[Analysis of unintentional injuries in vulnerable populations, Mexico 2018.] / Análisis de las lesiones accidentales no fatales en población vulnerable, México 2018.

OBJECTIVE: To estimate the prevalence of unintentional injuries (UI) in people residing in localities with <100 000 inhabitants and to analyze its association with different environmental, household and individual characteristics. MATERIALS AND METHODS: Cross-sectional design that analyses the UI component of Ensanut 100k, which is a probabilistic national survey that focused on households beneficiaries of the program Prospera and those with fewer economic capabilities. Prevalence of UI was estimated considering the complex design of the survey. Association with variables of interest was explored using logistic regression analysis. RESULTS: Prevalence of UI was 5.15% (CI95%: 1.43-6.16); probability was higher in male, those living in the region CDMX-EdoMex, and those with hearing and motor disability. CONCLUSIONS: Policies directed to prevent UI need to be strengthened to promote health and quality of life amongst individuals, par- ticularly those with social and economic vulnerability, and to reduce the burden that these conditions impose to public health in Mexico.

OBJETIVO: Estimar la prevalencia de lesiones accidentales en población que reside en localidades con <100 000 habitantes y analizar su asociación con características individuales, ambien­tales y del hoga. MATERIAL Y MÉTODOS: Diseño transversal que analiza el componente de accidentes de la Ensanut 100k, encuesta probabilística, estratificada, por conglomerados que sobrerrepresenta hogares beneficiarios del programa Prospera y aquellos con menos recursos económicos. Su asociación con distintas variables independientes se estableció a partir de un modelo de regresión logística, considerando el muestreo complejo. RESULTADOS: La prevalencia de lesiones acciden­tales fue 5.15% (IC95%: 1.43-6.16) equivalente a cerca de 3.3 millones de personas. La probabilidad fue mayor en hombres, en la región CDMX-EdoMex y en personas con discapacidad auditiva/motora. CONCLUSIONES: Es necesario fortalecer la política de prevención de lesiones accidentales, especialmente la dirigida a grupos con alta vulnerabilidad social y económica, para cuidar su salud y calidad de vida, y reducir la carga que generan para la salud pública.

Análisis de las lesiones accidentales no fatales en población vulnerable, México 2018 / Analysis of unintentional injuries in vulnerable populations, Mexico 2018

Resumen: Objetivo: Estimar la prevalencia de lesiones accidentales en población que reside en localidades con <100 000 habitantes y analizar su asociación con características individuales, ambientales y del hogar. Material y métodos: Diseño transversal que analiza el componente de accidentes de la Ensanut 100k, encuesta probabilística, estratificada, por conglomerados que sobrerrepresenta hogares beneficiarios del programa Prospera y aquellos con menos recursos económicos. Su asociación con distintas variables independientes se estableció a partir de un modelo de regresión logística, considerando el muestreo complejo. Resultados: La prevalencia de lesiones accidentales fue 5.15% (IC95%: 1.43-6.16) equivalente a cerca de 3.3 millones de personas. La probabilidad fue mayor en hombres, en la región CDMX-EdoMex y en personas con discapacidad auditiva/motora. Conclusiones: Es necesario fortalecer la política de prevención de lesiones accidentales, especialmente la dirigida a grupos con alta vulnerabilidad social y económica, para cuidar su salud y calidad de vida, y reducir la carga que generan para la salud pública.

Abstract: Objective: To estimate the prevalence of unintentional injuries (UI) in people residing in localities with <100 000 inhabitants and to analyze its association with different environmental, household and individual characteristics. Materials and methods: Cross-sectional design that analyses the UI component of Ensanut 100k, which is a probabilistic national survey that focused on households beneficiaries of the program Prospera and those with fewer economic capabilities. Prevalence of UI was estimated considering the complex design of the survey. Association with variables of interest was explored using logistic regression analysis. Results: Prevalence of UI was 5.15% (CI95%: 1.43-6.16); probability was higher in male, those living in the region CDMX-EdoMex, and those with hearing and motor disability. Conclusions: Policies directed to prevent UI need to be strengthened to promote health and quality of life amongst individuals, particularly those with social and economic vulnerability, and to reduce the burden that these conditions impose to public health in Mexico.

[Therapeutic adherence to retraining programs for women and men involved in abusive relationships in Mexico]. / Adherencia terapéutica a programas de reeducación para mujeres y hombres en relaciones de pareja violentas.

OBJECTIVE: To analyze the therapeutic adherence among participants in the retraining program operated by the Ministry of Health of Mexico, in eight states in 2010. MATERIALS AND METHODS: This is a cross-sectional and descriptive study that assesses therapeutic adherence in a retraining intervention program for male perpetrators and female victims of intimate partner violence. The intervention was coordinated by a team of previously trained professionals. The selection of participants was made by means of a specific screening test. Overall performance for both groups was analyzed, and based on the attendance they were classified in low adhesion (1-12) medium to high (13 and>). To determine the possibility of adhesion, Student's t tests, a bivariate analysis, and a logistic regression model were performed for each program. RESULTS: 5 539 screenings were applied, of which 88.3% (n = 4 891) were positive. 85% agreed to participate (n = 4 151), but only 75% of potential participants attended at least one session (n = 3 022). 78.5% attended between 1-12 sessions. In the women's program, significant differences in marital status, religion and age groups (p<0.05) were found. In the program for men, significant differences in religion and age groups (p<0.05) were found. CONCLUSIONS: In the Mexican context there are few studies that assess adherence to programs of care and retraining for partner violence. This study is a first approach that opens the possibility to enhance the design and evaluation of such interventions, which are crucial to dismantle violence against women.

Adherencia terapéutica a programas de reeducación para mujeres y hombres en relaciones de pareja violentas / Therapeutic adherence to retraining programs for women and men involved in abusive relationships in Mexico

Objetivo. Analizar la adherencia terapéutica en participantes de un programa de reeducación operado por los servicios estatales de salud en ocho estados de México en 2010. Material y métodos. Estudio transversal y descriptivo que evaluó la adherencia terapéutica de un programa de reeducación para hombres agresores y mujeres víctimas de violencia de pareja. La intervención fue coordinada por un equipo de profesionales previamente capacitados. La selección de los participantes se realizó con el cumplimiento estricto de criterios de inclusión/exclusión evaluados por una prueba de tamizaje. Con base en la asistencia, se clasificó en adherencia baja (1 a 12), media-alta (13 y más). Se realizó una prueba de t student, un análisis bivariado y un modelo de regresión logística para identificar la posibilidad de adherencia en cada programa. Resultados. Se aplicaron 5 539 tamizajes, 88.3% (n=4 891) fueron positivos; 85%(n=4 151) aceptó participar, 75% de los potenciales participantes asistió al menos a una sesión (n=3 699), siendo ésta la muestra del presente estudio. En el programa para mujeres hubo diferencias significativas por estado civil, religión y grupos de edad (p<0.05). En el programa para hombres hubo diferencias significativas por religión y grupos de edad (p<0.05). Conclusiones. En México son inexistentes los estudios que evalúan la adherencia a los programas de atención a la violencia; este estudio es una primera aproximación que abre la posibilidad de profundizar en el diseño y evaluación de este tipo de intervenciones, cruciales para desarticular la violencia contra las mujeres.

Objective. To analyze the therapeutic adherence among participants in the retraining program operated by the Ministry of Health of Mexico, in eight states in 2010. Materials and methods. This is a cross-sectional and descriptive study that assesses therapeutic adherence in a retraining intervention program for male perpetrators and female victims of intimate partner violence. The intervention was coordinated by a team of previously trained professionals. The selection of participants was made by means of a specific screening test. Overall performance for both groups was analyzed, and based on the attendance they were classified in low adhesion (1-12) medium to high (13 and>). To determine the possibility of adhesion, Student's t tests, a bivariate analysis, and a logistic regression model were performed for each program. Results. 5 539 screenings were applied, of which 88.3% (n = 4 891) were positive. 85% agreed to participate (n = 4 151), but only 75% of potential participants attended at least one session (n = 3 022). 78.5% attended between 1-12 sessions. In the women's program, significant differences in marital status, religion and age groups (p<0.05) were found. In the program for men, significant differences in religion and age groups (p<0.05) were found. Conclusions. In the Mexican context there are few studies that assess adherence to programs of care and retraining for partner violence. This study is a first approach that opens the possibility to enhance the design and evaluation of such interventions, which are crucial to dismantle violence against women.

Methodological proposal for implementing an intervention to prevent pedestrian injuries, a multidisciplinary approach: the case of Cuernavaca, Morelos, Mexico.

OBJECTIVE: To describe the process for implementing an intervention to prevent pedestrian injuries in Cuernavaca, Mexico, using a multidisciplinary and evidence-based approach. METHODOLOGY: This study included two phases with several stages. The first was an overall assessment of pedestrian mortality in Cuernavaca that included a comparison of pedestrian mortality between Cuernavaca and the rest of Morelos State (1998-2007), an analysis and geocoding of pedestrian injuries (2008-2009), and a description of techniques for selecting and analysing clustered events using road audits. The second phase focused on selecting an intervention through a review of the literature seeking the 'best evidence' adaptable to the local context and a methodological evaluation for implementation including techniques for cluster randomisation and for the evaluation of possible effects of the intervention. RESULTS: Between 2008 and 2009, in Cuernavaca there were 620 pedestrian injury events: 59.4% were men, the mean age was 36.3 years, 70% occurred during daylight hours, 55% had mild severity and there were no differences by sex (p>0.05). We generated evidence, that when combined with the results from a systematic search of the literature, provided sufficient information for the implementation of a pedestrian injury prevention intervention. CONCLUSIONS: A combination of strategies and disciplines makes it possible to comprehensively address this public health problem, allowing interventions to strengthen aspects of pedestrian safety while accounting for characteristics of the local context; the promotion of local measures, of low cost and high impact, with modifications to the road infrastructure, are more effective in addressing pedestrian vulnerabilities.

[Injuries in emergency rooms of urban areas in Mexico: prevalence and severity]. / Atención de lesiones por tipo de causa externa en salas de urgencia en tres ciudades de México: composición, frecuencia y gravedad.

OBJECTIVE: To identify frequency and severity of injuries by type of external cause in people attending emergency services for medical attention. MATERIAL AND METHODS: Cross-sectional study held in the cities of Guadalajara, Colima and Mexico City, from September 2007 to February 2008. All people requiring emergency medical attention due to injuries were included. VARIABLES: sex, age, anatomical area of the injury, type of injury, external cause, type of aggressor and severity according to the abbreviated injury scale. Statistical analysis was univariate simple and multivariate. RESULTS: 26.3% of the emergency medical attention was due to injuries, with the main cause being falls (49.3%). Individuals from 15 to 44 years (55.8%) reported a higher frequency, while those over 60 years presented the most serious injuries. Associated variables to severity were interpersonal aggression (OR 6.7, IC 95% 4.20-10.69) and road traffic injuries (OR 3.00, IC 95% 1.72-5.23). Conclusions. Accidental and intentional injuries represent an important demand of emergency medical attention; with interpersonal aggression and road traffic injuries being responsible for the highest number of serious injuries.

Economic impact of fatal and non-fatal road traffic injuries in Guadalajara Metropolitan Area and Jalisco, Mexico.

OBJECTIVE: To estimate the economic cost of fatal and non-fatal road traffic injuries (RTI) in Guadalajara metropolitan area (GMA) and Jalisco, Mexico during 2007. MATERIALS AND METHODS: Using an incidence-based cost of illness analysis from a household perspective employing a bottom-up approach all direct medical and non-medical costs, and indirect costs were estimated for a sample of RTI people who sought care during 1 month in four different medical facilities. Individuals were surveyed just before discharge from emergency rooms (ER) and hospitalisation services. Hospitalised individuals were followed up at 8 weeks after discharge. Productivity loss was estimated with the human capital approach. Using estimated costs and administrative records of mortality and morbidity, the economic costs were dimensioned for GMA and for Jalisco. A multivariate and probabilistic sensitivity analysis was conducted to evaluate variations resulting from assumptions used. RESULTS: 297 injured were included in the study, 20% were hospitalised and 237 only received care at ER. A total cost of US$21190 was estimated in all injured receiving care at ER and $83309 for those hospitalised. Direct cost represents more than 30% of reported income in 8% of the ER users and 80% of hospitalised. Total economic cost was US$329,061,813 for GMA (discount rate of 3%), nearly 51% of the state total (US$650,908,924 or 1.3% of State GNP). CONCLUSIONS: This estimation shows the high cost (both, direct and indirect) RTI impose in households affecting their economy and leading families to lose wealth assets, get in debt or impoverished.

Economic impact of fatal and nonfatal road traffic injuries in Belize in 2007 / Repercusiones económicas de los traumatismos mortales y no mortales por accidentes de tránsito en Belice en 2007

OBJECTIVE: To estimate the economic cost of road traffic injuries in Belize in 2007. METHODS: A cross-sectional study was conducted using secondary cost data, assuming the health system and social perspectives. Epidemiologic information was obtained from the mortality database, the national hospital discharge database, and administrative records from police and the Ministry of Health. A health provider survey was carried out in order to estimate the postdischarge ambulatory utilization figures. Direct cost was estimated with the World Health Organization WHO-CHOICE (CHOosing Interventions that are Cost Effective) database. Prehospital costs were obtained from the Belize emergency response team. After estimating years of potential life lost using the Belize life expectancy for 2008 and methodology proposed by the Pan American Health Organization, the indirect cost associated with premature death was estimated with the human capital approach. Total estimation of road traffic injuries' economic costs used a decision tree model approach. Multiway sensitivity analysis was used to incorporate uncertainty in the estimations. RESULTS: Sixty-one people died due to road traffic injuries during 2007, 338 were hospitalized, and 565 people were estimated to be slightly injured. A total of 2 501 years of potential life were lost in Belize due to premature death, with a total economic cost of US$11-062-544. This figure represents 0.9 percent of the Belize gross domestic product. Direct cost was estimated at US$163-503, of which 2.4 percent was spent on fatalities, 46.7 percent on the severely injured, and 50.9 percent on the slightly injured. CONCLUSIONS: The economic cost estimations make clear the need to prevent road traffic injuries with a strategic and multisectoral approach that focuses on addressing the main problems identified.

OBJETIVO: Calcular el costo económico de los traumatismos por accidentes de tránsito registrados en Belice durante el año 2007. MÉTODOS. Se realizó un estudio transversal a partir de datos secundarios sobre los costos, tanto desde la perspectiva social como desde la del sistema de salud. La información epidemiológica se obtuvo a partir de la base de datos de mortalidad, la base de datos nacional de egresos hospitalarios y los expedientes administrativos de la policía y el Ministerio de Salud. Se llevó a cabo una encuesta a los prestadores de servicios de salud para calcular las cifras correspondientes a la atención ambulatoria posterior al egreso. Para calcular los costos directos, se utilizó la base de datos del proyecto WHO-CHOICE (elección de intervenciones eficaces en función de los costos) de la Organización Mundial de la Salud. El equipo de respuesta a las urgencias médicas de Belice aportó los datos sobre los costos prehospitalarios. Después de calcular los años de vida potencial perdidos tomando como parámetro la esperanza de vida de Belice correspondiente al año 2008 y empleando el método propuesto por la Organización Panamericana de la Salud, se calculó el costo indirecto asociado a la muerte prematura desde el enfoque del capital humano. Se utilizó un modelo de árbol de decisiones para calcular el costo económico total derivado de los traumatismos causados por el tránsito y se hizo un análisis de sensibilidad multivariado y probabilístico para incorporar los parámetros de incertidumbre en las estimaciones. RESULTADOS: En Belice, durante el año 2007, los traumatismos causados por el tránsito provocaron la muerte de 61 personas, la hospitalización de 338 y, según se calcula, lesiones menores a 565. Se perdieron 2 501 años de vida potencial a causa de las muertes prematuras, lo que se tradujo en un costo económico total de US$11 062 544. Esta cifra representa 0,9 por ciento del producto interno bruto de Belice. Se calculó que el costo directo fue de US$ 163 503, del cual 2,4 por ciento fue ocasionado por las muertes, 46,7 por ciento por la atención de las personas que sufrieron traumatismos graves y 50,9 por ciento por la atención de quienes presentaron lesiones menores. CONCLUSIONES: El costo económico calculado en este estudio pone de manifiesto la necesidad de prevenir los traumatismos causados por el tránsito adoptando un método estratégico y multisectorial que se centre en abordar los principales problemas detectados.

Economic impact of fatal and nonfatal road traffic injuries in Belize in 2007.

OBJECTIVE: To estimate the economic cost of road traffic injuries in Belize in 2007. METHODS: A cross-sectional study was conducted using secondary cost data, assuming the health system and social perspectives. Epidemiologic information was obtained from the mortality database, the national hospital discharge database, and administrative records from police and the Ministry of Health. A health provider survey was carried out in order to estimate the postdischarge ambulatory utilization figures. Direct cost was estimated with the World Health Organization WHO-CHOICE (CHOosing Interventions that are Cost Effective) database. Prehospital costs were obtained from the Belize emergency response team. After estimating years of potential life lost using the Belize life expectancy for 2008 and methodology proposed by the Pan American Health Organization, the indirect cost associated with premature death was estimated with the human capital approach. Total estimation of road traffic injuries' economic costs used a decision tree model approach. Multiway sensitivity analysis was used to incorporate uncertainty in the estimations. RESULTS: Sixty-one people died due to road traffic injuries during 2007, 338 were hospitalized, and 565 people were estimated to be slightly injured. A total of 2,501 years of potential life were lost in Belize due to premature death, with a total economic cost of US$11,062,544. This figure represents 0.9% of the Belize gross domestic product. Direct cost was estimated at US$163,503, of which 2.4% was spent on fatalities, 46.7% on the severely injured, and 50.9% on the slightly injured. CONCLUSIONS: The economic cost estimations make clear the need to prevent road traffic injuries with a strategic and multisectoral approach that focuses on addressing the main problems identified.

[Prevalence of non-fatal road traffic injuries in Mexico: results from ENSANUT 2006]. / Prevalencia de accidentes de tránsito no fatales en México: resultados de la ENSANUT 2006.

OBJECTIVE: To determine non-fatal road traffic injuries (NFRTI) prevalence and its distribution in Mexico. MATERIAL AND METHODS: Data from ENSANUT Survey 2006 were used. Using simple random sampling, one adult, one adolescent and one child were selected in each household, constituting a final sample of 94,197 representing an N of 102,886,482 people. The dependent variable was the prevalence of road traffic injuries (RTI) during the 12 months prior to the survey. RESULTS: The general accident prevalence was 6.0%; 16.7% corresponded to NFRTI. Men in the 20 to 44 age group living in urban areas and with high socioeconomic status had a higher RTI prevalence (p<0.05). Jalisco, Aguascalientes and Sonora were states with the highest prevalence of RTI, while Guerrero, Michoacan and Oaxaca were those with the lowest. CONCLUSIONS: NFRTI are frequent in Mexico and they are concentrated among men in productive ages in urban areas; they are associated with socioeconomic status at the individual level and with the state's development at the population level.

Prevalencia de accidentes de tránsito no fatales en México: resultados de la ENSANUT 2006 / Prevalence of non-fatal road traffic injuries in Mexico: results from ENSANUT 2006

OBJETIVO: Determinar la prevalencia y distribución de los accidentes de tránsito no fatales (ATNF) en México. MATERIAL Y MÉTODOS: Se utilizaron datos de la ENSANUT 2006. En los hogares visitados se seleccionó a un adulto, un adolescente y un niño, hasta conformar una muestra de 94197 sujetos que representa a la N de 102 886 482 individuos. La variable dependiente fue la prevalencia de ATNF en los 12 meses anteriores a la encuesta. RESULTADOS: La prevalencia de accidentes (de tránsito o no) fue de 6.0 por ciento y de esa cifra 16.7 por ciento correspondió a ATNF. Los hombres del grupo de 20 a 44 años, los habitantes de áreas urbanas y los de mejor nivel socioeconómico (NSE) presentaron mayor prevalencia (p<0.05). Jalisco, Aguascalientes y Sonora registraron la mayor prevalencia y Guerrero, Michoacán y Oaxaca la menor. CONCLUSIONES: Los ATNF en México se concentran en hombres de edad productiva en zonas urbanas y se relacionan con el NSE individual y el desarrollo económico de cada estado.

OBJECTIVE: To determine non-fatal road traffic injuries (NFRTI) prevalence and its distribution in Mexico. MATERIAL AND METHODS: Data from ENSANUT Survey 2006 were used. Using simple random sampling, one adult, one adolescent and one child were selected in each household, constituting a final sample of 94 197 representing an N of 102 886 482 people. The dependent variable was the prevalence of road traffic injuries (RTI) during the 12 months prior to the survey. RESULTS: The general accident prevalence was 6.0 percent; 16.7 percent corresponded to NFRTI. Men in the 20 to 44 age group living in urban areas and with high socioeconomic status had a higher RTI prevalence (p<0.05). Jalisco, Aguascalientes and Sonora were states with the highest prevalence of RTI, while Guerrero, Michoacan and Oaxaca were those with the lowest. CONCLUSIONS: NFRTI are frequent in Mexico and they are concentrated among men in productive ages in urban areas; they are associated with socioeconomic status at the individual level and with the state's development at the population level.

[Violence scale and severity index: a methodological proposal for measuring violence by the partner in Mexican women]. / Escala de violencia e indice de severidad: una propuesta metodológica para medir la violencia de pareja en mujeres mexicanas.

OBJECTIVE: To construct and validate a scale to assess violence by the male partner against women. An index of severity of the emotional and physical damage was also designed to assess the intensity of the violent actions against women. MATERIAL AND METHODS: The sample consisted of a total of 26 042 women who participated as respondents in the National Survey on Violence against Women (ENVIM per its abbreviation in Spanish) conducted in Mexico during 2003. Respondents were all users of health services provided by the Mexican government. The questionnaire was organized into 17 sections, one of which was a 27-item scale to assess partner violence. The purpose of this scale was to measure the type (physical, emotional, sexual and financial) and degree of violence based on severity. A severity index was constructed based on two procedures: 1) the validity, reliability, and factor analyses of the scale and 2) the assessment of severity by expert judges who assigned a value to each item of the scale. RESULTS: The validity and reliability results indicated this scale has adequate internal validity (Cronbach's Alpha = 0.99). The factor analysis with Varimax rotation yielded a four-factor solution. The factors were: 1) Psychological violence; 2) Physical violence; 3) Severe physical violence; and 4) Sexual violence. The combination of the four factors accounted for 62.2% of the variance in the scale. Using the ratings from the judges a table of values for each of the violent actions described was obtained. The scores assigned by the judges ranged from 0 to 354. Results revealed a prevalence of 21% partner violence in the last twelve months. The prevalence of psychological violence was 18.5%; of physical violence 10.1%; severe physical violence 6.7% and sexual violence 7.0%. CONCLUSION: The scale of violence described in this article is a very useful and reliable instrument to assess marital violence against women. It is suggested that this instrument be used in other settings to compare results with different samples.

Factors influencing the use of dental health services by preschool children in Mexico.

PURPOSE: The purpose of this study was to identify the factors associated with dental health services utilization (DHSU) within a publicly funded oral health program for preschool children in Campeche, Mexico. METHODS: A cross-sectional study in 1,303 preschoolers (3 to 6 years old) enrolled in 10 public schools was conducted. The independent variables were: (1) sex; (2) age; (3) tooth-brushing frequency; (4) caries severity; (5) enamel defects; (6) mother's maximum education level; (7) mother's attitude toward oral health; (8) health services availability; and (9) family's socioeconomic status. The mothers completed a questionnaire, and their children were clinically examined. The DHSU (none vs any) in the previous 12 months was the dependent variable. Data were analyzed using binary logistic regression (BLR). RESULTS: Average age was 4.3 +/- 0.8 years, and 52% of participants were boys. The prevalence of DHSU any was 31%. The variables associated with DHSU were: (1) moderate and high oral health needs; (2) access to private health services; and (3) older age. The authors' model supported an interaction between tooth-brushing frequency and the importance that the mother ascribed to her child's oral health. CONCLUSIONS: A low prevalence of DHSU was observed. The source of health services and oral health needs determined DHSU in this population, with some attitudes and behaviours modifying utilization. These findings have implications for designing oral health care policies to improve the supply of services to children.

Escala de violencia e índice de severidad: una propuesta metodológica para medir la violencia de pareja en mujeres mexicanas / Violence scale and severity index: a methodological proposal for measuring violence by the partner in Mexican women

OBJETIVO: Construir y validar, en el país, una escala para medir violencia hacia las mujeres por parte de la pareja masculina. Asimismo, construir un índice de severidad que permita establecer una dimensión del daño emocional y físico de las acciones violentas perpetradas en contra de las mujeres. MATERIAL Y MÉTODOS: La muestra consistió de 26 042 mujeres de 15 años y más. Se incluyeron las respuestas de las mujeres que contestaron a toda la escala de violencia del cuestionario de la Encuesta Nacional sobre Violencia contra las Mujeres 2003 (ENVIM 2003). Este cuestionario, aplicado a usuarias de servicios de salud, estuvo integrado por 17 secciones, de las cuales una fue escala de violencia de 27 reactivos. El objetivo era medir distintos grados de violencia en sus diferentes modalidades: violencia física, emocional, sexual y económica. Se construyó un índice de severidad a partir de dos procedimientos: Procedimiento 1: análisis de confiabilidad, validez y factorial a partir de las respuestas de las mujeres a la escala de violencia y Procedimiento 2: realización de un jueceo para asignar pesos diferenciales a cada reactivo de la escala. RESULTADOS: Los resultados del Procedimiento 1(confiabilidad y validez), usando todos los reactivos, arrojaron un Alpha de Cronbach cuyos resultados indican una consistencia interna muy alta de 0.99. Por otro lado, el análisis factorial con rotación Varimax arrojó una solución de cuatro factores con cargas factoriales de cada reactivo mayores a 0.40, que se identificaron como: Factor 1 Violencia psicológica; Factor II Violencia física; Factor III Violencia física severa; Factor IV Violencia sexual. La combinación de los cuatro factores explicó 62.2 por ciento del total de la varianza. Procedimiento 2: a través de un jueceo se obtuvo una tabla de pesos asignados a cada acción evaluada. De los 27 reactivos iniciales, se eliminaron ocho como resultado del análisis factorial y otros dos correspondientes a violencia económica, quedando un total de 19 reactivos a los que se les aplicaron los pesos obtenidos en el jueceo. El puntaje mínimo fue 0 y el máximo fue de 354. A través de la clasificación propuesta, se calcularon las siguientes prevalencias: 21% sufrió, en los últimos 12 meses, algún tipo de violencia por parte de su pareja actual. La violencia por tipos se distribuyó de la siguiente manera: psicológica 18.5%; física 10.1%; física severa 6.7%; y sexual 7%. CONCLUSIÓN: La escala de violencia desarrollada demostró ser un instrumento útil y confiable para medir la violencia masculina ejercida en las relaciones de pareja. Así entonces, se sugiere ampliar su uso en otras mediciones nacionales y locales para permitir la comparación posterior de los resultados.

OBJECTIVE: To construct and validate a scale to assess violence by the male partner against women. An index of severity of the emotional and physical damage was also designed to assess the intensity of the violent actions against women. MATERIAL AND METHODS: The sample consisted of a total of 26 042 women who participated as respondents in the National Survey on Violence against Women (ENVIM per its abbreviation in Spanish) conducted in Mexico during 2003. Respondents were all users of health services provided by the Mexican government. The questionnaire was organized into 17 sections, one of which was a 27-item scale to assess partner violence. The purpose of this scale was to measure the type (physical, emotional, sexual and financial) and degree of violence based on severity. A severity index was constructed based on two procedures: 1) the validity, reliability, and factor analyses of the scale and 2) the assessment of severity by expert judges who assigned a value to each item of the scale. RESULTS: The validity and reliability results indicated this scale has adequate internal validity (Cronbach's Alpha=0.99). The factor analysis with Varimax rotation yielded a four-factor solution. The factors were: 1) Psychological violence; 2) Physical violence; 3) Severe physical violence; and 4) Sexual violence. The combination of the four factors accounted for 62.2 percent of the variance in the scale. Using the ratings from the judges a table of values for each of the violent actions described was obtained. The scores assigned by the judges ranged from 0 to 354. Results revealed a prevalence of 21 percent partner violence in the last twelve months. The prevalence of psychological violence was 18.5 percent; of physical violence 10.1 percent; severe physical violence 6.7 percent and sexual violence 7.0 percent. CONCLUSION: The scale of violence described in this article is a very useful and reliable instrument to assess marital violence against women. It is suggested that this instrument be used in other settings to compare results with different samples.

[Medical care of injuries caused intentionally by domestic violence]. / Atención médica de lesiones intencionales provocadas por la violencia familiar.

OBJECTIVE: To describe and analyze the causes of emergency care services for intentional injuries, especially those caused by domestic violence, at four public hospitals in Mexico City. MATERIAL AND METHODS: A cross-sectional study was conducted between January and April 1998, which included variables related with the victim, the aggressor, and the medical care provided to the victim. A questionnaire was applied to individuals who had been injured intentionally. Statistical analysis of data consisted of simple frequencies, the chi 2 test, and odds ratios (OR) with 95% confidence intervals (CI). A logistic regression model was also used to adjust for variables associated with the injury requiring emergency medical care. RESULTS: A total of 598 cases of intentional injuries were analyzed, 16% of which were due to domestic violence. Females were the most frequent victims (76%), followed by young people between 15 and 29 years old (46%). Variables associated with medical care due to injuries by domestic violence were: age 30 or older (OR 2.36, 95% CI 1.13-4.90), female gender (OR 8.60 95% CI 4.25-17.40), history of injuries (OR 4.93 95% CI 2.03-11.95), home as place of occurrence (OR 36.25 95% CI 16.59-79.18), and low education level (OR 2.33 95% CI 1.03-5.26). CONCLUSIONS: Study findings are consistent with those from other studies and call for enforcement of the Mexican Official Norm for Medical Care of Domestic Violence (Norma Oficial Mexicana para la Atención Médica de la Violencia Familiar) established in March 2000.

Atención médica de lesiones intencionales provocadas por la violencia familiar / Medical care of injuries caused intentionally by domestic violence

OBJETIVO: Describir y analizar las características de la demanda provocada por lesiones intencionales, en especial las provocadas por violencia familiar en los servicios de urgencias de hospitales públicos de la Ciudad de México. MATERIAL Y MÉTODOS: Se realizó un estudio transversal, en el cual se incluyeron variables relacionadas con el agresor, el agredido y con la atención médica. Se diseñó un cuestionario, que se aplicó durante los meses de enero a abril de 1998 en cuatro hospitales seleccionados. Se realizó un análisis con base en frecuencias simples, ji cuadrado, razón de momios con sus respectivos intervalos de confianza de 95 por ciento, y se aplicó modelo de regresión logística ajustado por las variables asociadas con este tipo de demanda. RESULTADOS: De los 598 casos que presentaron lesiones intencionales, 16 por ciento correspondió a violencia familiar. Los más afectados fueron el sexo femenino (76 por ciento), y jóvenes entre 15 y 29 años de edad (46 por ciento). Las variables que se encontraron asociadas con la demanda por lesiones provocadas por violencia familiar, en comparación con otro tipo de violencia, fueron: edad mayor de 30 años (RM 2.36, IC 95 por ciento 1.13-4.90), sexo femenino (RM 8.60, IC 95 por ciento/4.25-17.40) antecedentes de lesiones previas (RM 4.93, IC 95 por ciento 2.03-11.95), el hogar como lugar de ocurrencia (RM 36.25, IC 95 por ciento 16.598-79.18) y escolaridad primaria o menos (RM 2.33, IC 95 por ciento 1.03-5.26). CONCLUSIONES: Los resultados encontrados coinciden con reportes de otros estudios sobre el tema, y son de gran utilidad como antecedentes para la aplicación de la Norma Oficial Mexicana para la Atención Médica de la Violencia Familiar, que entró en vigencia en marzo de 2000