Vulnerability in women primary caregivers of children in palliative care due to intimate partner violence in a pediatric hospital in Mexico / Vulnerabilidad en mujeres cuidadoras primarias de menores en cuidados paliativos debida a violencia de pareja en un hospital de niños en México

Abstract Background: Women are the primary caregivers of children in palliative care. Research has shown that the presence of intimate partner violence at home exacerbates the vulnerability of the caregiver. Current statistics indicate a high prevalence of violence in Mexico present in the intersectionality between intimate partner violence and the role of the primary caregiver. This study aimed to describe the frequency of intimate partner violence among primary palliative caregivers at the Hospital Infantil de México Federico Gómez. Methods: We conducted a cross-sectional and prospective study with convenience sampling; no sample calculation was performed. All female primary caregivers of children in the palliative care unit were invited to participate. The Scale of Violence and Index of Severity of Violence was used as the measuring instrument. Results: One hundred women participated in the study by submitting their survey in a designated mailbox. No sociodemographic data or patient diagnoses were collected. The frequency of intimate partner violence was 28%, of which 16% were considered severe cases. Women reported psychological violence (36%), sexual violence (23%), and physical violence (22%). Conclusions: Almost one-third of female primary caregivers of pediatric patients at the Hospital Infantil de México Federico Gómez have been victims of some form of violence by current partners. This study highlights a previously unreported problem and opens the door for studies to correlate intimate partner violence among primary caregivers and the quality of life of children in palliative care.

Resumen Introducción: Las mujeres son las principales cuidadoras de los niños en cuidados paliativos. Las investigaciones han demostrado que la violencia de pareja en el hogar exacerba la vulnerabilidad del cuidador. Las estadísticas actuales sobre violencia en México indican una alta prevalencia presente en la interseccionalidad entre la violencia de pareja y el rol de cuidador principal. El objetivo de este estudio fue describir la frecuencia de violencia de pareja entre los cuidadores primarios del Hospital Infantil de México Federico Gómez (HIMFG). Métodos: Se llevó a cabo un estudio transversal y prospectivo con muestreo por conveniencia; no se realizó ningún cálculo de muestra. Se invitó a participar a todas las mujeres cuidadoras primarias de niños en la Unidad de Cuidados Paliativos. Se utilizó como instrumento la Escala de Violencia e Índice de Severidad de la Violencia. Resultados: Cien mujeres participaron en el estudio; no se recogieron sus datos sociodemográficos ni diagnósticos. La frecuencia de violencia de pareja fue del 28%: 16% se consideraron casos graves. Las mujeres reportaron violencia psicológica (36%), violencia sexual (23%) y violencia física (22%). Conclusiones: Alrededor de la tercera parte de las mujeres cuidadoras principales de pacientes pediátricos del HIMFG han sido víctimas de algún tipo de violencia por parte de sus parejas actuales. Este estudio destaca un problema no informado previamente y abre la puerta a estudios para correlacionar la violencia de pareja íntima entre los cuidadores primarios y la calidad de vida de los niños en cuidados paliativos.

Feelings of insecurity regarding organized crime in Tamaulipas, Mexico / Sentimientos de inseguridad en relación con el crimen organizado en Tamaulipas, México

Abstract Objective To understand the meanings, feelings and practices associated with insecurity in a context with the presence of organized crime. Materials and methods The study was conducted in a municipality of Tamaulipas, México, with high levels of violence. Semi-structured interviews were conducted with a purposive sample of thirty indirect victims. Interview transcriptions underwent computer-assisted qualitative analysis using the MAXQDA program. Results Threatening situations and perceived causes of insecurity in the local context were identified. Various psychosocial consequences of insecurity and coping strategies are also described. Conclusions Although the strategies used attempt to reduce the impact of insecurity on mental health, a transformation of mobility in public space and social relations is observed. Citizens handle insecurity at the individual level, even when it is attributed to structural causes.

Resumen: Objetivo Comprender los significados, afectos y prácticas asociadas con la inseguridad en un contexto con presencia del crimen organizado. Material y métodos El estudio se realizó en un municipio de Tamaulipas, México, con altos niveles de violencia. Se llevaron a cabo entrevistas semiestructuradas, con una muestra propositiva de treinta víctimas indirectas. Las transcripciones de las entrevistas fueron sometidas a un análisis cualitativo asistido por computadora mediante el programa MAXQDA. Resultados Se identificaron las situaciones amenazantes y las causas percibidas de la inseguridad en el contexto local. También se describen diversas consecuencias psicosociales de la inseguridad y las estrategias empleadas para su afrontamiento. Conclusiones Aunque las estrategias empleadas buscan disminuir el impacto de la inseguridad en la salud mental, se observa una transformación de la movilidad en el espacio público y las relaciones sociales. Los ciudadanos manejan la inseguridad a nivel individual, aún cuando le atribuyen causas estructurales.

La coerción sexual asociada con los mitos de violación y las actitudes sexuales en estudiantes universitarios / Sexual coercion associated with the myths of rape and sexual attitudes in college students

La violencia sexual es el logro de actos sexuales mediante coerción, intimidación, chantaje, lesiones o amenazas de daño físico y varía desde acercamientos hasta la violación. Involucra algún tipo de persuasión para que se den intercambios sexuales no consensuados y acontece con mayor frecuencia en relaciones de cortejo, noviazgo o románticas. El objetivo de este trabajo es medir la asociación entre las actitudes sexuales y la aceptación de los mitos de violación con la coerción sexual en una muestra de jóvenes universitarios y hacer una comparación por sexo y grupos de edad. La muestra del estudio fue no aleatoria e incluyó a 630 estudiantes universitarios. El 51% de la muestra reportó experiencias de coerción sexual; los hombres la ejercieron casi tres veces más (71.1%) que las mujeres (28.9%). Las mujeres que ejercieron coerción reportaron una actitud sexual menos tradicional que los hombres (F= 21.413, p<.001) y las que la sufrieron aceptaron más la permisividad (F=37.432, p<.001). Los hombres que sufrieron coerción culpabilizaron más a las víctimas de violación que las mujeres (F=10.603, p=.001); esto mismo se observó en el grupo de 17-20 años de edad (F=9.841, p=.002). El ejercicio de coerción por parte de las mujeres tiene un carácter paradójico en cuanto al rol de género. En los sujetos existe una dificultad para negociar un encuentro sexual seguro o consensuado; las mujeres que reportaron mayor permisibilidad sexual mostraron una mayor propensión a involucrarse en relaciones sexuales no planificadas y ser más vulnerables a la coerción. Es importante hacer esfuerzos para erradicar las creencias que sostienen que los comportamientos sexuales abusivos en las relaciones erótico-afectivas son normales o naturales.

Sexual violence occurs when an individual obtains sexual interaction through coercion, intimidation, blackmail, lesions or threats of physical harm. It ranges from slight approaches to rape, and involves some kind of persuasion to obtaining unwanted sexual interactions; it happens more often in dating relationships. The aim of this paper is to measure the association of sexual attitudes and the acceptance of rape myths with sexual coercion in a sample of college students, and compare these variables by sex and age. The sample was non-probabilistic and included 630 students (51% had experiences of sexual coercion); 71% of men reported practicing sexual coercion. Women who practiced sexual coercion had a less traditional sexual attitude than men (F= 21.413, p<.001), and women who faced sexual coercion had a more permissive attitude in sexual interactions (F=37.432, p<.001). Men who faced sexual coercion blamed rape victims more than women (F=10.603, p=.001). Younger men also blamed rape victims more than the older ones (F=9.841, p=.002). When women use sexual coercion it seems to have a paradoxical implication regarding their gender role. It also appears to be a problem for negotiating safe sexual encounters; women who reported more sexual permissiveness seem to participate more frequently in unplanned sexual interactions and they may be more vulnerable to coercion. It is necessary to modify beliefs about abusive sexual behaviors being normal in dating relationships.

"Salir del clóset" en la Ciudad de México / Outing in Mexico City

El objetivo de este artículo es comprender el proceso de construcción de la identidad lésbico-gay en una muestra de dieciséis personas. El artículo concluye que el modelo de Pérez es comprensivo, aunque no exhaustivo, que la identidad lésbico-gay fortalece el autoconcepto individual y puede generar procesos de cambio social a pequeña escala.

This article seeks to understand the process of LGBT identity construction in a sample of sixteen participants. It concludes that the Pérez model is comprehensive but not exhaustive, and that LGBT identity can strengthen individual self-concept and may generate small-scale social changes.

Los nuevos empresarios: Trayectoria del uso a la venta de drogas en contextos de fiesta / The new businessmen: Pathways from drug use to drug dealing in party contexts

Drugs use at party contexts has increased in recent decades. Drugs dealing facilitates consumer access to substances, whose sales practices vary according to drugs use, places for the consumption and the drug social function. Drug dealing is socially constructed from a set of practices ranging from reasons to dealing and those related to the consolidation as a common practice. The aim of this research was to describe and analyze the drugs users' experience in party contexts, about their dealer's construction process. An interpretative multiple-case study with the snowball technique was carried out to get the participants. The information was obtained by a semi-structured interview and nonparticipant observation at the dealing places. The information obtained points out the group's participation on the selection of the dealer as the initiation of drugs dealing, the extroversion features and communication skills as an important profile to be a dealer; specially, the capability to satisfy the group's emotional request through the drugs. Also, benefits as acceptation, protection and the warmth from the group and the economical earning. The dealer/businessmen consolidation is socially constructed according to the new identity assumed, the group participation and the specific activities as a business.

El uso de drogas en contextos de fiesta se ha incrementado en las últimas décadas. El narcomenudeo facilita el acceso a sustancias de consumo, cuyas prácticas de venta varían conforme a la droga de uso, los espacios de consumo y la función de la droga en los grupos que la consumen. La venta de drogas implica una serie de prácticas que la construyen y que incluyen los motivos del inicio de venta, el proceso de desarrollo y las relacionadas con la consolidación de la venta como práctica habitual. El objetivo de esta investigación fue describir y analizar la experiencia de usuarios de drogas en contextos de fiesta respecto al proceso en que se construyen como dealers. Para lo anterior, se realizó un estudio interpretativo de casos múltiples, empleando la técnica de "bola de nieve" para captar a los participantes. La observación se obtuvo por medio de una entrevista semiestructurada y la observación no participante en escenarios de venta. Se obtuvo información relacionada con los elementos del salto del uso a la venta como la elección del dealer por el grupo, su perfil para ser elegido como la extroversión y habilidades de comunicación; y sobre todo su capacidad para satisfacer la demanda de emociones de los miembros de su grupo por medio de las drogas de venta. Además, de la aceptación, protección y afecto del grupo y las ganancias económicas. La consolidación como dealer/empresario se construye conforme se asumen una nueva identidad, la participación del grupo y las actividades específicas de la empresa.

Inequidades de género, abuso de sustancias y barreras al tratamiento en mujeres en prisión / Gender inequities, substance abuse and treatment barriers in women in prison

The vast majority of women in Mexican prisons have several mental health disorders and addictions, as well as problems obtaining access to treatment for this type of problems. These women's personal background and prison conditions reflect the unresolved problems of the country, such as education and illiteracy, access to health and housing and inequity in the justice systems. The literature has shown that substance abuse affects female prisoners to a greater extent than other women, and that their disadvantaged socio-economic status makes them more likely to engage in and continue substance abuse. Other aspects that exacerbate this vulnerability are their low educational attainment, lack of job skills, and exposure to stigmatization and discrimination in addition to the physical and psychological consequences of addictive behavior. One aspect that has been internationally acknowledged is that gender inequities make women's health more vulnerable, particularly that of female prisoners, since they have greater health deficits and more treatment barriers. International literature has shown that female users of psychoactive substances in general face more barriers than men in seeking or continuing treatment. Research has also shown that the most common personal barriers in women are denial, shame and guilt. Likewise, women's anxiety and depressive disorders tend to be more prevalent and severe, which in turn prevents them from seeking help when they have substance abuse problems. The most common family-related barriers are the difficulty of attending treatment due to family, partner or childcare obligations, pregnancy or fear of losing custody of their children. The main barriers faced by women regarding treatment institutions are the insensitivity or inadequate training of the staff that work there, prejudice and negative attitudes towards women, lack of information on available treatment and extremely long waiting lists. As a result of the above, the aim of this study is to document the barriers to the treatment of addictions of female prisoners, a disadvantaged group that has rarely been studied in Mexico, in order to understand certain aspects related to this population's access to treatment and continuation of the latter. The design used for this research is an ex post facto, descriptive, non-experimental, cross-sectional field study. The sample consisted of 213 women, chosen for convenience, who met the following criteria: alcohol and drug users, ages 18 to 65, able to read and write and with no psychiatric disorders or handicaps that would prevent the interview. The women that participated in this study were drawn from two Mexico City prisons: the Centro Preventivo Femenil Oriente, which houses women that have been accused, tried and sentenced, and the Centro de Readaptación Social Femenil Tepepan, where the inmates are women who have been sentenced and also have psychiatric problems. The ethical care observed included informing the interviewees of the objectives of the study, voluntary participation, confidential handling of the information and the use of witnesses, as well as guaranteeing participants the right to abandon the study and not to answer questions they found uncomfortable. The instrument was designed as a semi-structured interview with 242 questions covering various areas including Allen's Questionnaire on Treatment Barriers. It can be self-administered by the respondents, has internal consistency, construct and content validity and was adapted by Romero (2002). Some of the respondents had to have the questionnaire read out to them because of their low educational attainment. This questionnaire consists of 41 items, 30 of which are divided into three categories: 1. characteristics of treatment services, 2. beliefs, feelings or thoughts, and 3. socio-environmental aspects. Each category also includes an open question to discover other types of barriers not included in the three categories. The results yielded the following socio-demographic profile of the interviewees: 45.5% were in the 28 to 40 year age group; and had had 6 or less years' education (41.3%) or completed junior high school (36.2%). The majority were single (48.6%) or common law (21.6%), while 50.7% had children under the age of 18. Certain other characteristics of this sample such as depression, violence and alcohol and drug use have been reported in other studies. Of the total group of women that had received treatment at some time in their lives, 52.6% (n = 112) mentioned some type of barrier to treatment for addictions. A total of 29.1% (n = 62) of these women mentioned some type of barrier to treatment for alcohol use, while 44.1 % (n = 94) cited some type of barrier to treatment for drug use. Lastly, 39.2% (n = 44) mentioned some type of barrier to treatment for both types of consumption. An analysis of the treatment sub-scale by socio-demographic variable showed greater difficulty in obtaining treatment among women ages 28 to 40 and among those with children under 18. Statistically significant differences were observed regarding the type of offense (robbery) and availability of treatment. As for the beliefs, feelings and thoughts sub-scale, statistically significant differences were found among women with children under 18 and those finding it hard to abandon consumption. The sub-scale related to situational aspects, such as rejection from friends, proved to be the main barrier to enter treatment and was statistically significant among single women. The results of this study pose challenges to the health and mental health service sector regarding the timely treatment and rehabilitation of marginalized women. Likewise, acknowledging gender inequities is crucial when it comes to designing health promotion strategies. Without this perspective, their effectiveness could be jeopardized and gender inequalities actually exacerbated.

La gran mayoría de las mujeres recluidas en las prisiones de México presentan una gran cantidad de trastornos de salud mental y adicciones, así como dificultades para acceder al tratamiento para este tipo de problemas. Los antecedentes personales y las condiciones de reclusión de estas mujeres reflejan los problemas no resueltos del país como son educación y analfabetismo, acceso a la salud, vivienda e inequidad en los sistemas de procuración de justicia. En la bibliografía se ha señalado que el abuso de sustancias afecta a las mujeres presas en mayor medida que a otras mujeres y que su situación socioeconómica desfavorable las hace más susceptibles de incidir y prevalecer en la conducta de abuso de sustancias. Otros aspectos que acentúan esta vulnerabilidad son el bajo nivel educativo, las pocas habilidades para el trabajo, la exposición a la estigmatización y la discriminación, además de las consecuencias físicas y psicológicas de la conducta adictiva. Un aspecto reconocido internacionalmente es que las inequidades de género vulneran de manera particular la salud de las mujeres, lo cual es aún más evidente en las mujeres presas, pues presentan mayores déficits en su salud y mayor número de barreras al tratamiento. Se ha documentado en la bibliografía internacional que las usuarias de sustancias psicoactivas en general se enfrentan a un mayor número de barreras que los hombres para buscar o seguir un tratamiento. Por lo anterior, el objetivo del estudio es documentar las barreras al tratamiento de adicciones de mujeres en prisión, una población desfavorecida poco estudiada en México a fin de entender algunos aspectos relacionados con el acceso a tratamientos de esta población y su permanencia en ellos. El diseño utilizado para esta investigación corresponde a un estudio de campo transversal no experimental, descriptivo, ex post facto. La muestra se conformó de 213 mujeres, seleccionadas por conveniencia, con los siguientes criterios: usuarias de alcohol y drogas, edad de 1 8 a 65 años, que supieran leer y escribir, sin trastorno psiquiátrico o discapacidad que impidiera la entrevista. Las mujeres que participaron en este estudio se seleccionaron de dos prisiones de la Ciudad de México: el Centro Preventivo Femenil Oriente, donde se encuentran mujeres indiciadas, procesadas y sentenciadas, y el Centro de Readaptación Social Femenil Tepepan, donde se encuentran mujeres sentenciadas y con problemas psiquiátricos. Los cuidados éticos observados en el estudio fueron: información de los objetivos a las entrevistadas, participación voluntaria, confidencialidad de la información, empleo de testigos, así como el derecho de abandonar el estudio y de no responder aquellas preguntas que les resultasen incómodas. El instrumento empleado tuvo un formato de entrevista semiestructurada con 242 preguntas que abarcan diversas áreas, entre ellas, el <

Reconocimiento y uso de tácticas de coerción sexual en hombres y mujeres en el contexto de relaciones heterosexuales: Un estudio en estudiantes universitarios / Recognition and use of sexual coercion tactics in men and women in the context of heterosexual relations a study of university students

Violence is a problem gone through by people in one way or another because of the great amount of manifestations in which it is presented. Sexual violence constitutes one of those ways. At the present time, sexual violence is considered a high-priority problem of public health and of human rights; this type of violence is presented in a continuum that goes from groping to forced sexual relationships. Most of the people associate sexual violence with its extreme form which is rape, but, what does it happen with that type of violence where subtlety or persuasions are involved in order to obtain a sexual relationship? This kind of violence is denominated sexual coercion, and it is defined as the use of any type of physical or emotional pressure used by a person to impose on another one acts of sexual order in the context of a heterosexual encounter of mutual agreement to go out together, to get to know themselves, or to have a romantic or erotic relationship, or a more formal relationship such as the courtship. Sexual coercion is a phenomenon mainly studied in heterosexual and student populations and by means of the theory of sexual scripts is one of the forms adopted by it that have been theoretically tackled with. Sexual scripts are all those structural blocks of knowledge information processing where concepts, categories and relationships based on social experience are gathered and which indicate how heterosexual sexual relationships are to be. The vast majority of the studies on sexual coercion have provided enough evidence on the fact that men are the main perpetrators and women are mostly the injured victims. In developing countries, such as Mexico, several studies show that young men frequently feel with the right, precisely for the fact of being men, to have sexual relationships with young women. For this reason, it is understandable that young women's sexual activity is mostly stigmatized, what can contribute to the acceptance of sexual coercion within the intimate couple relationships as a more <> behavior and socially accepted. For this reason, although men can in some moment be sexually constrained and women can exert coercion, the meaning of the fact can be different and, besides, behaviors that are carried out to obtain the wanted sexual behavior themselves also differ between men and women. Tactics constitutes a clear example on the difference between men and women in the act of coercion. Some international studies have identified, in general terms, two types of sexual coercion tactics: indirect and the direct ones. The indirect tactics are strategies in which the person hides his/her sexual purpose. The direct tactics are strategies where the person openly uses physical or psychological force to compel the other one to get involved in certain sexual activity. In Mexico there are not studies about sexual coercion in non formal relationships of heterosexual couples. Because of the above-mentioned, the present work objectives were to know the frequency and type of sexual coercion tactics in men and women university students. Methods and material Three hundred and twenty students were interviewed, 49.7% of them were men and 50.3% women, and the average individual age was of 21 years. The sample was a non random one and the study was of exploratory type. A questionnaire ad hoc of open questions was elaborated, which made inquiries on the tactics used by men and women to press people of another sex to have a sexual relationship. Personal experiences of sexual coercion were also investigated. The application of the instrument was carried out in a group way and its length was around 45 minutes. Open questions were analyzed through the search of thematic units and categories. The contents analysis was used and later transformed into cases count in order to make the corresponding statistical analysis. Result About the experience of sexual coercion, 33.4% of the total sample mentioned that he/she had been victim of sexual coercion. Women (56.1 %) reported being mainly victims of sexual coercion contrary to the men (43.9%), when carrying out an X² statistics there were not significant differences, in statistical terms, between men and women. Nine point four percent of the total sample mentioned that he/she had exerted sexual coercion toward his/her couple. Men (83.3%) reported to have mainly exerted sexual coercion toward their couple contrary to women (16.7%). When carrying out an X² statistics a significant difference, in statistical terms, between men and women was found [X²=16.21, (gl =320/1) p = .000]. Regarding the frequency of the different tactics used by men, men and women reported that the indirect tactics are the most used by men to press women to have sexual relationships. Among the indirect tactics there were found the blackmail, the <>, the verbal deceits, etc. On the other hand, the direct tactics such as threats of physical violence, use of physical violence, insistent petting, etc., were less used by men. Regarding sexual coercion tactics used by women, men and women who participated in the sample, mentioned that direct tactics are more used by women to press a man to have sexual relationships. Within this kind of tactics there were found sexual advances using the body, use of physical violence, use of verbal violence, etc. With respect to the indirect tactics, there were verbal deceits, blackmail, psychological threats, among others. Discussion This research is barely an exploratory study, non representative, but we consider that it makes a contribution of descriptive type to the understanding of sexual coercion in heterosexual relationships when considering both men as women. As it is observed in the results about the experience of sexual coercion, in general terms, such as it is shown in other studies, women were the main victims of sexual coercion, although some men reported being victims, there were no significant difference. Besides, as in other studies, men were those who mostly reported to exert sexual coercion contrary to women, being differences significant in statistical terms. Regarding the tactics used by men in order to coerce their couple, men and women who participated in the sample recognized the indirect tactics as the most used ones, which is in agreement with the outcomes found in other studies. What makes these results interesting is the fact that women recognize in a more open and significant way, that the way a man exerts coercion to a woman is by means of an indirect tactics. These results are much related with the sexual scripts where the man has to gain a sexual access to the woman. With regard to sexual coercion tactics used by women, the direct ones are outstanding, that is to say, those in which woman openly uses the physical, psychological or economic force to press a man to have sexual relationships. The studies about domestic violence state, on the whole, that violence is more exerted by men toward women than the opposite case. Nevertheless, there are also studies about domestic violence which state that women are as aggressive as men. These studies have been questioned and at the moment the debate persists about the findings, because although women use physical violence, it is important to wonder about the intensity of the blow or if the physical violence is rather a defensive answer. The results of this study show the relevance of knowing more about this phenomenon, since many of the subjects in this study are not able to identify any event of sexual coercion in their relationship, reason for which it will be necessary to search what is happening in Mexico on this matter and to even go into the topic of youth's relationships, in particular, the heterosexual ones and the scripts that regulate this relationship, in order to be able of creating better prevention programs guided to eliminate domestic violence to obtain a better mental, sexual and reproductive health.

La violencia es un problema que nos afecta a todas las personas de una u otra manera por la gran cantidad de manifestaciones en las que se presenta. Una de esas formas es la violencia sexual. En la actualidad ésta es considerada un problema prioritario de salud pública y de derechos humanos y se presenta en un continuo que va desde el manoseo hasta las relaciones sexuales forzadas. Una de las formas de este tipo de violencia es la coerción sexual que se define como el uso de cualquier tipo de presión física o emocional que es utilizada por una persona para imponer actos de orden sexual sobre otra en el contexto de un encuentro heterosexual de mutuo acuerdo para salir juntas, para conocerse o sostener una relación romántica o erótica, o en una relación más formal como el noviazgo. La coerción sexual ha sido abordada teóricamente a través de la teoría de los guiones sexuales o scripts. Aunque hombres y mujeres pueden sufrir este tipo de violencia, la gran mayoría de los estudios sobre coerción sexual han evidenciado que los hombres son los principales perpetradores y las mujeres, las víctimas. Un claro ejemplo sobre la diferencia entre hombres y mujeres en la forma de coercionar son las tácticas. Por lo anterior, el presente trabajo tiene como objetivos conocer la frecuencia y tipo de tácticas de coerción sexual en hombres y mujeres universitarios. Material y métodos Se entrevistaron a 320 estudiantes, un 49.7% de los sujetos fueron hombres y 50.3% mujeres, la media de edad fue de 21 años. La muestra fue no probabilística y el estudio fue de tipo exploratorio. Se elaboró un cuestionario ad hoc de preguntas abiertas, las cuales indagan sobre las tácticas utilizadas por hombres y mujeres para presionar a personas de otro sexo a tener una relación sexual; también se indagó sobre las experiencias personales de coerción sexual. La aplicación del instrumento se realizó de manera grupal con una duración aproximada de 45 minutos. Las preguntas abiertas fueron analizadas a través de la búsqueda de unidades temáticas y categorías. Se utilizó el análisis de contenido y después se transformó en conteo de casos para hacer el análisis estadístico correspondiente. Resultados Sobre la experiencia de coerción sexual, un 33.4% de la muestra total menciona que ha sido víctima de ella. Un 9.4% de la muestra total menciona que ha ejercido coerción sexual hacia su pareja; al realizar una X² se encontró una diferencia estadísticamente significativa entre hombres y mujeres [X² =16.21, (gl = 320/1) p = .000]. En cuanto a la frecuencia de las diferentes tácticas utilizadas por los hombres, los y las participantes reportan que las tácticas indirectas son más utilizadas por éstos, mientras que las mujeres utilizan más las tácticas directas. Discusión: Como se observa en los resultados, en general, al igual que en otros estudios, las mujeres son las principales víctimas de coerción sexual y los hombres quienes la ejercen. Los resultados de este estudio evidencian la importancia de conocer más sobre este fenómeno ya que muchos de los sujetos en este estudio no fueron capaces de identificar algún evento de coerción sexual en su relación, por lo que habrá que profundizar mucho más en el tema de las relaciones de pareja de los jóvenes, en particular en la heterosexualidad, y los guiones que la norman, para poder crear cada vez mejores programas de prevención encaminados a eliminar la violencia en las relaciones de pareja y para obtener una mejor salud mental, sexual y reproductiva.

Riesgo y letalidad suicida en pacientes con trastorno límite de la personalidad (TLP), en un hospital de psiquiatría / Suicidal risk and lethality in patients with borderline personality disorder (BPD), at a psychiatry hospital

Suicide attempt in patients diagnosed with Borderline Personality Disorder (BPD) is the most frequent cause of hospitalization in this clinical category and suicidal risks are usually the first manifestation of such disorder. Patients frequently relapse, thus generating high personal and family costs, including: treatments, hospitalization, medication, work disability in economically active people and even death. The American Psychiatric Association, through the DSM-IV, defines the Borderline Personality Disorder as <>. More specifically, criterion five of the disorder mentions self-mutilating behavior, threats, and recurrent suicidal behavior. DSM-IV reports that 8-10% of borderline patients commit suicide. In our country, however, there are no specific data about people diagnosed with BPD who actually have commited suicide. Prevalence of BPD among the general population ranks from 1 to 2%, from 11 to 20% of the psychiatric population; representing 20% of hospitalized patients. The gender distribution is 3:1, being more frequent among women than men. The objective of this study is the assessment of suicidal risk and lethality of 15 patients diagnosed with Borderline Personality Disorder. This research was conducted at the doctors' offices of the host institution, where 1.39% of a total of 1151 hospitalized patients in 2007 were diagnosed with BPD. The comorbidity of DSM-IV Axis I and BPD is frequent and can be found together with mood disorders (depression, dysthymia), substance-related disorders, eating disorders (bulimia nervosa), post-traumatic stress disorder, anxiety disorder and/or attention-deficit hyperactivity disorder. A research conducted in the USA with 504 patients diagnosed with BPD showed that 93% (n = 379) of the patients showed comorbidity of DSM-IV Axis I and mood disorders. Similar results were reported by other researchers. This study was designed to be a descriptive and transversal study. We went through the records of all the adult patients who had been hospitalized due to suicide ideation or attempt, diagnosed by psychiatrists as Borderline Personality Disorder, and confirmed by the SCID-II, and medicated by a psychiatrist. Selection criteria: 18 year-old patients or older, hospitalized due to suicide attempt or ideation, and diagnosed with BPD. The research was conducted in compliance with the regulations governing human research ethics set forth in the Declaration of Helsinki (1975). The instruments used were: the medical history of the patients, the ID file for clinical and epidemiological studies, the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID -II), the Hopelessness Scale, the Depressive Syndrome Questionnaire, the Suicidal Ideation Scale, the Risk-Rescue Scale and some risk factors such as: sexual abuse, separation from partner, parental divorce, the suicide of a close relative, and alcohol and substance abuse. The results on the lethality of suicide attempts are similar to the results of other studies: women show a higher number of less lethal suicide attempts, and the methods used are also similar (medication intoxication and mutilation). The comorbidity with depressive disorders was of 86.6%, thus our results concur with those of other studies. Regarding risk factors, 86.6% (n = 13) mentioned they have experienced some type of sexual abuse, 46.6% (n = 7) separated from their partner, 40% (n = 6) had divorced parents, and 6.6% (n = 1) had a close relative who had committed suicide. During their last suicide attempt, one of the subjects had consumed alcohol and none of them had taken drugs; however, these behaviors did not appear to potentiate the suicidal risk. According to the scales applied, 46% of the subjects (n = 7) showed severe hopelessness, while 54% (n = 8) ranged between mild or moderate hopelessness; 13% (n = 2) had severe depression according to Calderon's scale. According to the Suicidal Ideation Scale, 93.3% (n=14) had a >10 score, which means patients show risk of attempting suicide again. The Risk-Rescue Scale suggests that most patients (n = 13) exhibited deliberate self-harming behavior (e.g. cutting superficially the skin around the wrist, taking prescription drugs or intoxicating near key people who could rescue them or provide help and rescue), which are not considered true parasuicidal behavior. The literature shows that BPD is the most prevalent of all personality disorders, both in the general and clinical population, the one with the highest number of suicide attempts in the DSM-IV Axis II, and the one with the highest comorbidity with Axis I mood disorders and Axis II personality disorders. The 15 patients in this sample carried out a total of 128 suicide attempts throughout their lives, which coincides with other research results, which describe that a history of multiple suicide attempts is a predictor of future suicidal behavior and increase the suicidal risk. As shown above, there were no cases obtaining high scores in all the scales applied (hopelessness, depression, suicidal ideation, high risk and low rescue), even in the result integration per subject, thus showing very few, high-lethality suicidal cases. It would be a mistake, however, to think that suicide attempts will always be less lethal, since there is always the risk of someone attempting a more lethal suicide that translates into the death of the patient. Suicide attempt assessment in dealing with Borderline Personality Disorder becomes a necessary condition to design better therapeutic strategies, since it allows health professionals to know the degree of lethality and timely treatment. The assessment of suicide attempts enables a more realistic prognosis, which backs up and guides clinical decisions.

¿Qué es la coerción sexual? significado, tácticas e interpretación en jóvenes universitarios de la ciudad de México / What is sexual coercion? Meaning, tactics and interpretation in young university students in Mexico City

Sexual coercion in the context of flirting or courtship is a form of sexual violence that has rarely been explored in Mexico, with studies mainly being undertaken in the United States and some European countries. This may be due to the fact that it includes the use of certain practices that have traditionally not been regarded as violent and, on the contrary, been viewed as <> within intimate heterosexual relations. Like other forms of sexual violence, the definition of social coercion involves conceptual and methodological problems, since the term has been used interchangeably with other forms of sexual violence. Generally speaking, violence on dates or during courtship and sexual aggression tend to refer to a domineering behavior in sexual behavior in which physical aggression is used. At the same time, sexual coercion comprises a continuum of practices ranging from subtle psychological pressure and the use of language to the utilization of physical aggression to secure a sexual encounter. This form of violence may trigger major problems in the areas of mental, sexual, and reproductive health. For the purposes of this study, sexual coercion is defined as any type of physical or emotional pressure used by a person to impose acts of a sexual nature on another person within the context of a mutually agreed on heterosexual encounter to go out together, get to know each other or engage in a romantic or erotic relationship or in a more formal relationship such as courtship. This type of sexual violence occurs in Latin American countries where couple relationships continue to be regulated by certain cultural traditions that may prevent the problem from being detected. These norms, which are often stereotyped, create <>, in other words, structural blocks of information processing that combine concepts, categories and relationships based on the social experience that indicate how heterosexual relationships <> be conducted. These scripts and their particular expression are strongly influenced by cultural attitudes and beliefs for men and women. In view of this context, it is hardly surprising that men and women engage in coercion in different ways to secure a sexual encounter. These different forms of coercion have been conceptualized as <>, whether direct or indirect. Given the need to know how sexual coercion is defined, how it is exercised and whether coercive behavior is in fact identified, this study seeks to determine the meaning of sexual coercion, the tactics used by both sexes and the way in which young university students interpret the same coercive event. Method One way of dealing with the significance of a phenomenon, as well as its interpretation, is through the qualitative approach; for the purposes of this study, focus groups were used. Participants A total of 27 students comprised four focus groups, two comprising women, two comprising men. Three of these groups consisted of seven participants and one of six. The age range was 18 to 25. Data gathering techniques In order to obtain the information, thematic guidelines were drawn up to explore the meaning and interpretation students give sexual coercion as well as the type of tactics they recognize as being used by men and women. Procedure The study was carried out at two universities, after inviting participants to attend a focus group. At each public and private university, two groups (one of men, one of women) were formed. Analytical strategy For the analysis of the focus groups, audio-recorded interviews were transcribed. For each of the study, the entire transcription was read out for the first level of analysis. This was followed by segmentation, the extraction of fragments or paragraphs, sentences, phrases of words regarded as significant. Results As far as the significance of sexual coercion is concerned, it is striking that both men and women associate the term with extreme force, divided into three main categories: physical force, rape and violence against women. To a lesser extent, the term is identified with family violence and a continuum of sexual violence ranging from subtle to extremely severe. In order to obtain the meanings attributed to a situation of sexual coercion in courtship, participants discussed the two characters in a cartoon in order to reveal the aspects that could be regarded as accepted, permitted, questioned or rejected as means of obtaining a sexual relationship. The group discussion revealed two different points of view: men's and women's. In the analysis of the female character in the story, the men described her as a <> while the women regarded her as being responsible for what had happened. As for the male character in the story, the men perceived him as someone who was tactless and abusive, whereas the women labeled him as <>. The analysis of the tactics of sexual coercion used by men and women to obtain a sexual relationship revealed that indirect tactics are most commonly used by men and women. Conclusions It is important to note that although there are very few studies on sexual coercion in Latin American countries except in Argentina, Peru and Mexico, they must be undertaken, since failure to do so would mean neglecting a significant part of young people's sexual, reproductive, social and mental health. The following conclusions may be drawn from the results of this study: a) Most of the subjects interviewed are unclear as to the meaning of the term <>; b) Both the men and women in this study blame women for their victimization. This is particularly evident from the discussion of the cartoon on sexual coercion; c) Sexual coercion is a more common problem in women, although it has been said that men can be victims of sexual coercion as well. This finding opens up a significant line of research on how men perceive this type of violence, and d) Although both the male and female students in this study mentioned that men and women used indirect tactics more frequently to secure a sexual encounter, it is important to note that these are different, since men use subtle tactics with threats whereas women do not. This study showed that women are more likely to suffer some type of sexual coercion and that men use indirect tactics with threats. Although the subjects that participated in this study mentioned certain types of tactics used by women to obtain a sexual relationship, this result must be treated with caution, since further study is required on this issue. This exploratory study on the phenomenon shows the need for prevention strategies to enable men and women to identify an event in which they perceive they are being pressed in to having a sexual encounter. This is why it is important for sex education programs to include a gender perspective and to emphasize the notion of people's rights in order to eradicate inequalities of power and thereby eliminate any type of violence.

La coerción sexual, en el contexto de situaciones de "ligue" o en el noviazgo, es una forma de violencia sexual poco investigada en México. Posiblemente esto responda a que incluye el uso de ciertas prácticas que tradicionalmente no han sido reconocidas como violentas y que, muy por el contrario, se han visto como <> en las relaciones heterosexuales íntimas. Para los fines de este trabajo, la coerción sexual se define como cualquier tipo de presión física o emocional utilizada por una persona para imponer a otra actos de orden sexual en el contexto de un encuentro heterosexual de mutuo acuerdo para salir juntas. El presente trabajo tiene como objetivo conocer el significado de coerción sexual, las tácticas utilizadas por ambos sexos y la manera en que interpretan un mismo suceso coercitivo distintos jóvenes universitarios. Método Para los fines de este estudio, se utilizaron grupos focales. Participaron un total de 27 estudiantes que conformaron cuatro grupos focales: dos de mujeres y dos de hombres. Para obtener la información, se elaboró una guía temática que abordaba el significado e interpretación que otorgan los estudiantes a la coerción sexual, así como el tipo de tácticas que reconocen son utilizadas por hombres y mujeres. Procedimiento El estudio se llevó a cabo en las instalaciones de las Universidades participantes, previa convocatoria para asistir al grupo focal. Para el análisis de los grupos focales se transcribieron las entrevistas audiograbadas. Se realizó una segmentación que es la extracción de fragmentos o párrafos, oraciones, frases o palabras consideradas significativas. Resultados En cuanto al significado de la coerción sexual, destaca que hombres y mujeres asocian el concepto con el uso de una fuerza extrema. Para dar una idea de los significados atribuidos a una situación de coerción sexual en el noviazgo, se discutieron los dos personajes de una viñeta con el fin de dar cuenta de los aspectos que pueden considerarse aceptados, permitidos, cuestionados o rechazados como medios para obtener una relación sexual. Tras analizar las tácticas de coerción sexual utilizadas por hombres y mujeres para obtener una relación sexual, se encontró que las tácticas indirectas son las más utilizadas por ambos. Conclusiones De los resultados de este estudio se puede concluir lo siguiente: a) La gran mayoría de los sujetos entrevistados no tiene claro el significado del concepto <>. b) Tanto los hombres como las mujeres de este estudio culpan a las segundas de su victimización, situación que se ve muy clara en la viñeta sobre coerción sexual, c) Se pudo constatar que la coerción sexual es un problema que padecen con más frecuencia las mujeres, aunque se menciona que los hombres también pueden ser víctimas de coerción sexual. Este hallazgo abre una importante línea de investigación sobre cómo perciben los hombres este tipo de violencia. d) Por último, aunque todos los estudiantes participantes en este estudio mencionan que las tácticas indirectas son las que utilizan con más frecuencia los hombres y las mujeres para obtener un encuentro sexual, es importante señalar que hay diferencias ya que los primero recurren a una táctica sutil con amenaza y las mujeres no. Este estudio exploratorio sobre el fenómeno permite formular las estrategias de prevención necesarias para que hombres y mujeres sean capaces de identificar un evento en que perciban que se les presiona para tener un encuentro sexual. Por lo cual es importante que los programas de educación sexual contemplen una perspectiva de género y que además enfaticen sobre la noción de derechos de las personas para erradicar las desigualdades de poder y así eliminar cualquier tipo de violencia.

Female depression and substance dependence in the Mexico City penitentiary system / Depresión en mujeres y la dependencia a sustancias en el sistema penitenciario de la Ciudad de México

Summary: The prevalence of mental disorders in people deprived of freedom has been estimated at between 10 and 15%. Acute or chronic mental illnesses provoke a major breakdown and maladjustment to prison conditions. The more frequent diagnose of mental disorders have been substance consumption, major depression, bipolar disorder, post-traumatic stress disorder and psychotic disorders. Objective To identify the frequency of major depressive episode in women in prison in Mexico City, its frequency of association with alcohol and substance dependence, and to describe the symptomatic and socio-demographic characteristics. Material and method A transversal, non-experimental, descriptive, ex post facto field study, in two prisons of Mexico City (Centro Preventivo Femenil Oriente [Preventivo Oriente] and the Feminine Center for Social Readaptation Tepepan CERESO), in a non- probabilistic sample of 213 women, selected by convenience. The instrument was designed ex profeso. For the evaluation of the major depressive episode, the Mini International Neuropsychiatric Interview (MINI) and DSM-IV criteria were used for substance dependence. Field work lasted from August 2001 to March 2004. Interviews were carried out under previous informed consent; confidentiality and anonymity were guaranteed. In collaboration with the Center of Orientation and Classification (COC), each center elaborated a list of inmates with a history of substance abuse who met the inclusion criteria to take part in the research. Results The mean age of the interviewed population was 30.6 ± 7.9 years; 45.5% belonged to the age group between 28 to 40 years; the school attainment more frequent was elementary school (41.3%), followed by secondary school. Single women represented 48.6% of the population and 50.2% referred having, at the moment of the interview, a partner relationship. The type of offense reported with major frequency was robbery (51.6%, in different modalities: unspecific, simple, aggravated, not-aggravated, unspecific, burglary, tentative of robbery and car theft). The researched population referred that 43.7% had previously done time in some penal institution. The frequency of depressive episodes was 62% (n=132) in the interviewed population. The group between 18 to 27 years, with lower years of schooling, single mothers with children under 18 years presented the highest frequency of depression and substance abuse. Alcohol dependence and depression were more frequent in women with less than six months in prison. For depression and substance dependence, the more affected group was the one between one to four years of imprisonment. As to the length of the sentence, women with three to seven years were the most affected by the two diagnoses. Conclusions The interviewed population showed that the longer the imprisonment or the sentence, the higher the frequency of the depressive disorder. A possible explanation is that being imprisoned for a long time may have severe consequences in women's well-being due in part to the fact that in most of the cases women are abandoned by their relatives and loved ones, which intern increases their loss of social support networks. The problem of mental disorders becomes more evident when it is estimated that only 40% of the people who have a disorder had received treatment. Nearly half of the depressed women had not received support and care for their mental health problem. In the group of women with alcohol dependence, less than a quarter had asked for help, in contrast with the group with substance dependence where half of the women had asked for help. On the other hand, prison by itself generates depression and it is a normal reaction in the face of the new situation. There is also the erroneous belief that symptoms will fade away by themselves. In other studies it has been observed that being deprived of freedom causes the lose of emotional relationships, solitude and boredom, lack of services, heterosexual relationships, autonomy, security, a problematic cohabitation with other unpredictable prisoners, all of which cause fear and anxiety. All these deprivations may constitute serious threats to the personality and self-esteem.

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Riesgos asociados al consumo de alcohol durante el embarazo en mujeres alcohólicas de la Ciudad de México

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Summary: Alcoholism is among the main worldwide public health problems and it affects men and women differentially. Several studies show that, when compared to men, women develop more severe dependence, more family and social consequences and experience more difficulties to stop drinking. Differences on the impact that substance abuse has on women's life and health are related to the roles, functions and social expectancies placed on them concerning the continuity and care for the rest of the family. For this reason, alcohol intake constitutes a special problem since it affects the health of both the mother and her offspring. Alcoholic women have a higher risk of suffering obstetric complications during pregnancy, such as placenta insufficiency, intrauterine development retardation, early placenta detachment, spontaneous abortion, stillbirth and pre-term delivery. Alcohol abuse during pregnancy is also associated with low weight offspring, congenital abnormalities and further behavioral and learning difficulties. In some countries, drinking during pregnancy is considered an offense which requires legal action. In some cases, women may be put in jail until delivery and lactation. In other regions, children welfare authorities view drinking during pregnancy as a form of aggression or neglect. Such measures prevent women from searching prenatal attention which in its case might lead to severe health consequences for the mother, the embryo and the society. Estimates of alcohol consumption during pregnancy around the world vary considerably and figures range from 4.1% to 83%. However, the variation might be related to the amount of alcohol units and the period of time considered in each measurement. A case-control study in Naucalpan, Mexico, found that 11% of the women interviewees admitted having drank during pregnancy, 5% of the mothers in the control group and 2% of the case group stopped drinking during lactation. Still, any of the considered variables was found to predict postnatal mortality through logistic regression analyses. Another study performed with data from the 1988 National Survey on Addictions documents that alcohol intake during pregnancy is a risk factor for congenital abnormalities (OR=3.4). The available data about the risks associated with drinking during pregnancy in Mexico comes from research in general population, while little is known about clinical population. For this reason, the objectives of this article are: 1. to analyze the characteristics of alcohol consumption in a group of women who sought help to stop drinking, 2. to identify family history of alcohol abuse in this group and 3. to explore the consequences of drinking on their offspring. In this case study, interviews were held with 200 women who attended two treatment agencies in Mexico City due to alcohol consumption problems. The questionnaire used includes the Spanish version of the CIDI-SAM and other sections to explore drinking during pregnancy and lactation, as well as family history of alcoholism. Selection criteria were: 1. aged 18 or older, 2. seeking help for the first time, 3. physical and mental conditions that would allow to answer the questionnaire, 4. having drank during the previous year. Women agreed to participate voluntarily once the objectives of the study were explained and confidentiality assured. Personnel of both treatment agencies administered the questionnaire and interviews lasted 60 minutes average. The diagnostics of alcohol dependence were obtained according to DSM-IV criteria. Data were analyzed with the statistical program SPSS v. 10, for Windows. A total of 134 women reported having been pregnant at least once, and 57.5% of them admitted having drank alcoholic beverages during pregnancy. Age ranged from 18 to 61 years (mean=40), 50% were married or living with a partner, 18% were divorced or separated and 13% had never married. The number of children ranged from 1 to 12 with a mean of 3. High percentages of family history of alcohol abuse were found among this group (93.5%): mostly the father (72.7%), siblings (63.6%) and the partner (48.1%). Significant differences in family history of alcohol use were found between women who drank during pregnancy and those who did not drink. Around 66% reduced alcohol intake after the confirmation of pregnancy; however, 26% continued drinking as usual and 6.5% started drinking at this period. The mean number of drinks consumed per drinking occasion during pregnancy was 3.5, being the traditional beverage pulque (48.8%) and beer (34.9%) the preferred beverages. In addition, 9.2% also took medical drugs. At least three out of the seven criteria proposed in DSM-IV for alcohol dependency were met by 70.3% of the women who drank during pregnancy. More severe dependence was found among the women who drank during pregnancy than among the group of women who abstained. As to the consequences of drinking, 12% of the women reported spontaneous abortion, 13.7% pre-term deliveries, 5.5% stillbirth, 6.8% congenital abnormalities and 13.7% low birth weight. When comparing women who drank and those who did not during pregnancy, significant differences were found in the percentage of pre-term deliveries (X2=5.63; p=0.01) and congenital abnormalities (X2=4.22; p=0.05). A number of logistic regression models was assessed using three independent variables: drinking during pregnancy, frequency of alcohol consumption and severity of dependence. Dependent variables, on the other hand, were spontaneous abortion, pre-term delivery, stillbirth, congenital abnormalities, low birth weight, alcohol use by the offspring and drinking problems in the offspring. The analysis shows that alcohol consumption during pregnancy is related to pre-term deliveries (OR=7.9), and alcohol use by the offspring (OR=2.1). Severity of dependence is related as well to low birth weight (OR=3.7) and further drinking problems in the offspring (OR=2.7). Likewise, drinking every day or almost every day is also related to later drinking problems in their children (OR=2.9). Finally, having siblings who drink (OR=2.11) and meeting alcohol dependency (OR=2.21) criteria are factors that predict alcohol consumption during pregnancy. These results are consistent with other studies that report positive family history of alcohol abuse among alcoholic women. The proportion of women who stopped drinking during pregnancy (42.5%) is higher than the one reported by other authors. Prevalence of spontaneous abortion, stillbirth and congenital abnormalities are higher than the prevalence reported among general population. These findings suggest that women with severe dependence face more difficulties to stop drinking during pregnancy in spite of the social stigma imposed to future mothers who drink. The results provide some elements that support an association of alcohol abuse during pregnancy with adverse pregnancy outcomes. Nevertheless, the impact of fetal alcohol exposure responds to a complex model where a number of interacting factors, longitudinal reaserch is needed to determine the weight of each participating variable and the underlying relationship between them.

Experiencias de violencia física ejercida por la pareja en las mujeres en reclusión

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Abstract: Violence against women is an everyday problem which is expressed in various ways, whether physically, sexually or emotionally, and it may occur at either public or private level. The subject of violence against women has been regarded as a worldwide priority, since it obstructs every area of women's development. Society has acknowledged the fact that this violence "prevents the achievement of the objectives of equality, development and peace and that it violates, reduces or prevents (women's) enjoyment of human rights and fundamental liberties. A recent report by the Johns Hopkins School of Public Health and the Center for Health and Gender Equity shows that at least one out of every three women has been physically mistreated, forced to engage in sexual relations or suffered some type of abuse in the course of their lives. In Mexico as in other countries, violent behavior has been regarded as "natural" in relation to the way how to treat women; norms and everyday life have kept it hidden. Epidemiological surveys, however, show figures that reflect the scope of the problem, which in turn has meant that it is now considered as a serious health problem. Consequently, approaching the issue of intra-familial violence compels one to consider a characteristic cultural aspect: the questionable fact of referring to its existence solely within the private sphere. It is felt that what goes on inside a home is an intimate affair and that outsiders should not be aware of this, far less intervene. The same happens when one discusses the violence experienced by women living in prison, since they often continue to experience violence or abuse when they receive their conjugal visits; or else at the hands of other prisoners or from the institute itself and no-one seems willing to intervene. Women living in a penitentiary environment designed essentially for men, occupy a secondary position and are marginalized as regards planned work, cultural, sports, and recreational programs, partly due to the fact that the prison population is thought to be primarily male (1990 to 1994 reports). As Barquín notes, most women in prison experienced violence from their parents or witnessed their mothers being mistreated, and therefore became used to this type of behavior and more tolerant of it. This does not mean that these experiences should be regarded as the reason why women commit a crime or the main cause why they were admitted to the penal system. The cycle of violence that begins in the family is perpetuated in marriage and would appear to be completed in prisons, recommencing when women are released from prison. Being deprived of freedom as a result of imprisonment, together with the abuse that take place in jail appear to be a further link in the chain of multiple types of violence which constitute the path for some part of this population. Human Rights Watch is an organization that has undertaken specialized research in prisons since 1987 and in its 1988 report points out that Venezuelan prisons housed a total population of 25381 individuals, 4% of which were women. This same source reported that drug-related crimes led to a 55% increase in the jail population. In 1991, the percentage of female prisoners held in US state prisons for violent crimes was 32.2%, although that the majority had been imprisoned for non-violent crimes. Donzinger points out that the majority of women prisoners that had been sentenced for the murder of someone close to them had been victims of mistreatment or sexual abuse at some time in their lives, and thus violence against women should become an important issue for the authorities, as it is one of the most outstanding problems that reflects the current situation of the living conditions in prison centers. Given the importance that has violence against women in general, and the lack of statistical indicators on the issue of women in prison, the main objective of this paper was to describe the types of physical violence exercised by the partners of 213 women, interviewed at a Preventive Center and at Social Re-adaptation Center, in order to determine the scope of the problem and to propose intervention strategies. A non-probabilistic sample of 213 women, selected for reasons of convenience, was used. A specially designed instrument was used, consisting of a semi-structured interview with 242 questions, covering the following areas of the lives of the women interviewed: demographic data, school history, current family, family of origin, legal status, previous history of imprisonment, work experience, social networks depression, suicide risk, anguish, alcohol consumption variables, alcohol consumption measurement, variables for measuring the use of medical and non-medical drugs, scale of motives for consumption, treatment barriers, intimate relationships and sexuality, sexual abuse, violence/victimization, criminal violence, post-traumatic stress, prison environment, general health, and life styles and impulsiveness. The most important demographic characteristics of women found were: most were in the group aged from 28 to 40 year (45.5%), had six years or less of schooling (41.3%), secondary school (36.2%) and high school or technical college (16.4%) and were single (48.6%) or living with their partners (21.6%) while 50.7% had children under the age of 18. Of the 213 women interviewed, only 161 reported having suffered violence at the hands of their partners; 29.2% had experienced 1 to 5 acts, 23.4% had experienced 6 to 10, and 23.4% had been the object of 11 to 17 acts of violence. Statistics presented in this article in various research studies on family violence in most countries only show a small part of all the violence produced in families, and the results found in this research show that violence is higher among the group of female prisoners. One should not forget that prison reflects an exercise of the system that performs a marginalizing function, as it includes the poorest women from the most disadvantaged sectors, with low educational level. As Lima suggests, women are doubly stigmatized in prison, as they suffer first as women and second as criminals, not only because they belong to an underprivileged group in every social aspect, but because they belong to the group that has violated the classic image of women imposed by society, a fact for which they are severely punished, while the violence and abuse they have suffered is ignored.

Violencia sexual y problemas asociados en una muestra de usuarias de un centro de salud / Sexual violence and related problems in women attending a healthcare center

Objetivo. Estimar la frecuencia de diferentes formas de violencia sexual y su asociación con sintomatología depresiva, ideación e intento suicida, y uso de alcohol y otras drogas alguna vez en la vida. Material y métodos. Estudio transversal, hecho en un centro de salud oficial de México, D.F., México, entre febrero y marzo de 1998. La muestra estuvo constituida por 345 mujeres usuarias del establecimiento asistencial las cuales, en el momento del estudio, vivían con pareja. Se calcularon proporciones para observar la frecuencia de tres diferentes formas de violencia sexual, y ji cuadrada para compararlas en cuanto a los problemas mencionados. Resultados. De las mujeres, 19 por ciento señaló haber sido objeto de tocamientos sexuales contra su voluntad al menos alguna vez en su vida, en tanto 11 por ciento habían sido violadas y 5 por ciento fueron forzadas a tocar los órganos sexuales de otra persona contra su voluntad. Una de cada cinco mujeres reportó haber experimentado alguna violencia sexual dentro de la relación de pareja. Se encontró una asociación significativa entre algunas formas de violencia sexual y la depresión, la ideación e intento suicida y el uso de psicofármacos. Conclusiones. La violencia sexual es un problema grave de salud pública que requiere implementar programas de capacitación para obtener una respuesta especializada de los proveedores de salud. El texto completo en inglés de este artículo está disponible en: http://www.insp.mx/salud/index.html

La mujer embarazada con problemas de adicciones: consideraciones de genero, investigación y tratamiento / The pregnant women with addiction problems: gender, research and treatment issues

El presente artículo resume brevemente los problemas y las controversias en torno al consumo de sustancias psicoactivas en mujeres embarazadas, entre ellos: la prevalencia del consumo en las mujeres, los efectos dañinos del uso del alcohol y las drogas sobre el feto y el desarrollo infantil; los instrumentos con los que puede contar el profesionista de la salud para la detección oportuna de estos casos y finalmente la accesibilidad y las barreras al tratamiento con las que se enfrentan las mujeres. Asimismo, se describe todo lo antes mencionado con la presentación de historia de vida de una mujer adicta-madre. La metodología que se utilizó fue cualitativa. Se destacan entre las conclusiones la relación recíproca entre la influencia cultural y el desarrollo individual como una unidad integral básica para comprener la experiencia adictiva de las mujeres

Necesidades de atención a la salud mental de la mujer adicta / Attention needs for the mental health of addict women

El presente artículo describe y analiza el material cualitativo resultado de las narrativas de "historias de vida", de mujeres adictas a sustancia psicoactivas, de diversas zonas urbanas de la Ciudad de México, que permiten delinear para cada mujer, un número de obstáculos para la atención de su salud, una trayectoria posible de sufrimiento y un número de recomendaciones para su virtual atención y tratamiento

Efectos del abuso de drogas y alcohol en la sexualidad / Effects of the abuse of drugs and alcohol in the sexuality

"El presente capítulo constituye una revisión bibliográfica sobre la literatura más relevante que trata los efectos del abuso de drogas y alcohol en la sexualidad. En él, se describen el papel que han jugado las sustancias psicoactivas en la cultura y la forma en como se une su consumo con la actividad sexual. Aborda suscintamente cuatro puntos básicos: a)Las diferencias de género en el consumo de alcohol y drogas en la población mexicana, y se ofrecen resultados de investigaciones epidemiológicas realizadas en nuestro país b)Las teorías sobre la interacción del alcohol/drogas y el mecanismo de la sexualidad. En este inciso se exponen la teoría que vincula los niveles de alcohol en sangre, la ansiedad y la actividad sexual; las fantasías y expectativas en relación con uso de sustancias para estimular la actividad. Se describe el modelo de recompensa cerebral y la apetencia por las drogas; cómo se vincula esta teoría al consumo de drogas y las experiencias subjetivas en los usuarios, principalmente de los adictos a la cocaína c)Las consecuencias biológicas del uso de sustancias en la sexualidad de acuerdo al género d)El vínculo existente entre el alcohol, las drogas y las enfermedades transmisibles, particularmente el SIDA"

Validez de una versión del cuestionario general de Salud, para detectar psicopatología en estudiantes universitarios / Validity of a version of the general health questionnaire for dectecting psychopathology in university students

En el presente estudio se revisan los principales resultados que se obtuvieron aplicando el Cuestionario General de Salud de Goldberg, D.P. (1972) a una muestra de estudiantes universitarios mexicanos, para determinar, entre otras cosas, la validez de una versión breve de 28 reactivos adaptada para este tipo de población. Se presentan los resultados más relevantes que se obtuvieron sobre la prevalencia global de trastornos emocionales en la población estudiada, así como la proporción y el tipo de alteraciones más frecuentes. La investigación se llevó a cabo en una muestra de 296 alumnos de uno y otro sexo, que tomaban 2 materias obligatorias, a los que les fue aplicado el GHO en su versión de 60 reactivos. De ella se seleccionaron 134 sujetos cuyas respuestas incluían más de 6 reactivos, así como una muestra al azar de aquéllos que presentaron menos de 6 síntomas positivos. A esta muestra se le aplicó la Entrevista Psiquiátrica Estandarizada (Goldberg D P y cols., 1970). La entrevista la llevó a cabo uno de los 5 psicólogos que habían sido entrenados previamente para que aplicaran el instrumento, y quienes en este curso obtuvieron una confiabilidad entre puntuaciones de + 0.84 al evaluar la presencia, la ausencia y la severidad de los síntomas. Con la finalidad de desarrollar la versión breve, todas las preguntas fueron recalificadas de acuerdo con el método de Liker (0, 1, 2, 3). Primero se llevó a cabo un análisis de los componentes principales y después se realizó una rotación varimax utilizando una serie de paquetes estadísticos. Se encontró que el 39.32% de la población que se estudió presentaba algún tipo de padecimiento que requería atención especializada. En el grupo de mujeres, el 53.07% mostró síntomas de irritabilidad; el 51.84%, de ansiedad; el 49,3%, de ánimo depresivo; el 40.73%, de disminución en la concentración; el 39.49%, de fatiga, y el 32.09%, de alteraciones...