis was performed of the follow-up report of law 1/2004 of integral protection measures against gender violence sent by each Spanish region (2005) and the most recent regional laws and acts.

RESULTS

The prevalence of gender-based violence was 14.3% in Spanish women and 27.9% in immigrant women. The likelihood of gender-based violence was higher in immigrant (odds ratio adjusted: 2.06; 95% confidence interval: 1.61-2.64). Immigrant women more frequently reported that they had denounced their intimate partners and that they did not know how to manage the situation. Some Spanish regions have already started interventions to overcome access barriers to social and health services, but only three have provided data on the number of immigrant women who received economic and occupational help up to 2005.

CONCLUSIONS

Inequalities were observed in the prevalence of gender-based violence according to country of origin, with immigrant women being more frequently affected. Immigrant women more frequently denounce their intimate partners than Spanish women but this action does not guarantee effective results. Other specific interventions have been identified in some autonomous regions of Spain but these interventions need to be evaluated to ensure that they benefit immigrant women.

[The protective role of social support and intimate partner violence]

OBJECTIVE

To describe the relationship between the presence of social support and overall support from different sources and intimate partner violence in women attending primary care centers irrespective of reason.

METHOD

We performed a cross-sectional survey in 1,402 women aged 18 to 65 years old, randomly selected from 23 primary health practices in the autonomous communities of Andalusia, Madrid and Valencia (Spain) in 2003. The information on sociodemographic characteristics, physical, psychological and sexual intimate partner violence, and social support was gathered using an anonymous, self-administered questionnaire.

RESULTS

Thirty-two percent of the women stated they had been abused by a partner (physically, psychologically or sexually) at some time in their lives. Women who reported having social support had a 89% lower probability of having been abused by a partner at some time than women who reported not having social support (odds ratio [OR] = 0.11; 95% confidence interval [95%CI]: 0.06-0.20). Among women who reported abuse by a partner in the past, those who stated they had social support had a lower probability of being abused again by a different partner than those who had no social support (OR = 0.14; 95%CI: 0.05-0.37).

CONCLUSIONS

The cross-sectional design of this study does not allow us to determine whether lack of social support increases women's vulnerability to being abused, or whether social isolation is a consequence of partner abuse. Nevertheless, interventions in women experiencing abuse by their partners should aim to reestablish their social networks.

Factors associated with improvement in disability-adjusted life years in patients with HIV/AIDS

BACKGROUND

The epidemic of HIV/AIDS and treatments that have emerged to alleviate, have brought about a shift in the burden of disease from death to quality of life/disability. The aim was to determine which factors are associated with improvements in the level of health of male and female patients with HIV/AIDS in Andalusia, in terms of disability-adjusted life years.

METHODS

Descriptive study based on a sample group of 8800 people on the Andalusian AIDS register between 1983 and 2004.

DEPENDENT VARIABLES

Life lost due to premature mortality (YLL), years lost due to disability (YLD) and disability-adjusted life years (DALY).

INDEPENDENT VARIABLES

vital state, sex, age at the time of diagnosis, age at the time of death, transmission category, province of residence, AIDS-indicator disease and the period of diagnosis. A bivariate analysis was carried out to find out if the health level variables changed in accordance with the independent variables. Using the independent variables which had a statistically significant link with the level of health variables, a multivariate linear regression model, disaggregated by gender, was constructed.

RESULTS

Amongst the women, we found a model which explained the level of health of 64.9%: a link was found between a higher level of health (lower DALYs) and not intravenous drug use, the province of residence, being diagnosed during the HAART era and older age at the time of diagnosis. Amongst the men, we found a model which explained the level of health of 64.4%: a link was found between a higher level of health (lower DALYs) and intravenous drug use, the province of residence, being diagnosed during the HAART era and older age at the time of diagnosis.

CONCLUSION

A higher level of health (lower DALY) amongst both men and women was found to be linked to not be intravenous drug user, the province of residence, being diagnosed during the HAART era and older age at the time of diagnosis.

Influence of antiretroviral treatment on quality of life in seropositive inmates

The aim of the study is to evaluate the influence of antiretroviral treatment on health-related quality of life (HRQOL) of three groups of HIV-positive inmates: those who are taking antiretroviral treatment, those who are not on treatment as it has not yet been indicated, and those who refuse to take treatment even though it has been recommended. A cross-sectional study was conducted on 585 HIV+ inmates in three prisons. The response variable was HRQOL. Independent variables were: sociodemographic variables, psychosocial and drug-related variables. Two multivariate linear regression models were constructed in order to determine the HRQOL, physical health score (PHS) and mental health score (MHS), for each of the three groups identified, using patients who refused treatment as the reference category. Patients who refused therapy had a lower MHS compared with patients in whom treatment was not indicated (P = 0.038). With regard to PHS, patients refusing therapy had a lower score than patients who were not indicated therapy (P = 0.005), and than patients receiving therapy (P = 0.010).

Methodological issues in the study of violence against women

The objective of this paper is to review the methodological issues that arise when studying violence against women as a public health problem, focusing on intimate partner violence (IPV), since this is the form of violence that has the greatest consequences at a social and political level. The paper focuses first on the problems of defining what is meant by IPV. Secondly, the paper describes the difficulties in assessing the magnitude of the problem. Obtaining reliable data on this type of violence is a complex task, because of the methodological issues derived from the very nature of the phenomenon, such as the private, intimate context in which this violence often takes place, which means the problem cannot be directly observed. Finally, the paper examines the limitations and bias in research on violence, including the lack of consensus with regard to measuring events that may or may not represent a risk factor for violence against women or the methodological problem related to the type of sampling used in both aetiological and prevalence studies.

Analysis of the impact of fibromyalgia on quality of life: associated factors

We analysed the impact of fibromyalgia (FM) on the functional capacity of patients suffering this syndrome and identified factors that are associated with greater disease impact. We performed a cross-sectional descriptive telephone survey on all patients diagnosed with fibromyalgia during 2003 in a university hospital in Spain. Variables studied were socio-demographic, job, clinical, health and psycho-social characteristics of patients diagnosed with FM and impact of FM on them. Disease impact was measured by means of the Fibromyalgia Impact Questionnaire (FIQ). The rest of variables were collected by means of an expressly designed questionnaire. The relation between FIQ score and the other variables was performed with a bivariate analysis, using several tests depending on the variables involved. To analyse the factors associated with greatest disease impact, a multivariate linear regression model was designed. The average FIQ score for the sample was 63.6. Having a larger number of children, being tired and being in a depressed mood were the symptoms that most affected activities of daily living. A diagnosis of any mental illness, reference to repercussion on the family environment, a lower self-rated health and having consulted more specialists before FM diagnosis were associated with a higher impact after adjusting according to all the variables in the model. It can be confirmed that the FIQ is a useful instrument for measuring the impact of FM on quality of life. Identifying factors that determine the extent of its impact will enable more effective therapeutic strategies to be designed.

Physical health consequences of intimate partner violence in Spanish women

BACKGROUND

Intimate partner violence (IPV) against women can result in serious health problems. The objectives of this study are to analyse the association between the different types of IPV and women's physical health, and to examine whether this association varies depending on the intensity, duration and timing of the violence.

METHODS

A sample of 1402 randomly selected women attending 23 family practices in Spain responded to an anonymous self-reported questionnaire. Measures considered were exposure to physical, sexual and psychological IPV; intensity, duration and timing of such violence; chronic physical disease; number of lifetime surgical operations and number of days spent in bed in the last three months. Descriptive, bivariate and multivariate analyses were conducted.

RESULTS

Lifetime IPV prevalence was 32%. Higher prevalence of chronic disease was observed in abused women than in never abused women, as well as greater number of days spent in bed. Women who reported having experienced the three types of IPV were more likely to suffer a chronic disease (OR = 2.03; 95% CI = 1.18-3.51) and to spend more days in bed (t = 2.35; P = 0.019) than those never abused. Women abused in the past but not in the present presented a higher probability of having a chronic disease than never abused women, and women who had been abused both in the past and in the present had a higher probability of spending more days in bed.

CONCLUSION

IPV can negatively affect physical health of the victims. It is therefore necessary to detect cases of IPV at a primary health care level.

Publicaciones sobre mujeres, salud y género en España (1990-2005)

BACKGROUND

The studies on women, gender and health are increasingly more frequent in Spain. This research is aimed at ascertaining the topics dealt with in these publications, the disciplines studying said topics, the sex of the leading author and whether these topics have been approached from a gender-related standpoint.

METHODS

A search was conducted for published studies in Biomedicine, Sociology, Nursing, Anthropology and Psychology databases. The main key words used were [women or gender] and [health] and [Spain]. Original articles, reviews and monographic studies, both national and international, published within the 1990-2005 period were included. The variables taken into consideration were the topic of study, field of expertise, gender focus and sex of those publishing the work. A total of 298 works were included.

RESULTS

The topics dealt with the most were sexual and reproductive health (39.2%) and mental health (12.4%). A total of 58.7% of the works were authored by a woman as the leading author and 47.3% had no gender focus. A total of 85.3% of the publications on sexual and reproductive health do not incorporate the gender standpoint, whilst 94.1% of the works on productive and reproductive work did however include this standpoint. A total of 80.4% of the works in Biomedicine have no gender focus.

CONCLUSIONS

Even though they are scarce, the works having a gender focus are signed mostly by women as the leading authors. In the material studied, women's health continues to be confined to reproduction, it being necessary for other factors having a direct bearing on women's health to be included.

Women's response to intimate partner violence

The responses of women to a situation of abuse by their partner has hardly been addressed in the literature. Using a self-administered, anonymous questionnaire, 400 women attending three practices in a primary health care center in Granada (Spain) were studied. The women's response to abuse was used as a dependent variable. Sociodemographics, intensity, duration, and combination of the types of abuse were used as independent variables. Lifetime prevalence of any type of partner abuse was 22.8%. Of abused women, 68% showed an active response, attempting to resolve the situation mainly through separation (58.2%). The factors independently associated with a woman's active response were being separated, widowed, or divorced; reporting a greater intensity of abuse; and being younger than age 35 years. The results of this study show that a large majority of abused women in Spain try to resolve their situation, and that they are not passive victims.

How do women in Spain deal with an abusive relationship?

OBJECTIVES

To determine the different responses adopted by women in Spain who are victims of intimate partner violence (IPV); identify the different sociodemographic profiles associated with each response; analyse the factors contributing to adopting a response; and study the association between the different types of response and the different types of IPV.

DESIGN

Cross sectional study.

SETTING

23 volunteer general practices in Spain.

PARTICIPANTS

1402 randomly selected women.

MAIN OUTCOME MEASURE

Women's response to IPV: none, partner separation, reporting the case to the police, seeking help from healthcare professionals and seeking help from associations for battered women.

RESULTS

Lifetime prevalence of any type of IPV (physical, psychological, and/or sexual) was 32%. Sixty three per cent of abused women took some kind of action to overcome IPV. Women who separated from their partners were mostly younger, with a smaller number of children and higher income and educational levels, compared with those abused women who reported the abuse to the police or sought help from healthcare professionals or associations for battered women. Independent factors associated with presenting a response to IPV were: being separated/divorced/widowed, having social support, having experienced IPV frequently, and having experienced physical and psychological abuse (compared with psychological abuse alone). Women who experienced the three types of abuse were also more likely to respond to violence.

CONCLUSIONS

Identifying the factors that have an influence on the response adopted by abused women allows us to better understand the support needed by them to abandon an abusive relationship.