RESUMEN Objetivo. Identificar el conocimiento y las barreras para acceder efectivamente a la interrupción voluntaria del embarazo (IVE), y en general a los servicios sexuales y reproductivos (SSR), entre mujeres provenientes de Venezuela (migrantes venezolanas y colombianas retornadas). Métodos. Estudio cualitativo de 20 entrevistas semiestructuradas en mujeres provenientes de Venezuela, residentes en Barranquilla que ejecutan acciones de liderazgo en comunidades o que participan (o se benefician) de las actividades. Las entrevistas comprendieron dimensiones sobre opiniones y experiencias relacionadas con el acceso a IVE, y en general a SSR, y sugerencias para mejorar el acceso para las mujeres migrantes. Se exploró la relación del acceso a estos servicios con el proceso migratorio y el papel de las organizaciones sociales. Resultados. Se identificó la falta de información sobre derechos en SSR como principal barrera para acceso a la IVE. Otras barreras identificadas fueron: actitud hacia la IVE, exceso de trámites para atención médica, dificultades para la inclusión al sistema de seguridad social, falta de capacitación y atención en SSR y xenofobia en hospitales. Las entrevistadas manifestaron desconocer el marco legal en Colombia y las rutas para la atención de un aborto seguro. Conclusiones. Pese a los esfuerzos institucionales y de cooperación internacional, las mujeres migrantes venezolanas en Barranquilla se encuentran en una situación de vulnerabilidad debido a la falta de acceso a los SSR incluida la IVE. Implementar estrategias para atención integral a migrantes, permitirá mejorar condiciones de salud actual y el goce efectivo de los derechos en SSR.

RESUMO Objetivo. Identificar os conhecimentos e as barreiras para o acesso efetivo das mulheres provenientes da Venezuela (migrantes venezuelanas e retornadas colombianas) à interrupção voluntária da gravidez (IVG) e aos serviços de saúde sexual e reprodutiva (SSR) em geral. Métodos. Estudo qualitativo de 20 entrevistas semiestruturadas com mulheres provenientes da Venezuela, residentes em Barranquilla, que atuam na liderança comunitária ou que participam (ou se beneficiam) das atividades. As entrevistas compreenderam as dimensões de opiniões e experiências relacionadas ao acesso à IVG e aos serviços de SSR em geral, e sugestões para melhorar o acesso das mulheres migrantes. Explorou-se a relação do acesso a esses serviços com o processo migratório e o papel das organizações sociais. Resultados. Identificou-se a falta de informações sobre direitos em SSR como a principal barreira para o acesso à IVG. Outras barreiras identificadas foram: atitude em relação à IVG, excesso de burocracia para obter atenção médica, dificuldades para inclusão no sistema de seguridade social, falta de capacitação e atenção em SSR e xenofobia nos hospitais. As entrevistadas declararam desconhecer o enquadramento jurídico na Colômbia e os trâmites para obter atenção ao aborto seguro. Conclusões. Apesar dos esforços institucionais e de cooperação internacional, as mulheres migrantes venezuelanas em Barranquilla estão em situação de vulnerabilidade por falta de acesso aos serviços de SSR, incluindo a IVG. A implementação de estratégias para atenção integral a migrantes possibilitará a melhoria das condições atuais de saúde e a efetiva fruição dos direitos em SSR.

ABSTRACT Objective. Identify knowledge about and barriers to effective access to voluntary interruption of pregnancy (VIP), and to sexual and reproductive health (SRH) services in general, among women from Venezuela (Venezuelan migrants and Colombian returnees). Methods. Qualitative study of 20 semi-structured interviews with women from Venezuela who are residents of Barranquilla and who carry out leadership activities in communities or who participate in or benefit from those activities. The interviews included opinions and experiences related to access to VIP, and to SRH in general, as well as suggestions for improving access for migrant women. The relationship between access to these services and the migration process was explored, as well as the role of social organizations. Results. A lack of information on SRH-related rights was identified as the main access barrier to VIP. Other identified barriers were: attitude towards VIP, excessive steps involved in accessing medical care, difficulties in admission to the social security system, lack of training and care in SRH, and xenophobia in hospitals. The interviewees said they did not understand the legal framework in Colombia and did not know the channels for safe abortion care. Conclusions. Despite the efforts of institutions and international cooperation, Venezuelan migrant women in Barranquilla are in a situation of vulnerability due to their lack of access to sexual and reproductive health, including voluntary interruption of pregnancy. Implementing strategies for comprehensive care for migrants will improve current health conditions and the effective enjoyment of SRH-related rights.

Resumen Objetivo: Describir la utilización de métodos anticonceptivos de gestantes migrantes venezolanas, en dos ciudades de la costa norte de Colombia (Barranquilla y Riohacha), entre 2018 y 2019. Metodología: Se diseñó un estudio descriptivo de corte transversal. Las participantes se seleccionaron mediante muestreo sistemático en hospitales y muestreo en bola de nieve en la comunidad. Un cuestionario estandarizado permitió la recolección de variables sociodemográficas, de migración, de uso de anticonceptivos, entre otras. Resultados: Fueron encuestadas 552 mujeres gestantes provenientes de Venezuela, principalmente jóvenes, casadas o en unión libre; la minoría de los embarazos fueron planificados (37,7 %), aun cuando las mujeres conocían sobre métodos de anticoncepción. El preservativo (condón) y la píldora fueron los métodos más conocidos (94,7 y 96,1 %, respectivamente). Conclusión: Casi todas las mujeres conocen métodos anticonceptivos y los lugares dónde obtenerlos; no obstante, solo la mitad logró conseguirlos la última vez que los buscó; así, la mayoría de los embarazos fueron no planificados. La garantía de los derechos sexuales y reproductivos, incluyendo la satisfacción de necesidades de planificación familiar, debe ser una prioridad en las acciones de atención a la población migrante, en el marco del fenómeno migratorio colombo-venezolano.

Abstract Objective: To describe the use of contraceptive methods by pregnant Venezuelan migrants in two cities on the north coast of Colombia (Barranquilla and Riohacha), between 2018 and 2019. Methodology: A descriptive cross-sectional study was designed. Participants were selected through systematic sampling in hospitals and snowball sampling in the community. A standardized questionnaire allowed the sociodemographic, migration, contraceptive use and other variables to be collected. Results: 552 pregnant, mainly young, women from Venezuela who are married or living with their partner were surveyed. The minority of pregnancies were planned (37.7%), even though the women knew about contraception methods. The condom and the pill were the most well-known methods (94.7 and 96.1%, respectively). Conclusion: Nearly all of the women knew about birth control and where it can be accessed. However, only half managed to get them the last time they looked for them, meaning that most of the pregnancies were unplanned. Guaranteed sexual and reproductive rights, including satisfactory family planning requirements, must be a priority in actions aimed at the migrant population, within the framework of the Colombian-Venezuelan migratory phenomenon.

Resumo Objetivo: Descrever o uso de métodos anticoncepcionais de gestantes migrantes venezuelanas, em duas cidades do litoral norte da Colômbia (Barranquilla e Riohacha), entre 2018 e 2019. Metodologia: Foi desenhado um estudo de corte transversal descritivo. As participantes foram selecionadas através de uma amostragem sistemática em hospitais e amostragem em bola de neve feita na comunidade. Um questionário padrão permitiu a coleta de variáveis sócio demográficas, de informação relacionada à migração, ao uso de anticoncepcionais, entre outras. Resultados: O questionário foi aplicado a 552 mulheres gestantes vindas da Venezuela, principalmente jovens, casadas ou em união estável; a minoria das gestações foi planejada (37,7%), mesmo conhecendo os métodos anticoncepcionais. O preservativo (camisinha) e a pílula foram os métodos mais identificados (94,7 e 96,1% respectivamente). Conclusão: Quase todas as mulheres conhecem métodos anticoncepcionais e os lugares onde podem obtê-los; porém somente a metade delas conseguiu adquiri-los quando procuraram pela última vez; assim que a maioria das gestações não foi planejada. A garantia dos direitos sexuais e reprodutivos, incluindo a satisfação das necessidades de planejamento familiar, deve ser uma prioridade nos programas de atenção à população migrante, dentro do marco do fenômeno migratório colombo-venezuelano.

Resumen Introducción: En el fenómeno migratorio desde Venezuela hacia Colombia, las mujeres representan una proporción significativa entre los migrantes irregulares; de ellas, las gestantes han sido priorizadas por sus condiciones particulares de vulnerabilidad. Sin embargo, se desconocen sus condiciones de salud. Objetivos: Caracterizar multidimensionalmente la situación de salud de las gestantes venezolanas migrantes irregulares, residentes en las principales ciudades receptoras del Caribe colombiano: Barranquilla y Riohacha. Metodología: Estudio descriptivo de corte transversal en 520 gestantes venezolanas migrantes irregulares, captadas por muestreo sistemático en hospitales públicos, y comunitariamente a través de búsqueda activa en bola de nieve entre agosto de 2018 y mayo de 2019. Con un cuestionario estandarizado se evaluaron los principales problemas de salud, estado nutricional, seguridad alimentaria, presencia de síntomas depresivos, accesibilidad y satisfacción con los servicios de salud. Resultados: La mitad percibía su salud durante el embarazo como buena o muy buena (53,4%). El 51,3% presentó anemia ferropénica y la mayoría algún grado de inseguridad alimentaria (87,5%). La prevalencia de síntomas depresivos clínicamente significativos fue del 32,1%. Una alta proporción reportó algún tipo de violencia por parte de su pareja (90,2%). El 25,9% requirió atención sanitaria por urgencias independiente de la atención prenatal. El 62,7% calificó la atención por urgencias como muy buena o buena, mientras que el 73,1% piensa que le brindaron la atención necesaria para su problema de salud. Conclusiones: Los principales problemas de salud en gestantes que participaron en el estudio corresponden a la inseguridad alimentaria, anemia, síntomas depresivos, violencia de pareja y ausencia de controles prenatales. Su situación de salud debe considerarse en el marco del proceso migratorio y desde los determinantes sociales de la salida, tránsito, llegada y retorno. Las medidas de atención primaria para esta población deben seguir siendo fortalecidas por el sistema de salud a nivel territorial y basadas en evidencia.

Abstract Introduction: In the current migration from Venezuela to Colombia, women represent a significant proportion of the irregular migrant population, and those who are pregnant have been a priority given their particularly vulnerable condition. Nevertheless, their health conditions are not known. Objectives: To obtain a multi-dimensional characterization of the health situation of irregular Venezuelan migrants who are pregnant and residing in the main receiving the Caribbean region of Colombia: Barranquilla and Riohacha. Methods: We carried out a descriptive, cross-sectional study with 520 pregnant women surveyed from August 2018 to May 2019 with a systematic sampling in public hospitals and an active community search using snowball sampling. We used a standardized questionnaire to evaluate the main health problems, nutritional status, food security, presence of depressive symptoms and accessibility/ satisfaction with health services. Results: Half of the participants perceived their health during pregnancy as good or very good (53.4%), 51.3% presented iron deficiency anemia, and the majority (87.5%) experienced some lack of food security. The prevalence of clinically significant depressive symptoms was 32.1%. A high proportion reported some type of intimate partner violence (90.2%). 25.9% required urgent medical care, irrespective of the prenatal care they received. With regard to quality of care in the emergency service, 62.7% rated it as very good or good, and 73.1% reported that they received the care that was needed for their health problem. Conclusions: Food insecurity, anemia, depressive symptoms, violence committed by the partner and lack of prenatal care were the main health problems for pregnant women who participated in the study. Their health situation should be viewed in the context of the migration process, based on the social determinants of emigration, transit, arrival, and return. The health care system should continue to strengthen primary care measures for this population at the local level and based on the evidence.

ABSTRACT The purpose of this study was to identify changes in the risk of eating disorders after a one-year follow-up of a dissonance-based eating disorders prevention program. The Body Project was implemented in a sample of male and female university students: 133, 110, and 74 at baseline, post-test, and follow-up respectively, and we tested the change in disordered eating behaviors (DEB) over time, and by levels of variables that according to the theoretical model lie on the path between the intervention and DEB, with one-way MANOVA analyses of repeated measures for the associations between internalization of the esthetic thin ideal, depressive symptoms, and DEB. The average value of DEB was 5.23 at pre-test, 3.45 at post-test, and 2.80 at follow-up. The model with DEB at each time point, as dependent variables, and internalization of the esthetic thin ideal and depressive symptoms, as independent variables, showed a significant effect of internalization of the esthetic thin ideal, F(2, 136) = 7.66, p = .0011, while there was no significant effect of depressive symptoms, F(2, 136) = 0.45, p = .6191, indicating that the intervention exerted its effect on DEB via the former variable. The intervention proved to produce effects after a one-year follow-up. These findings support the implementation of universal prevention programs using dissonance-based techniques.

RESUMEN El objetivo de este trabajo fue identificar los cambios en el riesgo de desarrollar trastornos de la conducta alimentaria después de un año de seguimiento de un programa de prevención basado en la técnica de la disonancia cognitiva para trastornos de la conducta alimentaria. El Body Project fue implementado en una muestra de estudiantes universitarios, hombres y mujeres: 133, 110 y 74 en el pre-test, post-test y seguimiento, respectivamente. Se comprueba el cambio en las conductas alimentarias de riesgo (CAR) a lo largo del tiempo y según las variables que, de acuerdo con el modelo teórico, se encuentran entre la intervención y las CAR, con un análisis MANOVA de medidas repetidas para las asociaciones entre interiorización del ideal estético de delgadez, los síntomas depresivos y las CAR. El valor promedio de las CAR en el pre-test fue 5.23, 3.45 en el post-test y 2.80 en el seguimiento. El modelo de las CAR como variable dependiente e interiorización del ideal estético de delgadez y los síntomas depresivos como variables independientes mostró un efecto significativo de la internalización del ideal estético de delgadez, F(2, 136) = 7.66, p = .0011, mientras que no hubo un efecto significativo de los síntomas depresivos, F(2, 136) = 0.45, p = .6191, lo que indica que la intervención tuvo un efecto en las CAR por vía de la variable antecedente. Se mostró que la intervención produce efectos después de un año de seguimiento. Este hallazgo sustenta la implementación de programas universales de prevención que utilicen la técnica de disonancia cognoscitiva.

Abstract: Objective: To estimate the prevalence of disordered eating behaviors (DEB) and identify their associations with demographic and psychological variables among freshman students at a public university in Mexico City. Materials and methods: A sample of 892 subjects participated in the study. Bivariate and multinomial models were performed to determine associations between DEB and covariates. Results: Of those surveyed, 6.8% of the women and 4.1% of the men exhibited DEB (p<0.05). The variables increasing the risk of eating disorders (ED) for women were internalization of the aesthetic thin ideal (IATI), body mass index (BMI), self-esteem and physical activity, while for men they were IATI, drive for muscularity, and self-esteem. Conclusions: The frequency of DEB among women and men and the internalization of the thin ideal in both sexes suggest the possibility of a change in the precursor conditions for eating disorders, particularly for men, who exhibit increased risk of such behaviors.

Resumen: Objetivo: Estimar la prevalencia de conductas alimentarias de riesgo (CAR) e identificar asociaciones con variables sociodemográficas y psicológicas en estudiantes de nuevo ingreso de una universidad pública de la Ciudad de México. Material y métodos: Se aplicó una encuesta a 892 estudiantes de ambos sexos. Para analizar asociaciones entre CAR y sus covariables se emplearon modelos bivariados y multivariados. Resultados: Se estimó que 6.8% de las mujeres y 4.1% de los hombres presentaron CAR (p>0.05). Entre las mujeres las variables que aumentaron el riesgo de CAR fueron interiorización del ideal estético de la delgadez (IIED), índice de masa corporal (IMC), autoestima y actividad física. Entre los hombres, las variables que sobresalieron fueron IIED, deseo por un cuerpo musculoso y autoestima. Conclusiones: La frecuencia de CAR entre mujeres y hombres, así como la IIED en ambos sexos sugiere un cambio en las condiciones de riesgo, especialmente entre los varones.

Abstract This article explores the institutional capacity to respond to the health needs of Mexican migrants repatriated through Tijuana, Baja California, Mexico. Twenty-one semi-structured interviews with governmental and civil society organizations were conducted. The information was analyzed using the concept of "cooperation." Results show an informal inter-institutional network based on common goals and interdependence of resources. Health service provision is not completely functional, due in part to lack of trust between some actors and to demand overload in the most important public provider of secondary and tertiary care services in Tijuana.

Resumen Este artículo explora la capacidad de respuesta institucional a las necesidades de salud de migrantes repatriados por Tijuana, Baja California, México. Se realizaron 21 entrevistas semiestructuradas a actores gubernamentales y de la sociedad civil. La información fue analizada usando el concepto cooperación. Se encontró la presencia de una red interinstitucional informal basada en objetivos comunes y una interdependencia de recursos. La oferta de servicios de salud no es del todo funcional debido, en parte, a la ausencia de confianza entre algunos actores y a la saturación del más importante proveedor público de segundo y tercer nivel de atención en salud en Tijuana.

Abstract: Objective: To estimate the prevalence of disordered eating behaviors (DEB) and identify their associations with demographic and psychological variables among freshman students at a public university in Mexico City. Materials and methods: A sample of 892 subjects participated in the study. Bivariate and multinomial models were performed to determine associations between DEB and covariates. Results: Of those surveyed, 6.8% of the women and 4.1% of the men exhibited DEB (p<0.05). The variables increasing the risk of eating disorders (ED) for women were internalization of the aesthetic thin ideal (IATI), body mass index (BMI), self-esteem and physical activity, while for men they were IATI, drive for muscularity, and self-esteem. Conclusions: The frequency of DEB among women and men and the internalization of the thin ideal in both sexes suggest the possibility of a change in the precursor conditions for eating disorders, particularly for men, who exhibit increased risk of such behaviors.

Resumen: Objetivo: Estimar la prevalencia de conductas alimentarias de riesgo (CAR) e identificar asociaciones con variables sociodemográficas y psicológicas en estudiantes de nuevo ingreso de una universidad pública de la Ciudad de México. Material y métodos: Se aplicó una encuesta a 892 estudiantes de ambos sexos. Para analizar asociaciones entre CAR y sus covariables se emplearon modelos bivariados y multivariados. Resultados: Se estimó que 6.8% de las mujeres y 4.1% de los hombres presentaron CAR (p>0.05). Entre las mujeres las variables que aumentaron el riesgo de CAR fueron interiorización del ideal estético de la delgadez (IIED), índice de masa corporal (IMC), autoestima y actividad física. Entre los hombres, las variables que sobresalieron fueron IIED, deseo por un cuerpo musculoso y autoestima. Conclusiones: La frecuencia de CAR entre mujeres y hombres, así como la IIED en ambos sexos sugiere un cambio en las condiciones de riesgo, especialmente entre los varones.

OBJETIVO Analisar o estado de saúde e o acesso aos serviços de saúde de imigrantes mexicanos deportados na fronteira entre México e Estados Unidos. MÉTODOS Foram analisados dados secundários do Inquérito sobre Migração na Fronteira do Norte do México de 2012. O inquérito é contínuo e desenhado para descrever fluxos migratórios na fronteira entre México e Estados Unidos com amostra de população móvel. Foram analisados indicadores de saúde e de acesso aos serviços de saúde dos imigrantes deportados em comparação aos imigrantes que retornaram voluntariamente. Nossa amostra análise incluiu 2.680 migrantes de retorno voluntário, e 6.862 deportados. Foi utilizado modelo de regressão logística ordinal para comparar as probabilidades da pior autopercepção de saúde entre os grupos estudados. RESULTADOS Em comparação com os migrantes de retorno voluntário, deportados foram menos propensos a ter seguro médico em os Estados Unidos (OR = 0,05, IC95% 0,04;0,06). No modelo de regressão uma pior saúde auto-percebida foi associado com ser deportado (OR = 1,71, IC95% 1,52;1,92), bem como a idade (OR = 1,03, IC95% 1,02;1,03) e os anos de escolaridade (OR = 0,94, IC95% 0,93;0,95). CONCLUSÕES De acordo com nossos resultados, deportados tinha menos acesso aos cuidados, enquanto em os Estados Unidos, em comparação com os migrantes de retorno voluntário. Nossos resultados também mostraram uma associação independente e estatisticamente significativa entre a deportação e ter pior saúde auto-percebida. Novas políticas de saúde pública são necessárias para promover a saúde e o acesso aos serviços de saúde nos imigrantes mexicanos deportados dos Estados Unidos.

OBJECTIVE To describe the health status and access to care of forced-return Mexican migrants deported through the Mexico-United States border and to compare it with the situation of voluntary-return migrants. METHODS Secondary data analysis from the Survey on Migration in Mexico’s Northern Border from 2012. This is a continuous survey, designed to describe migration flows between Mexico and the United States, with a mobile-population sampling design. We analyzed indicators of health and access to care among deported migrants, and compare them with voluntary-return migrants. Our analysis sample included 2,680 voluntary-return migrants, and 6,862 deportees. We employ an ordinal multiple logistic regression model, to compare the adjusted odds of having worst self-reported health between the studied groups. RESULTS As compared to voluntary-return migrants, deportees were less likely to have medical insurance in the United States (OR = 0.05; 95%CI 0.04;0.06). In the regression model a poorer self-perceived health was found to be associated with having been deported (OR = 1.71, 95%CI 1.52;1.92), as well as age (OR = 1.03, 95%CI 1.02;1.03) and years of education (OR = 0.94 95%CI 0.93;0.95). CONCLUSIONS According to our results, deportees had less access to care while in the United States, as compared with voluntary-return migrants. Our results also showed an independent and statistically significant association between deportation and having poorer self-perceived health. To promote the health and access to care of deported Mexican migrants coming back from the United States, new health and social policies are required.

OBJETIVO Analisar o estado de saúde e o acesso aos serviços de saúde de imigrantes mexicanos deportados na fronteira entre México e Estados Unidos. MÉTODOS Foram analisados dados secundários do Inquérito sobre Migração na Fronteira do Norte do México de 2012. O inquérito é contínuo e desenhado para descrever fluxos migratórios na fronteira entre México e Estados Unidos com amostra de população móvel. Foram analisados indicadores de saúde e de acesso aos serviços de saúde dos imigrantes deportados em comparação aos imigrantes que retornaram voluntariamente. Nossa amostra análise incluiu 2.680 migrantes de retorno voluntário, e 6.862 deportados. Foi utilizado modelo de regressão logística ordinal para comparar as probabilidades da pior autopercepção de saúde entre os grupos estudados. RESULTADOS Em comparação com os migrantes de retorno voluntário, deportados foram menos propensos a ter seguro médico em os Estados Unidos (OR = 0,05, IC95% 0,04;0,06). No modelo de regressão uma pior saúde auto-percebida foi associado com ser deportado (OR = 1,71, IC95% 1,52;1,92), bem como a idade (OR = 1,03, IC95% 1,02;1,03) e os anos de escolaridade (OR = 0,94, IC95% 0,93;0,95). CONCLUSÕES De acordo com nossos resultados, deportados tinha menos acesso aos cuidados, enquanto em os Estados Unidos, em comparação com os migrantes de retorno voluntário. Nossos resultados também mostraram uma associação independente e estatisticamente significativa entre a deportação e ter pior saúde auto-percebida. Novas políticas de saúde pública são necessárias para promover a saúde e o acesso aos serviços de saúde nos imigrantes mexicanos deportados dos Estados Unidos.

OBJECTIVE To describe the health status and access to care of forced-return Mexican migrants deported through the Mexico-United States border and to compare it with the situation of voluntary-return migrants. METHODS Secondary data analysis from the Survey on Migration in Mexico’s Northern Border from 2012. This is a continuous survey, designed to describe migration flows between Mexico and the United States, with a mobile-population sampling design. We analyzed indicators of health and access to care among deported migrants, and compare them with voluntary-return migrants. Our analysis sample included 2,680 voluntary-return migrants, and 6,862 deportees. We employ an ordinal multiple logistic regression model, to compare the adjusted odds of having worst self-reported health between the studied groups. RESULTS As compared to voluntary-return migrants, deportees were less likely to have medical insurance in the United States (OR = 0.05; 95%CI 0.04;0.06). In the regression model a poorer self-perceived health was found to be associated with having been deported (OR = 1.71, 95%CI 1.52;1.92), as well as age (OR = 1.03, 95%CI 1.02;1.03) and years of education (OR = 0.94 95%CI 0.93;0.95). CONCLUSIONS According to our results, deportees had less access to care while in the United States, as compared with voluntary-return migrants. Our results also showed an independent and statistically significant association between deportation and having poorer self-perceived health. To promote the health and access to care of deported Mexican migrants coming back from the United States, new health and social policies are required.

Purpose To provide an example of censored data analysis in the management of CED-S missing data, using a data set of a study conducted with Mexican rural women. Material and Methods Data used for this exercise were collected in a cross-sectional study with 416 women in the Mexican region known as the Mixteca Baja. Using a Survival Analysis (SA) focus we present a general description of the scores, along with the estimation of association patterns between those scores and the independent variables departing from Cox's proportional risk model. A comparison is made of these results and those obtained through a regression analysis. Results Using only the information from observations with complete data, the average CES-D score was 11.0 and the prevalence of symptoms above the cut-off point (16) was 23.2%. Twenty-six percent of the women did not respond to at least one item. When conducting the SA, the estimated mean score of the scale was 14.0. Survival above the cut-off point corresponded to an estimated prevalence of 21%. Conclusions SA is useful in the management of data sets with missing data in scales such as the CES-D. In this example, the increased percentage of observations with missing data produced a loss of precision in the estimators. The differences in mean item scores between observation with complete and incomplete data suggested a non-random, no-response pattern, if this is not taken into consideration it could bias the estimation in the scale mean and its association with other variables. Conducting SA we were able to use the information of most women participating in the study, including those who did not respond to all items in the scale.

Objetivo Ejemplificar el uso del análisis de datos censurados en el manejo de datos incompletos de la CES-D utilizando una base de datos de un estudio con mujeres rurales de México. Material y Método Los datos analizados se recogieron en un estudio transversal con 416 mujeres de la Mixteca Baja, al sur de México. Con un enfoque de Análisis de Supervivencia (AS), se presenta una descripción general del comportamiento de las puntuaciones de la CES-D junto con la estimación de patrones de asociación entre esos puntajes y variables independientes a partir del modelo de riesgos proporcionales de Cox, y se hace una comparación entre estos resultados y los obtenidos de un modelo de regresión lineal. Resultados Utilizando sólo la información de las observaciones con datos completos, la puntuación promedio de la CES-D fue de 11.0 y la preva-lencia de síntomas por arriba del punto de corte (16) fue de 23.2%. El 25.2% de las mujeres no contestó al menos un reactivo. Al hacer el AS, el promedio estimado de la puntuación fue de 14.8. La supervivencia por encima del punto de corte corresponde a una prevalencia estimada del 21%. Conclusiones El AS es útil en el manejo de bases que presentan datos faltantes por ejemplo en escalas como CES-D. En nuestro ejemplo, el elevado porcentaje de observaciones con respuestas faltantes ocasionó una pérdida de precisión en los estimadores. Las diferencias de puntuaciones promedio por reactivo entre observaciones con datos perdidos y completos sugieren un patrón de no-respuesta que no es aleatorio, y que de no tomarse en cuenta podría sesgar la estimación, tanto del promedio de la escala como de su asociación con otras variables. El AS utilizó la información de casi la totalidad de las participantes en el estudio incluyendo aquellas que no respondieron todos los reactivos de la escala.

OBJECTIVE: To describe the presence of depressive symptoms (DS) and factors associated with them among poor Mexican older male and female adults (OA). METHODS: A survey was conducted among OA enrolled in a governmental poverty relief program (Oportunidades) in Mexico. Participants completed a short version of the Center for Epidemiologic Studies Depression Scale and answered questions about health and life conditions. RESULTS: The prevalence of DS over the cutoff point was 43% (confidence interval (CI) 39.5-46.4). DS were associated with different variables among male and female participants. For men, difficulties in performing daily life activities were associated with DS over the cutoff point (odds ratio (OR) 2.62, CI 1.58-4.34) and literacy was associated with less DS (OR 0.46, CI 0.31-0.68). For women, difficulties with daily life activities were associated with more DS (OR 2.50, CI 1.57-3.97), and being head of the family was also positively associated (OR 1.81, CI 1.11-2.93). CONCLUSIONS: DS were frequent among this sample of poor OA. The differences between men and women in variables associated with DS highlight the importance of considering the gendered aspects of growing old.

OBJETIVO: Describir la presencia de síntomas depresivos (SD) y los factores asociados con ellos en adultos y adultas mayores pobres de México. MÉTODOS: Se realizó una encuesta a adultos y adultas mayores registrados en un programa gubernamental de alivio de la pobreza (Oportunidades) en México. Los participantes completaron una versión abreviada de la Escala de Depresión del Centro de Estudios Epidemiológicos y respondieron preguntas sobre su salud y condiciones de vida. RESULTADOS: La prevalencia de SD por encima del nivel de corte fue de 43% (intervalo de confianza de 95% [IC95%]: 39,5 a 46,4). Los SD se asociaron con diversas variables en los hombres y mujeres participantes. En hombres, la dificultad para realizar actividades de la vida diaria se asoció con la presencia de SD por encima del nivel de corte (razón de posibilidades [odds ratio, OR] = 2,62; IC95%: 1,58 a 4,34) y saber leer se asoció con menos SD (OR = 0,46; IC95%: 0,31 a 0,68). En las mujeres, la dificultad para realizar actividades de la vida diaria se asoció con más SD (OR = 2,50; IC95%: 1,57 a 3,97), al igual que ser la cabeza de la familia (OR = 1,81; IC95%: 1,11 a 2,93). CONCLUSIONES: Los SD fueron frecuentes en esta muestra de adultos mayores pobres. Las diferencias entre hombres y mujeres en cuanto a las variables asociadas con los SD subrayan la importancia de tomar en cuenta los aspectos de género asociados con el envejecimiento.

Abstract: The Eating Disorder Inventory (EDI) is a psychometric instrument developed by Garner et al. for the evaluation of psychological traits in patients with eating disorders. The questionnaire offers an integral evaluative approach that includes other psychological characteristics besides those of fear of fatness. It consists of 64 items in 8 subscales: 1) Drive for Thinness, 2) Bulimia, 3) Body Dissatisfaction, 4) Ineffectiveness, 5) Perfectionism, 6) Interpersonal Distrust, 7) Interoceptive Awareness, 8) Maturity Fears. The EDI is an instrument widely used for the exploration of eating disorders (ED). Nevertheless, the use of psychometric scales in a population other than the one in which they were originally developed, requires careful adaptation. Items should be phrased in a culturally significant way, and even after that, constructs still could have different meanings in different contexts. The factorial grouping of the EDI in open populations has been reported as different from the results in clinical samples. Also, Lee and cols. reported a low correlation of the EDI subscales that measure weight preoccupation and the General Health Questionnaire - 12, concluding that fear of fatness is not related with emotional distress in their sample. In Mexico City, Alvarez and Franco conducted a validation study, finding good reliability and discriminative power, and a factorial grouping close to the original. On the other hand, in a sample of teenage girls from a semi-rural area, the factorial grouping was very different. Although we already have data about the EDI's specificity and sensitivity in Mexican ED patients, there are no studies of the validity and reliability of the test in this population. Therefore, our main objective in this work was to validate the EDI in a sample of Mexican ED patients. Also, the score information provided could be used for comparison purposes with other clinical samples. A non-probabilistic sample was obtained of all subsequent patients attending the ED Clinic at the National Institute of Psychiatry Ramón de la Fuente (INPRF) in the period 1997 2002 (n=523). Patients were diagnosed according to DSM-IV criteria in a clinical interview. They also completed other questionnaires, such as the Symptom Check List (SCL90) and the Coopersmith's Self-esteem Inventory. According to diagnosis, the sample was composed of compulsive/purging type anorexia nervosa, 5.7%; restrictive anorexia nervosa, 8%; purging type bulimia nervosa 45.1% and eating disorders not otherwise specified 41.3%. Mean age was 19.9 years (s.d.=3.9), within a rank of 13 to 39 years. Mean age at the beginning of ED was 16 years (s.d.=3.1). Mean educational level was 12 years (s.d.=3), i.e. high-school level. The sample included single women 93.9%, married 4.8% and divorcees, 1.4%. Mean Body Mass Index was 21 (s.d. = 5.5). Participants completed the EDI, SCL90, and Coopersmith's self-esteem inventory during their first visit to the Clinic. They were assured of the voluntary nature and confidentiality of their participation. Completing the tests took them about 60 minutes. An internal reliability analysis was conducted, followed by a factorial analysis of main components with Varimax rotation. Pearson correlations were made to assess the concurrent validity of EDI and other instruments. Analysis of variance was employed to compare between diagnostic groups. Data were captured and analysed in the SPSS software, versión 10.0. The first step of the analysis was the item-total correlation, considering as valid correlations equal or over 0.28. This step eliminated 12 items that were not included in further analyses. Cronbach's alpha was 0.93. Most of the items in the Perfectionism subscale disappeared in this step. Second step was factorial analysis. We found 6 factors with a minimum of 3 items included with factorial charges equal or over .40. Then a second analysis was conducted with only the 40 items that had been grouped in the 6 factors. Factor 1 included items from Bulimia and Interoceptive Awareness; factor 2, from Drive for Thinness and Body Dissatisfaction; factor 3, from Interoceptive Awareness; factor 4, from Ineffectiveness; factor 5, from Maturity Fears; and factor 6, from Body Dissatisfaction. The resulting factorial structure explained 56% of total variance. Cronbach's alpha of the final version was 0.92. Correlation analysis showed a positive and significant correlation of EDI with SCL-90, and a negative and significant correlation of EDI with Coopersmith's self-esteem inventory. Comparisons between diagnostic groups showed that bulimia nervosa patients had the highest scores in the EDI. Patients with restrictive AN had the lowest scores in all sub-scales except for Maturity Fears. Bulimia nervosa and compulsive/purging type AN patients were different from restrictive AN and EDNOS patients in the total score of Interoceptive Awareness and Ineffectiveness subscales. Bulimia nervosa was different from the other groups in Bulimia and Drive for Thinness subscales. The results show that, in this sample, many of the EDI items have a poor correlation with the scale, and factorial grouping is different from the original. However, once non-correlated items are eliminated, a version of the EDI remains that is valid and reliable. Items from the Perfectionism subscale were eliminated because of low correlation with the rest of the EDI. This supports the findings in Bulgaria, rural Mexico, and Mexico City. Maturity Fears, which also had dubious results in other studies, grouped correctly in this sample, although it did not distinguish among diagnostic groups. Analysis of variance showed that subscales were able to differentiate the Bulimia nervosa patients. Also, most of the variance explained corresponded to the Bulimia subscale, suggesting that EDI can detect bulimic attitudes, and so is a useful complement to instruments that are more capable of detecting anorexia nervosa, such as the Eating Attitudes Test. However, this could also be an effect of the sample's composition, with more than half of it being bulimic patients. Another important segment of variance was explained by Interoceptive Awareness, Ineffectiveness and Maturity Fears subscales, psychological traits that are not necessarily related to ED. In this sample, psychological subscales correlated with eating and weight attitude subscales, showed that Mexican patients do present ED according to the way they are conceptualized in the DSM-IV. Our results show that the EDI is adequate for the evaluation of psychological traits of ED patients in Mexico. Perfectionism and Interpersonal Distrust subscales are an exception, that requires further investigation.

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