RESUMO
The regulation of the Hypothalamus-Pituitary-Adrenal axis (HPA-axis) with its end product cortisol seems to be affected in several psychiatric disorders. Although findings are not conclusive, internalizing symptoms have primarily been associated with higher diurnal cortisol levels and externalizing symptoms with lower cortisol levels. In this study on nine-year-olds in Nicaragua (n=111), we investigated associations between child psychiatric symptoms, using the Child Behavior Check List (CBCL), and saliva cortisol levels collected in the morning and afternoon, also adjusting for potential confounders. In line with previous findings, internalizing symptoms were significantly associated with higher morning, but not afternoon cortisol levels. Surprisingly, externalizing symptoms were also significantly associated with higher morning cortisol levels. Possibly, this association between externalizing symptoms and cortisol levels may be characteristic of early ages, representing a higher exposure to external stressors. The study highlights the need for prospective studies, following the development of the HPA-axis and its association with psychiatric symptoms.
Assuntos
Ritmo Circadiano/fisiologia , Hidrocortisona/análise , Sistema Hipotálamo-Hipofisário/fisiopatologia , Transtornos Mentais/fisiopatologia , Sistema Hipófise-Suprarrenal/fisiopatologia , Criança , Feminino , Humanos , Masculino , Nicarágua , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Saliva/químicaRESUMO
Psychometric properties of external HIV-related stigma and discrimination scales and their predictors were investigated. A cross-sectional community-based study was carried out among 520 participants using an ongoing health and demographic surveillance system in León, Nicaragua. Participants completed an 18-item HIV stigma scale and 19 HIV and AIDS discrimination-related statements. A factor analysis found that 15 of the 18 items in the stigma scale and 18 of the 19 items in the discrimination scale loaded clearly into five- and four-factor structures, respectively. Overall Cronbach's alpha of .81 for the HIV stigma scale and .91 for the HIV discrimination scale provided evidence of internal consistency. Hierarchical multiple linear regression analysis identified that females, rural residents, people with insufficient HIV-related transmission knowledge, those not tested for HIV, those reporting an elevated self-perception of HIV risk, and those unwilling to disclose their HIV status were associated with higher stigmatizing attitudes and higher discriminatory actions towards HIV-positive people. This is the first community-based study in Nicaragua that demonstrates that overall HIV stigma and discrimination scales were reliable and valid in a community-based sample comprised of men and women of reproductive age. Stigma and discrimination were reported high in the general population, especially among sub-groups. The findings in the current study suggest community-based strategies, including the monitoring of stigma and discrimination, and designing and implementing stigma reduction interventions, are greatly needed to reduce inequities and increase acceptance of persons with HIV.
Assuntos
Discriminação Psicológica , Infecções por HIV/psicologia , Preconceito , Estigma Social , Estereotipagem , Adolescente , Adulto , Estudos Transversais , Análise Fatorial , Feminino , Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Nicarágua , Vigilância da População , Psicometria , Análise de Regressão , Características de Residência , Autoimagem , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Nicaragua's HIV epidemic is concentrated among men who have sex with men. Nevertheless, the increasing number of HIV cases among heterosexuals, high levels of poverty and migration rates, and incomplete epidemiological data suggest the need to improve the understanding of the epidemic. OBJECTIVE: To examine the prevalence of HIV-related knowledge, attitudes, and sexual risk-taking behaviors, and their predictors among the adult population. METHODS: A community-based cross-sectional survey was conducted in 2009 among 520 participants ages 15-49 from an ongoing Health and Demographic Surveillance System in Nicaragua. Bivariate analysis and adjusted prevalence ratios were use to examine factors associated with HIV-related knowledge, attitudes, and sexual behavior. RESULTS: Contributing factors for risk-taking behaviors included cognitive, psychosocial, and emotional elements. Insufficient knowledge affecting the accurate assessment of HIV risk were low educational level, poverty, and rural origin, especially among females. Recognizing risk was not sufficient to promote safer sex: 90% of the females and 70% of the males who reported being sexually active in the past year did not use condoms during their last sexual encounter. Inconsistent condom use among men was associated with older age, long-term relationships, and lack of awareness about acquiring HIV infection. CONCLUSIONS: Interventions to reduce social-structural contextual factors in Nicaragua are needed so that individuals may adopt and maintain HIV risk reduction strategies. Increased gender-specific HIV education and skills-building programs need to be implemented. Sensitive mass media messages may also increase the knowledge of HIV and AIDS, and serve to encourage protective attitudes and behaviors.
Assuntos
Síndrome da Imunodeficiência Adquirida , HIV , Conhecimentos, Atitudes e Prática em Saúde , Assunção de Riscos , Comportamento Sexual , Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/psicologia , Adolescente , Adulto , Fatores Etários , Coito , Estudos Transversais , Epidemias , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nicarágua/epidemiologia , Prevalência , Fatores Sexuais , Fatores Socioeconômicos , Adulto JovemRESUMO
BACKGROUND: This study analyses whether a mother's exposure to different forms of Intimate Partner Violence (IPV) during pregnancy was associated with the index child linear growth, and whether these associations were modified by the gender of the child. METHODS: A pregnancy cohort of 478 women in León, Nicaragua, resulted in 461 live births. From this group, 81% (375/461) children were available for anthropometric follow-up at 40 to 46 months. Analysis of covariance (ANCOVA) was used to assess the association between IPV and height-for-age Z-scores, adjusting for confounding factors. RESULTS: Sixty-three percent (236/375) of the mothers had been exposed to some form of IPV during pregnancy (emotional, physical, sexual or controlling behavior). After adjustment for confounding factors, maternal exposure to any IPV during pregnancy was associated with 0.24 lower mean height-for-age Z-scores (p = 0.02). A separate analysis of each IPV type showed that emotional, physical or sexual IPV during pregnancy were not significantly associated with lower mean height-for-age Z-scores, whereas ever exposure to controlling behavior by the father of the child was related to 0.29 lower mean height-for-age Z-scores (p < 0.01) When stratified by gender, these associations remained significant only for young girls. CONCLUSIONS: This study has contributed to the growing amount of evidence pointing to the pervasive effect of different forms of IPV on child health. Our study highlights the relevance of maternal autonomy for linear child growth, especially for young girls in the Nicaraguan context.
Assuntos
Estatura , Desenvolvimento Infantil , Efeitos Tardios da Exposição Pré-Natal/etiologia , Maus-Tratos Conjugais , Adulto , Análise de Variância , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Nicarágua , Gravidez , Autorrelato , Fatores SexuaisRESUMO
This grounded theory study found that Nicaraguan mothers exposed to intimate partner violence (IPV) during pregnancy eventually acted to protect their children and themselves. They experienced ending abuse as an empowerment process characterized by a cognitive change in women's attitudes toward partner abuse and the emergence of help-seeking strategies that lead to ending violence with or without ending the relationship. This process was facilitated by a supportive environment that challenged abusive behaviors as well as being asked about abuse during their last pregnancy. Although environmental changes can facilitate ending abuse, Nicaragua's public institutions must be strengthened to reach women in need.
Assuntos
Mulheres Maltratadas , Cognição , Relações Interpessoais , Aceitação pelo Paciente de Cuidados de Saúde , Poder Psicológico , Apoio Social , Maus-Tratos Conjugais/prevenção & controle , Adulto , Atitude Frente a Saúde , Mulheres Maltratadas/psicologia , Criança , Feminino , Humanos , Masculino , Mães/psicologia , Nicarágua , Gravidez , Parceiros Sexuais , Maus-Tratos Conjugais/psicologia , Cônjuges , Adulto JovemRESUMO
BACKGROUND AND METHODOLOGY: The study aim was to examine whether exposure to intimate partner violence (IPV) was associated with reversible contraceptive use in ever-pregnant partnered women. The authors conducted a longitudinal panel study in León municipality, Nicaragua. At baseline (2002-2003), 478 pregnant women were interviewed and 398 were available for questioning about contraceptive use 40-47 months after childbirth. IPV was assessed at baseline and follow-up, with women classified as never abused, ending abuse, continued abuse or new abuse. Reversible contraceptive use was defined as women using any form of contraception apart from sterilisation. Adjusted odds ratios (AORs) were used to assess the association between reversible contraceptive use, IPV patterns and IPV exposures at follow-up. RESULTS: Eighty percent of the women were not pregnant and with a partner at follow-up. Half were using reversible contraceptives and 28% were sterilised. Women exposed to a continued abuse pattern (AOR 2.50, 95% CI 11.04-5.99), and those exposed to emotional (AOR 2.80, 95% CI 1.32-5.95), physical (AOR 3.60, 95% CI 1.15-11.10) or any IPV at follow-up (AOR 2.59, 95% CI 1.24-5.40) had higher odds of reversible contraceptive use than those not exposed, even after adjusting for demographic factors. No significant differences in the type of reversible contraceptive used were found between women exposed or not to IPV. DISCUSSION AND CONCLUSIONS: IPV exposure was associated with more reversible contraceptive use. Abuse inquiring at health facilities providing contraceptives should be implemented to identify women exposed to IPV and provide adequate support.
Assuntos
Anticoncepção/estatística & dados numéricos , Maus-Tratos Conjugais/estatística & dados numéricos , Adulto , Política de Planejamento Familiar , Serviços de Planejamento Familiar , Feminino , Humanos , Estudos Longitudinais , Nicarágua/epidemiologia , Gravidez , Fatores Socioeconômicos , Maus-Tratos Conjugais/psicologiaRESUMO
BACKGROUND: Although reducing intimate partner violence (IPV) is a pervasive public health problem, few longitudinal studies in developing countries have assessed ways to end such abuse. To this end, this paper aims to analyze individual, family, community and societal factors that facilitate reducing IPV. METHODS: A longitudinal population-based study was conducted in León, Nicaragua at a demographic surveillance site. Women (n = 478) who were pregnant between 2002 and 2003 were interviewed, and 398 were found at follow-up, 2007. Partner abuse was measured using the WHO Multi-country study on women's health and domestic violence questionnaire. Women's socio demographic variables, perceived emotional distress, partner control, social resources, women's norms and attitudes towards IPV and help-seeking behaviours were also assessed. Ending of abuse was defined as having experienced any abuse in a lifetime or during pregnancy but not at follow-up. Crude and adjusted odds ratios were applied. RESULTS: Of the women exposed to lifetime or pregnancy IPV, 59% reported that their abuse ended. This finding took place in a context of a substantial shift in women's normative attitudes towards not tolerating abuse. At the family level, no or diminishing partner control [ORadj 6.7 (95%CI 3.5-13)] was associated with ending of abuse. At the societal level, high or improved social resources [ORadj 2.0 (95%CI 1.1.-3.7)] were also associated with the end of abuse. CONCLUSION: A considerable proportion of women reported end of violence. This might be related to a favourable change in women's norms and attitudes toward gender roles and violence and a more positive attitude towards interventions from people outside their family to end abuse. Maintaining and improving social resources and decreasing partner control and isolation are key interventions to ending abuse. Abuse inquiring may also play an important role in this process and must include health care provider's training and a referral system to be more effective. Interventions at the community level are crucial to reducing partner violence.
Assuntos
Parto Obstétrico , Violência Doméstica/psicologia , Avaliação de Resultados em Cuidados de Saúde/métodos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Parceiros Sexuais , Adolescente , Adulto , Violência Doméstica/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Nicarágua/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Fatores Socioeconômicos , Inquéritos e Questionários , Saúde da Mulher , Organização Mundial da Saúde , Adulto JovemRESUMO
OBJECTIVE: To study the neuroendocrine release of cortisol in response to perceived stress among pregnant women exposed to partner violence and how this affects the duration of pregnancy and the intrauterine growth of the infant. DESIGN: Cross-sectional community-based study. SETTING: Health and Demographic Surveillance System of Leon, Nicaragua. POPULATION: One-hundred and forty-seven pregnant women. METHODS: Standardized scales to measure intimate partner violence, social resources, perceived stress, and socio-economic conditions were applied. Two salivary samples for cortisol were collected in the morning and afternoon on the same day. Linear regression and path analysis were used. MAIN OUTCOME MEASURES: Cortisol levels, gestational age, and weight at delivery. RESULTS: Partner violence during the pregnancy, low social resources, and perceived maternal stress were associated with high level of salivary cortisol. Pregnant women with high cortisol levels were significantly more likely to give birth to small-for-gestational age babies, but not to deliver preterm. A substantial decrease of birthweight, 121-186 g, was associated with an increase in cortisol in association with violence exposure. CONCLUSION: Partner violence during pregnancy is a stressor that provokes high levels of cortisol, which is associated with reduction of birthweight.
Assuntos
Desenvolvimento Fetal , Hidrocortisona/metabolismo , Resultado da Gravidez , Estresse Psicológico/metabolismo , Violência , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Nicarágua/epidemiologia , Vigilância da População , Gravidez , Complicações na Gravidez/epidemiologia , Fatores de Risco , Saliva/química , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: This study aims to estimate the prevalence and characteristics of partner abuse during pregnancy as well as to investigate associated social factors in León, Nicaragua. DESIGN: Cross-sectional community-based study. SETTING: All pregnant women from 50 randomly selected geographical clusters out of 208 in the municipality of León, Nicaragua. SAMPLE: A total of 478 pregnant women were included; only one woman refused to participate. METHOD: The domestic violence questionnaire from the WHO-co-ordinated Multi-Country Study on Women's Health and Life Events was used with each participant being interviewed twice during pregnancy. MAIN OUTCOME MEASURES: Prevalence and characteristics of partner violence during pregnancy. RESULTS: The prevalence of emotional, physical and sexual abuse during pregnancy was 32.4%, 13.4% and 6.7%, respectively. Seventeen percent reported experience of all three forms of violence. Two-thirds of the victims reported repeated abuse. Half of the abused women had experienced punches and kicks directed towards the abdomen and 93% had been injured. Most women had not sought health care in relation to the abuse, but those who did were usually hospitalised. Factors such as women's age below 20 years, poor access to social resources and high levels of emotional distress were independently associated with violence during pregnancy. CONCLUSION: Violence against pregnant women in Nicaragua is common and often repeated. Although these women have poor access to social resources and high levels of emotional distress, they are rarely assisted by the health services. Innovative strategies are needed to provide support and counselling.
Assuntos
Complicações na Gravidez/epidemiologia , Maus-Tratos Conjugais/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Nicarágua/epidemiologia , Gravidez , Complicações na Gravidez/psicologia , Prevalência , Fatores Socioeconômicos , Maus-Tratos Conjugais/psicologia , Estresse Psicológico , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To assess whether being physically abused during pregnancy increases the risk of a low birth weight (LBW) infant. METHODS: We conducted a hospital-based case-control study in León, Nicaragua. Cases consisted of 101 newborns with a birth weight under 2500 g, and for each case two controls with a birth weight over 2500 g were selected randomly from infants born the same day. Anthropometry of newborns was done immediately after birth, and background information and data on experiences of violence and potential confounders were obtained through private interviews with mothers. Crude and adjusted odds ratios (ORs) and population-attributable proportion were calculated for exposure to partner abuse in relation to LBW. Multivariate logistic regression analysis was used to control for potential confounding. RESULTS: Seventy-five percent of LBW newborns (cases) were small for gestational age and 40% were preterm. Twenty-two percent of the mothers of LBW infants had experienced physical abuse during pregnancy by their intimate partners compared with 5% of controls. Low birth weight was associated with physical partner abuse even after adjustment for age, parity, smoking, and socioeconomic status (OR 3.9; 95% confidence interval 1.7, 9.3). Given a causal interpretation of the association, about 16% of the LBW in the infant population could be attributed to physical abuse by a partner in pregnancy. CONCLUSION: Physical abuse by a partner during pregnancy is an independent risk factor for LBW.