salud comunitaria

"if the major determinants of health are social, so must be the remedies" Michael Marmot


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Integración de programas y servicios de salud sexual y reproductiva

(Remitido por Mercedes García)

Recien publicado documento de la OPS donde se realiza una propuesta de integración y vinculación entre los Programas de Salud Sexual y Reproductiva, Género y de Prevención de VIH-ITS.
Acceso al texto completo (pdf 10.2 MB)

Los temas que toca el documento en líneas generales son:

- Importancia de la armonización de los esfuerzos en salud sexual y reproductiva,perspectiva de género y respuestas programáticas al VIH/sida y otras infeccionesde transmisión sexual (ITS).

- Integración de salud reproductiva y sexual
– Sexualidad y prevención de la infección por el VIH
– Enfoque basado en derechos humanos
– Creación de una cultura de prevención.

- Progresos y obstáculos para la conexión de intervenciones en salud sexual y reproductiva, perspectiva de género y respuestas programáticas al VIH/sida y otras ITS

- Determinantes sociales de la infección por el VIH/sida y la función clave de la sexualidad.
– Metas, estrategias y espacios para atender la Salud Sexual y Reproductiva a través del ciclo de vida.
– Etapas en el desarrollo de estrategias para la articulación de programas y servicios de salud sexual, salud reproductiva y prevención y atención integral de VIH/ITS.
– Ejemplos de arquitecturas de servicios integrados.


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Who am I? Where am I?

“Who am I? Where am I?” Experiences of married young women in a slum in Islamabad, Pakistan
Saima Hamid email, Eva Johansson email and Birgitta Rubenson email
BMC Public Health 2009, 9:265doi:10.1186/1471-2458-9-265

Background

In Pakistan, 16% of the women aged 15-19 years are married. Many get married shortly after they attain menarche. This study explores the preparedness for and actual experiences of married life (inter-spousal relationship, sexual activity and pregnancy) among adolescent women.

Methods

Among married adolescent women residing in a slum of Islamabad ten were selected with the help of a community health worker and interviewed qualitatively till saturation was reached. They were interviewed three times at different occasions. Narrative structuring was used to explore how the participants represented their background, social situation, decision making and spousal communication and how they explained, understood and managed married life and bore children.

Results

Two categories identifying the respondents as either submissive-accepting or submissive-victims emerged. The married young women who belonged to the accepting group lived under compromised conditions but described themselves as satisfied with their situation. They were older than the other group identifying themselves as victims. However, none of the respondents felt prepared for marriage. Women belonging to the victimized group experienced physical and verbal abuse for their inability to cope with the duties of a wife, caretaker of the home and bearer of children. Their situation was compounded by the power dynamics within the household.

Conclusion

Knowledge about sexuality could prepare them better for the future life and give them more control of their fertility. Adolescent development and life skills education need to be addressed at a national level. There is need for innovative interventions to reach out and provide support to young women in disadvantaged homes.


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Desigualdad socioeconómica y decisión de abortar

[Socioeconomic Inequalities in Unintended Pregnancy and Abortion Decision. Laia Font-Ribera, Glòria Pérez , Joaquín Salvador and Carme Borrell. Journal of Urban Health. Vol 85, Number 1/enero 2008.]

Artículo en pdf

Estudio publicado en el Journal of Urban Health donde se describen las profundas desigualdades socioeconómicas en embarazos no deseados y en la decisión de abortar en mujeres de Barcelona.

Pregnancy planning allows women to better control their life trajectory and contributes to the future child’s health and development. Many studies that have analyzed socioeconomic inequalities in unintended pregnancy only took into account those pregnancies ending in births. Few of them that analyzed unintended pregnancy, including both induced abortion and births, and its socioeconomic determinants, concluded that unintended pregnancy is more frequent in young, poor, or unmarried women. These inequalities have been poorly studied in Europe, especially in the southern European context. The aim of the present study is to describe socioeconomic inequalities in unintended pregnancy and in abortion decision in Barcelona, Spain. The major findings are that unintended pregnancies accounted for 41% of total pregnancy and of these, 60% ended in abortion. From all pregnancies, the proportion of induced abortion reached 25.6%. Compared to women with university studies, those with primary education uncompleted had more unintended pregnancies (OR = 7.22). When facing an unintended pregnancy, women of lower socioeconomic position are more likely to choose induced abortion, although this is not the case among young or single women. This study reveals deep socioeconomic inequalities in unintended pregnancies and abortion decision in Barcelona, Spain, where the birth rate is very low and the abortion rate is rising. Women in low socioeconomic positions have many more unintended pregnancies than better educated women. Except for young or single women, the lower the socioeconomic position, the higher the proportion of women who choose an induced abortion when facing an unintended pregnancy.


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¿Equidad? Menos nivel de ingresos familiares, más morbimortalidad perinatal

Joseph KS, Liston RM, Dodds L, Dahlgren L, Allen AC. Socioeconomic status and perinatal outcomes in a setting with universal access to essential health care services. CMAJ. 2007;177:583-90.

David Pérez* nos envía este interesante artículo publicado el 11 de septiembre en el CMAJ y con traducción y comentarios en el Evidencias en Pediatría.
El objetivo del estudio es determinar si el nivel de ingresos familiar (NIF) está asociado con la morbimortalidad perinatal, neonatal e infantil en un Estado que ofrece cobertura sanitaria gratuita (estudio descriptivo transversal con una muestra amplia de 91.914 mujeres que dieron a luz entre los años 1988 y 1995 en Nueva Escocia-Canadá).
Los autores del estudio concluyen que pese a la disponibilidad de un servicio sanitario gratuito, un bajo NIF se asoció con mayor incidencia de diabetes gestacional, bajo peso para la edad gestacional y mortalidad infantil.

maternidadytabaco

(en el gráfico se indica el porcentaje de madres no-fumadoras en relación con los ingresos familiares. El gráfico completo relaciona también las mujeres que aportan y las que no aportan a fondos de jubilación como otra forma de medir el nivel socioeconómico)
(* David Pérez Solís, mítico pediatra asturiano, hermano del no menos mítico médico de familia Pablo Pérez. Artífice, siendo estudiante de medicina, de unas jornadas sobre Salud y Desarrollo donde participaron Pedro Alonso y David Werner allás por el 97, propiciando una inolvidable cena en Gijón con Werner. Coordinó la traducción del libro de Werner y Sanders “CUESTIONANDO LA SOLUCIÓN:Las Políticas de Atención Primaria de Salud y Supervivencia Infantil”

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