"La covid no ha podido con nosotrxs": impacto de la pandemia en el acceso efectivo de personas trans a tratamientos hormonales integrales en Córdoba, Argentina / "Covid couldn't get us down": pandemic impact on effective access to transgender hormone therapy in Cordoba, Argentina

Resumen El objetivo de este trabajo fue indagar el impacto de la pandemia de la covid-19 en el acceso de personas trans a tratamientos hormonales en los servicios de salud pública de la provincia de Córdoba, Argentina. En los meses de junio/julio de 2020, se realizaron 16 entrevistas telefónicas a personas trans en proceso de hormonización y usuarias de servicios públicos de salud, a profesionales sanitarios de dispositivos específicos de atención a personas trans, integrantes de organizaciones sociales y de gestión. Se aplicó un análisis temático que identificó tres temas y subtemas: 1) Estar a la deriva en relación al tratamiento hormonal: Reestructuración de servicios de salud; Sentimientos de incertidumbre; 2) Lo necesito, el cuerpo lo pide: suministro de hormonas: Significados en torno al tratamiento; Estrategias y resistencias; 3) Oportunidad de visibilizar fallas estructurales: las hormonas como la punta del iceberg: Déficit en las políticas públicas: en pandemia desde hace muchos años; Exclusiones del CIStema de salud. Se concluyó que la pandemia acarreó un grave retroceso para los derechos de las personas trans. Sin embargo, se identificaron estrategias claves de acceso, vinculadas principalmente a las organizaciones y activistas trans y travestis.

Abstract The purpose of this research was to study the impact of covid-19 pandemic on transgender people's access to healthcare and hormone gender-affirming treatments in public healthcare services of the province of Córdoba, Argentina. Between June/July-2020, sixteen telephone interviews were conducted with people in gender-affirming hormone treatments in public healthcare services, professionals, members of social organizations and management. A thematic analysis was carried out, identifiying three themes and sub-themes: 1) Being adrift in relation to hormonal treatment: Restructuring of healthcare services; Feelings of uncertainty. 2) I need it, the body asks for it: supply of hormones: Meanings around treatment; Strategies and resistance. 3) Opportunity to make visible structural failures: hormones as the tip of the iceberg: Deficit in public policies: in a pandemic for many years; Exclusions from the CISHealthcare System. We conclude that the pandemic implied a serious setback for transgender people's rights. However, strategies were identified, mainly linked to transgender organizations and activists, which were key to access.

Elaboración de escalas de valoración de obstáculos y medidas para abordar la violencia de género en las escuelas / Development of scales to study barriers and needed measures to addressgender-based violence in schools

Resumen El personal docente cumple un rol clave en la prevención de la violencia de género (VG) en el ámbito educativo. Este trabajo tiene como objetivo validar al contexto local dos escalas para indagar cómo el personal docente y directivo valoran los obstáculos para abordar la VG y conocer su valoración respecto a las medidas propuestas para mejorar la prevención y la forma de abordarla. Se realizó un estudio descriptivo, transversal y multicéntrico con personal docente y directivo de escuelas públicas de Córdoba, Argentina. Para ello, se utilizó un cuestionario autoadministrado que incluyó dos escalas, una sobre obstáculos y otra sobre medidas. Se realizó análisis descriptivo, bivariante, factorial exploratorio y alfa de Cronbach y se construyó un modelo de regresión múltiple utilizando cada factor como variable dependiente. La escala validada de obstáculos se compone de diez preguntas y la escala de medidas incluye trece. Los resultados de regresión múltiple indican que los vínculos y prejuicios funcionan como obstáculos importantes para el nivel primario. La importancia otorgada a la ayuda especializada, como medida para prevenir la VG, se asocia a los equipos educativos que han manifestado necesidad de formación en este tema. Quienes han realizado actividades de prevención en las escuelas de nivel primario valoran más la transversalización de la perspectiva de género como medida. Las escuelas con personal en situación de VG consideran la formación en VG como medida de gran relevancia. Las escalas validadas en este estudio son fiables y recogen dimensiones empíricas de las valoraciones sobre obstáculos y medidas en relación con el abordaje de la VG en las escuelas.

Abstract Teachers play a key role in the prevention of gender violence (GBV) in the educational field. However, studies evaluating the opinions of teaching and management staff regarding the necessary measures to prevent GBV or the obstacles they must face when addressing this problem in the educational field in our context are incipient. This work aims to validate two scales to know the opinions and evaluations of the educational personnel on the obstacles and the measures they consider necessary to tackle and prevent GBV in schools. A descriptive, cross-sectional and multicenter study was carried out to an intentional non-probability sampling. The study population was the directing and teaching staff of schools in the Province of Córdoba, Argentina. The study variables were: sex, years of experience in the position, age, educational level of the center (initial / primary / middle / tertiary), area (urban / rural), locality where the face-to-face training was carried out, prevention activities carried out in the educational center focused on: students, families, and the educational team; GBV training activities carried out by the educational team, women and/or families identified in GBV situation, families with judicial restraining order, team interventions education before GBV of the students and/or families, staff of the educational team that has lived or is experiencing a situation of GBV, meetings of the educational team with local community organizations to articulate activity to prevent and/or address GBV, need for training on GBV manifested by the teaching team. To measure opinions on the obstacles and measures necessary to address GBV in schools, we applied a self-administered questionnaire with two scales, one on obstacles and the other on measures, based on Spanish scales. A descriptive, bivariate analysis of the relationship of all variables with sex, exploratory factor and Cronbach's alpha was performed. Finally, a multiple regression model was constructed to test the convergent validity using each factor as the dependent variable. The first scale of ten items identifies a dimension of obstacles related to family ties and existing prejudices in the educational community. The second dimension, values ​​aspects related to the scarcity of resources. For its part, the thirteen item scale of measurements has three dimensions. The first dimension, groups measures related to specialized help to address GBV, such as prevention programs, materials, and coordination with external organizations. The second groups the measures related to the need to have gender mainstreaming measures in the approach to GBV at school. The third dimension reflects the importance of staff training on these topics. Bonds and biases function as major obstacles for the elementary level. The importance given to specialized help, as a measure to prevent GBV, is mainly associated with educational teams that have expressed a need for training in this area. Those who have carried out prevention activities and primary schools, value more the mainstreaming of the gender perspective as a measure. Schools with staff who have lived or are experiencing a GBV situation consider GBV training as a highly relevant measure. The scales validated in this study are reliable and include empirical dimensions of the assessments of obstacles and measures in relation to the GBV approach in schools.

Percepción de riesgo ante el coronavirus en la primera fase de la pandemia en Argentina / Perception of risk facing coronavirus in the first phase of the pandemic in Argentina / Percepção de risco perante o coronavírus na primeira fase da pandemia na Argentina

Resumen Objetivo. Analizar los factores asociados a la percepción de riesgo de coronavirus en la primera fase de la pandemia en Argentina. Métodos. Se desarrolló un estudio transversal en población adulta (n=992) argentina. En marzo 2020 se aplicó un cuestionario online de la Organización Mundial de la Salud adaptado a Argentina. Se estimó la asociación entre la percepción de probabilidad de contagio y de severidad en caso de contagio, y sentimientos en relación al coronavirus, autoeficacia y búsqueda de información, mediante modelos de regresión lineal múltiple. Resultados. La percepción de riesgo frente al coronavirus en la primera fase de la pandemia fue moderada. Sin embargo, la proporción de personas que indicó puntuaciones altas fue mucho mayor en la percepción de severidad, comparado con la percepción de probabilidad de contagio. La percepción de probabilidad de contagio fue menor a mayor percepción de lejanía del virus y a mayor frecuencia de búsqueda de información. La percepción de severidad en caso de contagio se asoció positivamente con la frecuencia de búsqueda de información. En cambio, se asoció inversamente con la percepción de lejanía del virus y la autoeficacia. Conclusiones. Existen diferentes factores tanto emocionales como sociales asociados a la percepción de contagio y de severidad en Argentina. Esta complejidad debería considerarse en el diseño de políticas públicas para la prevención de COVID-19.

Abstract Objective: to analyze the factors associated with the perception of risk of coronavirus in the first phase of the pandemic in Argentina. Methods: a cross-sectional study was carried out in the Argentine adult population (n = 992). An online survey of the World Health Organization adapted to Argentina was applied in March-2020. The association between the perception of probability of contagion and severity in case of contagion and feelings related to the coronavirus, self-efficacy and health, were estimated using multiple linear regression models. Results: The perception of risk facing the first phase of the pandemic was moderate. However, the proportion of people who indicated high scores in the perception of severity was much higher compared to the perception of probability of contagion. The perception of probability of contagion was lower at greater perception of remoteness of the virus and it was greater at a higher frequency of information search. The perception of severity in case of contagion was positively associated with frequency of information search. Instead, it was inversely associated with the perception of remoteness of the virus and self-efficacy. Conclusions: There are different social and emotional factors associated with the perception of contagion and severity of coronavirus in Argentina. This complexity should be considered in the design of public policies for the prevention of COVID-19.

Resumo Objetivo. Analisar os fatores associados à percepção de risco de coronavírus na primeira fase da pandemia na Argentina. Métodos. Desenvolveu-se um estudo transversal em população adulta (n=992) na Argentina. Em março de 2020 foi aplicado um questionario online da Organização Mundial da Saúde adaptado para a Argentina. Estimouse a associação entre a percepção de probabilidade de contágio e da severidade no caso de contágio, e sentimentos em relação ao coronavírus, auto-eficácia e busca de informação, mediante modelos de regressão linear múltipla. Resultados. A percepção de risco frente ao coronavírus na primeira fase da pandemia foi moderada. Entretanto, a proporção de pessoas que indicou pontuações altas foi muito maior na percepção de severidade, comparado com a percepção de probabilidade de contágio. A percepção de probabilidade de contágio foi menor quanto maior a percepção de distância do vírus e a maior frequência de busca de informação. A percepção de severidade no caso de contágio é associada positivamente à frequência de busca de informação; por outro lado é associada inversamente à percepção de distância do vírus e a auto-eficácia. Conclusões. Existem diferentes fatores tanto emocionais como sociais associados à percepção de contágio e de severidade na Argentina. Esta complexidade deveria ser considerada no planejamento de políticas públicas para a prevenção da COVID-19.

Abordajes de violencias de género y de interrupción legal del embarazo en servicios de salud durante el aislamiento por COVID-19 / Approaches to gender-based violence and legal abortion in health services during COVID-19 lockdown

RESUMEN Este estudio buscó indagar cómo los servicios de salud abordan las violencias de género y la interrupción legal del embarazo en contexto de aislamiento social preventivo y obligatorio. Entre mayo y junio de 2020, se realizaron 27 entrevistas telefónicas a profesionales sanitarios e informantes claves de las ciudades argentinas de Córdoba y Resistencia. Se identificaron cambios en la detección, abordaje y demanda vinculados a la reorganización sanitaria, las modificaciones en la relación asistencial y los recursos necesarios para canalizar la demanda. La pandemia ha profundizado los obstáculos de acceso a servicios sanitarios de las mujeres y ha generado otros nuevos. Ante ello, las redes entre profesionales, la práctica sanitaria feminista y los abordajes innovadores fueron identificados como facilitadores de acceso, claves para amortiguar la pandemia y garantizar derechos.

ABSTRACT: This study is interested in analyzing how health services address gender-based violence and legal abortion in a context of mandatory preventive social isolation. Between May and June 2020, 27 telephone interviews were conducted with healthcare professionals and key informants from Córdoba and Resistencia. Changes in detection, methods, and demand were identified, related to the reorganization of the healthcare system, modifications in the care relationship, and the resources needed to respond to demand. The pandemic has deepened barriers to women's access to health services and has added new ones. Networks among healthcare professionals, feminist healthcare practices, and innovative approaches were identified as facilitators of access, which have been central in mitigating the effects of the pandemic and guaranteeing rights.

El abordaje de la violencia de género desde la perspectiva de las comunidades del norte cordobés, Argentina / The approach to gender violence from the perspective of communities in northern Córdoba Province, Argentina / A abordagem da violência de gênero desde a perspectiva das comunidades do norte cordobês, Argentina

Resumen: La violencia de género es una violación a los derechos humanos y un grave problema de salud pública que debe ser abordado de forma intersectorial y con un enfoque interdisciplinario. La colaboración y coordinación entre los sectores, incluido salud, es fundamental para garantizar el correcto abordaje. Los objetivos de este trabajo son: conocer qué agentes abordan la violencia de género en las comunidades, y estudiar las opiniones de las comunidades en relación al rol y al abordaje del sistema público de salud ante esta problemática. Se realizó una investigación-acción cualitativa con talleres de autodiagnóstico comunitario local, utilizando diversas técnicas cualitativas. Análisis temático. Los resultados indican que existen diversos actores locales que abordan la problemática y que la atención primaria de la salud cumple un rol relevante, principalmente debido a sus características de cercanía con la población y abordaje interdisciplinario. Los obstáculos identificados por las comunidades para el abordaje desde el sistema de salud se vinculan principalmente con el modelo biomédico de atención, la descentralización y la falta de recursos, de capacitación y de políticas integradas. En conclusión, los talleres facilitaron la construcción de un conocimiento colectivo respecto a la realidad local, donde se destaca el rol de la atención primaria de la salud y la necesidad de articular acciones y abordajes entre sectores y localidades.

Abstract: Gender violence is a human rights violation and a serious public health problem that should be addressed with an inter-sector and interdisciplinary focus. Collaboration and coordination between sectors, including the health sector, is essential for guaranteeing such approach. The study aimed to learn which actors address gender violence in the communities and to study the communities' opinions concerning the public health system's role in (and approach to) this problem. A qualitative action-research project was conducted with local community self-diagnosis workshops, using various qualitative techniques and thematic analysis. The results pointed to various local actors that address the problem and showed that primary healthcare plays a relevant role, due mainly to its proximity to the population and interdisciplinary approach. The obstacles identified by the communities for the health system approach mainly involved the biomedical model of care, decentralization, and lack of resources, training, and integrated policies. In conclusion, the workshops facilitated the development of collective knowledge on the local reality, underlining the role of primary healthcare and the need to link action and approaches between sectors and communities.

Resumo: A violência de gênero e uma violação dos direitos humanos e um grave problema de saúde pública que deve ser abordado de forma transversal e com uma abordagem interdisciplinar. A colaboração e coordenação entre os setores, incluída a saúde, é fundamental para garantir a correta abordagem. Os objetivos deste trabalho são: conhecer quais são os agentes que abordam a violência de gênero nas comunidades, e estudar as opiniões das comunidades em relação ao rol e à função da abordagem do sistema público de saúde perante esta problemática. Foi realizada uma pesquisa-ação qualitativa com seminários de autoteste comunitário local, utilizando diferentes técnicas qualitativas. Análise temática. Os resultados indicam que existem diversos atores locais que abordam a problemática e que a atenção primaria em saúde cumpre uma função relevante, fundamentalmente, devido as suas características de proximidade com a população e abordagem interdisciplinaria. Os obstáculos identificados pelas comunidades relacionados para a abordagem desde o sistema de saúde estavam vinculados principalmente com o modelo biomédico de atenção, a descentralização e a falta de recursos, capacitação e políticas integradas. Em conclusão, os seminários facilitaram a construção de um conhecimento coletivo ao respeito da realidade local, onde se destaca a função da atenção primária à saúde e a necessidade de articular ações e abordagens entre setores e municípios.

Emociones, preocupaciones y reflexiones frente a la pandemia del COVID-19 en Argentina / Emotions, concerns and reflections regarding the COVID-19 pandemic in Argentina

Resumen El objetivo de este trabajo es explorar los sentimientos y expectativas que genera el COVID-19 en Argentina durante la primera etapa de la pandemia. Se aplicó una encuesta de la Organización Mundial de la Salud adaptada al contexto local. Se incluyeron preguntas abiertas para indagar sentimientos de las personas frente al COVID-19, y se realizó un análisis de contenido. Como resultados se advierte que la población encuestada siente incertidumbre, miedo y angustia, pero también emerge un sentimiento de responsabilidad y cuidado frente al COVID-19. Así mismo se destacan sentimientos positivos para la sociedad como una valoración de la interdependencia social. Los resultados arribados señalan que el impacto en la salud mental es desigual según el género, el nivel educativo alcanzado y el confort percibido en el hogar. El estudio permite concluir que las dimensiones emocionales y vinculares de las personas resultan aspectos centrales ante la pandemia del COVID-19 en Argentina. Es recomendable que estas dimensiones, así como y su impacto subjetivo y social diferencial entre los diversos grupos poblacionales, sean consideradas en la planificación de políticas para afrontar el COVID-19.

Abstract The scope of this work is to explore the feelings and expectations that COVID-19 has generated in Argentina during the first stage of the pandemic. A survey of the World Health Organization adapted to the local context was applied. Open-ended questions were included to study people's feelings about COVID-19, and content analysis was subsequently conducted. In terms of results, it is revealed that the population surveyed feels uncertainty, fear and anguish, albeit a feeling of responsibility and care in the face of COVID-19 also emerges. Moreover, positive feelings regarding society stand out as an achievement of social interdependence. The results obtained show that the impact on mental health differs in accordance with gender, educational level, and perceived comfort in the home. The study concludes that the emotional and bonding dimensions of people are central to confronting the COVID-19 pandemic in Argentina. It is recommended that these dimensions, as well as their subjective and differential social impact among the different population groups, should be considered in the planning of policies to address the COVID-19 pandemic.

Género y trayectorias profesionales de las médicas de familia en Andalucía, España, a comienzos del siglo XXI / Gender and career paths of female primary care physicians in Andalusia, Spain, at the beginning of 21st century

El objetivo de este trabajo es estudiar, desde una perspectiva feminista, la diversidad y homogeneidad en las trayectorias profesionales de las médicas de familia que ejercían en Andalucía a comienzos del siglo XXI, a través del análisis de los significados que ellas mismas confieren a su desarrollo profesional y de la influencia de los factores personales, familiares y laborales. Realizamos un estudio cualitativo con seis grupos de discusión. Participaron 32 médicas de familia que se encontraban trabajando en los centros de salud urbanos de la red sanitaria pública de Andalucía. El análisis del discurso revela que la mayoría de las médicas no planifican sus metas profesionales y que, cuando lo hacen, las van entrelazando con las necesidades familiares. Esto se traduce en que sus trayectorias profesionales sean discontinuas. Por el contrario, las trayectorias orientadas al desarrollo profesional y a la planificación consciente de metas son más frecuentes entre las médicas que ocupan cargos de dirección en centros de salud.

The purpose of this article was to study, from a feminist perspective, the diversity and homogeneity in the career paths of female primary care physicians from Andalusia, Spain in the early 21st century, by analyzing the meanings they give to their careers and the influence of personal, family and professional factors. We conducted a qualitative study with six discussion groups. Thirty-two female primary care physicians working in urban health centers of the public health system of Andalusia participated in the study. The discourse analysis revealed that most of the female physicians did not plan for professional goals and, when they did plan for them, the goals were intertwined with family needs. Consequently, their career paths were discontinuous. In contrast, career paths oriented towards professional development and the conscious planning of goals were more common among the female doctors acting as directors of health care centers.