Childbirth experiences of immigrant women in Chile: Trading human rights and autonomy for dignity and good care.

BACKGROUND: Childbirth is a transcendent life experience but may also be a moment of great vulnerability, especially when it occurs outside the mother's country of origin. OBJECTIVE: To explore the perceptions and experiences of Spanish-speaking immigrant women regarding the healthcare they received during labour and childbirth in Santiago, Chile. METHODS: This qualitative, transcendental phenomenological research was performed at two maternity hospitals using purposive criterion sampling. Eighteen individual and two group interviews were conducted. The resulting information was transcribed and then coded and categorised using phenomenological analysis. RESULTS: Six categories were extracted from the narratives which reflect a pragmatic relationship with the healthcare team that included a perception of 'justified' lack of care. The mothers' exercise of autonomy was subjugated by power-knowledge relations between the women and caregiver that compelled them to refrain from expressing their needs and preferences out of fear of abuse. The women valued emotional support, pain relief and satisfaction of needs in association with medical procedures and companionship. The women rated their experiences as positive if they avoided mistreatment and, as 'the essence of the experience', perceived the care as a favour rather than a right. CONCLUSION: Most immigrant women felt that they had received treatment similar to that of native-born mothers. However, low expectations of autonomy shaped their evaluations of the experiences. Also, a high value on companionship and pain relief, characterised the women's experiences of childbirth. These findings of the interviews reflect a need for a stronger focus on empowerment with an emphasis on gender and rights.

Comparison of bio-sociodemographic, obstetric and perinatal characteristics among immigrant and native women in the Metropolitan Region in Chile.

BACKGROUND: International migration is an increasing public health concern, particularly regard to maternal and neonatal health. OBJECTIVE: To compare obstetric and neonatal variables among native and immigrant childbearing women in a clinical hospital in Santiago, Chile. METHOD: A cross-sectional, analytic study with 2598 childbearing women and their newborn examined between January and July 2015. Data were collected from clinical records by students who had previously been trained. Ethical approval was obtained from the local Ethics Committee at the hospital. All participants signed an informed consent form. A descriptive and comparative analysis was performed. For comparison, a Chi-square test was used for categorical variables, and Student t-test was used for quantitative variables. RESULTS: Among the included women, 41.5% (n = 1078) were immigrants. The immigrants' mean age was 28.1 ±â€¯6.4 years, and that of natives was 26.8 ±â€¯6.9 (p < 0.001). Among natives, the obesity rate was 38.3%, as compared to 19.3% among immigrants (p < 0.001). A significantly higher rate of caesarean section was seen among natives (36.8%) than among immigrants (31.7%). Obstetric morbidity, pre-eclampsia, gestational diabetes and prematurity were significantly higher among natives. There was no difference regarding low birth weights. CONCLUSION: In general, immigrants present better maternal and neonatal indicators than native women. Controversially, this is known as the 'healthy immigrant' phenomenon in the literature.

[Psychometric properties of three rating scales for attention deficit hyperactivity disorder in Chilean students]. / Propiedades psicométricas de tres escalas de evaluación del trastorno por déficit de atención con hiperactividad en escolares chilenos.

OBJECTIVE: To assess, among Chilean students, the reliability and validity of three scales that measure attention deficit hyperactivity disorder (ADHD): the ADHD Rating Scale-IV (ADHD-IV); the scale for evaluating attention deficit disorder with hyperactivity (EDAH); and Spain's version of the ADHD Rating Scale-IV (Spa-ADHD-IV). METHODS: A study of the instruments was conducted with the tutors (n = 612) and teachers (n = 82) of a controlled sample of 640 children 6-11 years of age, who were students attending public schools (n = 228, 35.6% of total), subsidized schools (n = 200, 31.3%), or private schools (n = 212, 33.1%) in Antofagasta, Chile. The convergent validity of the ADHD rating instruments was determined using Stroop and Wechsler tests. RESULTS: All three scales studied had satisfactory levels of internal consistency (Cronbach's alpha of 0.88-0.97 for the scales; 0.76-0.97 for the items) and a factor structure that was theoretically-aligned for most of the assessment areas, although only the Spa-ADHD-IV with tutors and teachers and the ADHD-IV with teachers had comparative and relative fit indices greater than 0.90. Significant differences were found by age, gender, and type of evaluator (tutor or teacher). CONCLUSIONS: The ADHD-IV and Spa-ADHD-IV met all reliability and validity criteria; so both may be applied for screening and diagnosis in the Chilean population. The Spa-ADHD-IV scale offers the best psychometric properties based on its reliability and validity.

Propiedades psicométricas de tres escalas de evaluación del trastorno por déficit de atención con hiperactividad en escolares chilenos / Psychometric properties of three rating scales for attention deficit hyperactivity disorder in Chilean students

Objetivo: Evaluar en escolares chilenos la fiabilidad y la validez de tres escalas que miden el trastorno de déficit de atención con hiperactividad (TDAH): el inventario para déficit de atención (IDDA), la escala de evaluación del déficit de atención con hiperactividad (EDAH) y la adaptación española de la escala para la gradación del déficit de atención con hiperactividad IV (EGDAH IV). Método: Estudio instrumental con los tutores (n = 612) y los profesores (n = 82) de una muestra intencional de 640 niños y niñas de 6 a 11 años de edad, estudiantes de establecimientos municipales públicos (n = 228; 35,6 por ciento del total); subvencionados (n = 200; 31,3 por ciento) y privados (n = 212; 33,1 por ciento) de la ciudad de Antofagasta, Chile. La validez de convergencia de los instrumentos de medición del TDAH se determinó mediante las pruebas de Stroop y de Wechsler. Resultados: Las tres escalas evaluadas presentan niveles satisfactorios de consistencia interna (coeficiente alfa de Cronbach de 0,88 a 0,97 en las escalas y de 0,76 a 0,97 en las dimensiones) y una estructura factorial acorde a la teórica en la mayoría de las dimensiones evaluadas, aunque solo la EGDAH IV con los tutores y los profesores, y el IDDA con los profesores mostraron índices de ajuste comparativo y de ajuste relativo superiores a 0,90. Se encontraron diferencias significativas según la edad, el sexo y el tipo de informante (tutor o profesor). Conclusión: El IDDA y la EGDAH IV cumplieron favorablemente con todos los criterios de fiabilidad y validez, por lo que se pueden aplicar para el tamizaje y el diagnóstico en la población chilena. La escala EGDAH IV presentó las mejores propiedades psicométricas por su confiabilidad y validez.

Objective: To assess, among Chilean students, the reliability and validity of three scales that measure attention deficit hyperactivity disorder (ADHD): the ADHD Rating Scale-IV (ADHD-IV); the scale for evaluating attention deficit disorder with hyperactivity (EDAH); and Spain's version of the ADHD Rating Scale-IV (Spa-ADHD-IV). Methods: A study of the instruments was conducted with the tutors (n = 612) and teachers (n = 82) of a controlled sample of 640 children 6-11 years of age, who were students attending public schools (n = 228, 35.6 percent of total), subsidized schools (n = 200, 31.3 percent), or private schools (n = 212, 33.1 percent) in Antofagasta, Chile. The convergent validity of the ADHD rating instruments was determined using Stroop and Wechsler tests. Results: All three scales studied had satisfactory levels of internal consistency (Cronbach's alpha of 0.88-0.97 for the scales; 0.76-0.97 for the items) and a factor structure that was theoretically-aligned for most of the assessment areas, although only the Spa-ADHD-IV with tutors and teachers and the ADHD-IV with teachers had comparative and relative fit indices greater than 0.90. Significant differences were found by age, gender, and type of evaluator (tutor or teacher). Conclusions: The ADHD-IV and Spa-ADHD-IV met all reliability and validity criteria; so both may be applied for screening and diagnosis in the Chilean population. The Spa-ADHD-IV scale offers the best psychometric properties based on its reliability and validity.