Violence Exposure and Disability in Colombian Female Survivors of Intimate Partner Violence: the Mediating Role of Depressive Symptoms.

BACKGROUND: Violence is an important public health problem and one of the main causes of deaths worldwide. The mental health consequences of surviving intimate partner violence (IPV) include depression, anxiety and post-traumatic stress disorder. Previous studies have identified that there is a relationship between depression and level of disability in female survivors of IPV. Estimating the direct, indirect or total effect of an exposure on an outcome makes it possible to identify mediating effects between a group of variables. Detecting mediation effects is useful for identifying casual pathways that generate a final outcome and provides a rationale for designing interventions to target the mediator, which in turn positively affects the outcome. The objective was to identify the mediating role of depressive symptoms on the relationship between IPV and disability. METHODS: This was a cross-sectional study of 94 women over the age of 18 who were survivors of IPV by men. They were recruited from two public hospitals in Cali and Tuluá in southwest Colombia. An analysis of casual relationships was performed using structural equation modelling that was made up of: four exogenous observed variables (age, current relationship status [in a relationship or single], level of schooling, and history of an impairment), intermediate endogenous variables (violence and depressive symptoms), and the main endogenous variable (disability). The analyses were carried out in Stata14.2. RESULTS: The direct effect of IPV severity on the level of disability was not statistically significant (ß=0.09; P=0.63). However, the indirect effect of IPV severity on disability mediated by depressive symptoms was (ß=0.39; P<0.01). The total effect of IPV severity on the level of disability was even greater (ß=0.48; P=0.01). CONCLUSIONS: This study found a complete mediating role of depressive symptoms on the relationship between the severity of IPV and the level of disability for the female participants in this study. The results of this research contribute to defining strategies to prevent and address intimate partner violence, depressive symptoms and disability in this population.

Confiabilidad intra e inter evaluador de la medición de la presión inspiratoria máxima (Pimáx) en treinta sujetos sanos de la ciudad de Cali / Reliability Inter and Intra Evaluator of Maximum Inspiratory Pressure (MIP) in 30 Healthy Subjects in the City of Cali / Confiabilidade intra e inter avaliador da medição da pressão inspiratória máxima (Pimáx) em 30 sujeitos sãos da cidade de Cali

Introducción: La presión inspiratoria máxima (Pimáx) es un índice representativo de la fuerza global de los músculos inspiratorios. La medición de la Pimáx es un procedimiento sencillo, rápido y no invasivo, ampliamente utilizado en la práctica clínica. No existen estudios en el ámbito local que evalúen la confiabilidad de la medición de la Pimáx. Objetivo: determinar la confiabilidad intra e inter evaluador de la medición de la Pimáx. Materiales y métodos: Estudio descriptivo, de corte transversal, realizado en el marco de una prueba piloto del ensayo clínico controlado: Efectos del Entrenamiento Muscular Respiratorio en pacientes adultos en Ventilación Mecánica NCT02469064. De esta manera, 4 evaluadores realizaron 3 mediciones repetidas de Pimáx en 30 sujetos sanos. Para la evaluación de la confiabilidad intra e inter evaluador se calculó el índice de correlación intraclase (ICC) general y por cada evaluador, la concordancia entre los pares de mediciones se realizó por medio del gráfico Bland Altmant. Resultados: El ICC general fue de 0,83 (IC95% 0,835 - 0,939). Los valores de los ICC fueron 0,95 (IC95% 0,91-0,97), 0,97 (IC95% 0,95-0,98), 0,95 (IC95% 0,91-0,97), 0,91 (IC95% 0,85-0,97) para los evaluadores 1, 2, 3 y 4, respectivamente. El gráfico Bland Almant mostró adecuada concordancia entre las parejas de mediciones de Pimáx (p>0,05). Conclusión: La Pimáx mostró ser una medida de alta confiabilidad, las mediciones no se vieron afectadas por el orden en que fueron realizadas en cada sujeto, fundamentándose así su uso en la práctica clínica.

Introduction: The maximum inspiratory pressure (MIP) is a representative of the overall strength of the inspiratory muscles index. Measuring the MIP is a simple, fast and non-invasive procedure widely used in clinical practice. No studies locally to assess the reliability of the measurement of the MIP. Objective: Determining the intra and inter-rater reliability of the measurement of MIP in 30 subjects Materials and methods: Descriptive study, conducted in the framework of a pilot-controlled clinical trial: Effects of Respiratory Muscle Training in adult patients on mechanical ventilation NCT02469064. Four evaluators made 3 PImax repeated measurements in 30 healthy subjects. For the evaluation of intra and inter rater reliability index intraclass correlation (ICC) general and each evaluator was calculated, the correlation between pairs of measurements were performed using Bland graphic Altmant. Results: The general ICC was 0.83 (95% CI 0.835 to 0.939). ICC values were 0.95 (95% CI .91-.97), 097 (95% CI 0.95 to 0.98), 0.95 (95% CI from 0.91 to 0.97), 0.91 (95% CI from 0.85 to 0.97) for evaluators 1.2, 3 and 4 respectively. The Bland Almant Figure showed adequate correlation between pairs of measurements MIP (p > 0.05). Conclusion: MIP proved to be a highly reliable measure, measurements were not affected by the order in which they were made for each subject, and basing its use in clinical practice.

Introdução: a pressão inspiratória máxima (Pimáx) é um índice representativo da força global dos músculos inspiratórios. A medição da Pimáx é um procedimento simples, rápido e não invasivo, amplamente utilizado na prática clínica. Não existem estudos ao nível local que avaliem a confiabilidade da medição da Pimáx. Objetivo: determinar a confiabilidade intra e inter avaliador da medição da Pimáx. Materiais e métodos: estudo descritivo, de corte transversal realizado no marco de uma prova piloto do ensaio clínico controlado: Efeitos do Treinamento Muscular Respiratório em pacientes adultos em Ventilação Mecânica NCT02469064. Quatro avaliadores realizaram 3 medições repetidas de Pimáx em 30 sujeitos sãos. Para a avaliação da confiabilidade intra e inter avaliador secalculou o índice de correlação intraclasse (ICC) geral e por cada avaliador, a concordância entre os pares de medições se realizoy através do gráfico Bland Altmant. Resultados: o ICC geral foi de 0,83 (IC 95% 0,835 - 0,939). Os valores dos ICC foram 0.95 (IC 95% 0.91-0.97), 0.97 (IC 95% 0.95-0.98), 0.95 (IC 95% 0.91-0.97), 0.91 (IC 95% 0.85-0.97) para os avaliadores 1, 2, 3 y 4 respetivamente. O gráfico Bland Almant mostrou adequada concordância entre os pares de medições de Pimáx (p>0.05). Conclusões: a Pimáx mostrou ser uma medida de alta confiabilidade, as medições não se viram afetadas pela ordem em que foram realizadas em cada sujeito, fundamentando-se assim o seu uso na prática clínica.