1,720,995 research outputs found
Knowledge, attitudes and dietary practices in patients with diabetes mellitus type II [Conocimientos, actitudes y prácticas dietéticas en pacientes con diabetes mellitus II.]
No full textThe profile of type-II non-insulin dependent diabetic patients is characterized by overweight; exogenous obesity originates from inadequate nourishment habits and, among other things, educational, cultural, and psychological conditions. With regard to metabolic deficiency control, the explanation is centered fundamentally on the patient's not getting a complete diet. This could be due to a lack of information about their illness, thus becoming a determining factor in their treatment. The purpose of this study was to analyze the level of knowledge, attitudes, and dietary education practices by means of a survey using the likert scale. This was applied by means of a direct and codified interview directed to patients in a Primary Care Health Unit from the Mexican Social Security Institute (IMSS) in Guadalajara, Jalisco, Mexico. 201 Type II diabetic patients, selected from a systematic sample, were studied. The average age was 54 and predominantly female (a ratio of 1.7 to 1). The sample had an academic background not surpassing the elementary school level, and their occupation was that of housewife. Their central glycemia level was, on the average, 191 mg/dl with a standard deviation of 120. The average number of years of having suffered from the illness was 5.5 with a standard deviation of 5. Ninety per cent of the diabetic patients take oral hypoglucemiants. Although there does exist a high level of knowledge and attitudes about dietary education, there exists a low level of educational practices. We observed that only 10 per cent of the diabetic patients have both an acceptable metabolic control (CMA) and a high value in knowledge, attitudes, and practices (CAP).(ABSTRACT TRUNCATED AT 250 WORDS
Knowledge, attitudes and dietary practices in patients with diabetes mellitus type II [Conocimientos, actitudes y pr�cticas diet�ticas en pacientes con diabetes mellitus II.]
No full textThe profile of type-II non-insulin dependent diabetic patients is characterized by overweight; exogenous obesity originates from inadequate nourishment habits and, among other things, educational, cultural, and psychological conditions. With regard to metabolic deficiency control, the explanation is centered fundamentally on the patient's not getting a complete diet. This could be due to a lack of information about their illness, thus becoming a determining factor in their treatment. The purpose of this study was to analyze the level of knowledge, attitudes, and dietary education practices by means of a survey using the likert scale. This was applied by means of a direct and codified interview directed to patients in a Primary Care Health Unit from the Mexican Social Security Institute (IMSS) in Guadalajara, Jalisco, Mexico. 201 Type II diabetic patients, selected from a systematic sample, were studied. The average age was 54 and predominantly female (a ratio of 1.7 to 1). The sample had an academic background not surpassing the elementary school level, and their occupation was that of housewife. Their central glycemia level was, on the average, 191 mg/dl with a standard deviation of 120. The average number of years of having suffered from the illness was 5.5 with a standard deviation of 5. Ninety per cent of the diabetic patients take oral hypoglucemiants. Although there does exist a high level of knowledge and attitudes about dietary education, there exists a low level of educational practices. We observed that only 10 per cent of the diabetic patients have both an acceptable metabolic control (CMA) and a high value in knowledge, attitudes, and practices (CAP).(ABSTRACT TRUNCATED AT 250 WORDS
Impact of homicide on male life expectancy in Mexico [Impacto de la violencia homicida en la esperanza de vida masculina de México]
No full textObjective. To determine the impact of homicide on male life expectancy in Mexico and its 32 states during the three-year periods 1998-2000 and 2008-2010 and the weight of the different age groups in years of life expectancy lost (YLEL) due to this cause. Methods. Based on official death and population data, abridged tables for male mortality in Mexico as a whole and its states were created for the three-year periods studied. Health-adjusted life expectancy and YLEL for men aged 15 to 75 were calculated by selected causes (homicide, diabetes mellitus, and traffic accidents) and age groups in each three-year period. Results. In the years between the 1998-2000 and 2008-2010 periods, YLEL due to homicide increased both nationally and in 19 states. In four states, the YLEL in 2008-2010 exceeded two, with the state of Chihuahua standing out at 5.2 years. In 14 of the 18 states where health-adjusted life expectancy among men declined between the two three-year periods, the YLEL due to homicide increased. From 2008 to 2010, homicides were the leading cause of YLEL among men aged 20-44. YLEL due to homicide among those aged 15-44 increased between the two three-year periods. Conclusions. The increase in the rate of homicidal violence, especially among young people, is impeding an increase in male life expectancy in Mexico. In several states, such as Chihuahua and Durango, this violence appears to be the main reason for the decline in life expectancy among men aged 15 to 75
Clinical aptitude of family physicians to detect familial dysfunction in family medical units from Guadalajara, Mexico [Aptitud clínica de los médicos familiares en la identificación de la disfunción familiar en unidades de medicina familiar de Guadalajara, México]
No full textIntroduction: Familles function as dynamic systems, where the different members stimulate each other to achieve common objectives. Family development is thus conceived as a chain of changes, in form and function, which follow evolution stages. The balance of positive and negative forces inside the family is translated into an evolution, and so the ability to respond to internal or external changes is vital to avoid discrepancies or clashes between the tasks and roles of the different family members. In this sense, family physicians must be able to identify any potential dysfunction or difficulty inside the family, and to facilitate the compatibility of tasks in order to reestablish the continuity and good functioning of the family. The family physicians' clinical aptitude is made up of a series of abilities intended to identify any signs and symptoms of dysfunction. They must also be skilled in using auxiliary resources for the diagnosis and treatment of all these. Such an aptitude is measured by a structured and validated instrument. Material and methods: This is an observational, prospective and comparative research of a 450 family physicians sample from 23 first level family health care medical clinics from the National Social Security Institute (Instituto Mexicano del Seguro Social: IMSS). All family physicians working at the clinics were included, excepting those who were at the time on vacation, worked the night shift, attended the ER, were absent or refused to participate. Clinical aptitude for family dysfunction was measured in three areas: 1. Identification of risk factors for family dysfunction; 2. Diagnosis with an integral point of view and 3. Proposal, identification and guidance, which describes a physician's ability to judge decisions taken on case reports and to propose alternative actions. Other variables taken into account were sex, age, specialty, years of experience, shift, clinic and type of contract. Instruments. The instrument was designed to integrate theory and practice. It was conformed by real case reports, which were condensed, divided in sections, and followed by a series of questions with three possible answers: "true", "false" or "I don't know". In total, there were 187 questions, 94 of which were true and 93, false. Correct answers accounted for one point, while incorrect ones rested one point; "I don't know" answers had no effect on the results. There were 42 lines to explore risk factors; 24 to explore the use of diagnostic resources; 19 to explore the use of therapeutic resources; 36 to evaluate a physician's knowledge of family sociology; 42 to assess family psychology, and 24 designed to evaluate proposal abilities. It was all validated and standardized with a group of post-graduate medical residents in Family Medicine from Mexico City. The Richardson K index was 0.90. Clinical aptitude was measured using an ordinal scale, where a random level "1 was defined by 140 points. A descriptive and inferential statistical analysis was used with median, percentage, Mann-Whitney's and Kruskal-Wallis' tests. All this was then processed with the EPI INFO-6 and SPSS Plus software packages. Ethical considerations. This is a risk-free research, as established in the Health Research section of the Mexican Health Law. Nevertheless, a signed acceptance form was required from all participants. Results: Table 1 shows the general characteristics of the study sample. In turn, table 2 presents clinical aptitude to identify family dysfunction, sorted by clinic. Clinics B and D had, respectively, a median of 105 and 102, with similar ranges. There were no statistically signicant differences among the sub-indexes of each clinic. The diagnosis median was higher than that for guidance. Table 3 reveals a high level of clinical aptitude in 3% of the physicians, an intermediate level in 25%, a low level in 58%, and a random-defined level in 14%. There were no significant differences when clinical aptitude was correlated with sex, shift, type of contract, specialty and years of experience. Discussion. The main objective of a family dysfunction diagnosis is to reestablish the normal flow of a family's vital cycle with the support of a specialized physician. It has been reported that clinical aptitude measurement is useful to discriminate and establish the aptitude level of experiment and non-experiment physicians with the aim of creating educational opportunities. A slight advantage, with no significant difference, was appreciated in physicians who attended patients in their offices, which suggests they are in a better position to gain a higher level of trust from their patients. This is due to the fact that they attend a regular set group of patients assigned to their offices. Since the education of family physicians is aimed at offering an integral care to families, family dysfunction recognition is essential. Results also suggest a non-significant advantage from family physicians with curricular education (not all family physicians working at the IMSS have a degree in Family Medicine). Experienced physicians (10 to 19 years on the job) showed another non-significant advantage, which pointed to the value of clinical practice. This is a powerful reason to promote continuous educational programs for family physicians. Family physicians who worked the morning shift showed a non-statistical advantage over their afternoon shift counterparts. This could be explained by the fact that educational and other institutional activities are more likely to take place in the morning. The educational model of family physicians should promote the physicians' involvement in understanding how to become active elements in gathering their own knowledge. Such a model should promote physicians' initiatives for the development of an experience based on constructive critic. The current health care model is mainly focused on a biological interpretation of the health-disease process. However, this is only a partial approach which prevents the implementation of an integral clinical practice. From our research, we expect changes in institutional health care orientation and a reframing of the curricula of general and family physicians'. Although the acquisition of clinical aptitude requires the physicians' experience and involvement in developing their own knowledge, our results do not reflect this ideal condition. This is due to the low percentage of clinical aptitude, which correlates with an evident inability for research and interpretation. Half of the physicians were capable of elaborating diagnostic hypothesis and two thirds of them showed a adequate use of diagnostic resources, such as clinical tests, functional family diagnostic instruments and a guide to conform an integral family workup. All these should be useful educational tools to establish the social functions diagnosis of a family's members, together with their formal and informal roles and their importance in the health-disease process. Guidance requires the ability to judge decisions taken by other professionals and make suggestions for alternative actions in case reports. This latter skill includes the use of therapeutic resources for only less than half of the physicians know how to properly use these resources. The use of instruments to measure aptitude, competency and work performance is a growing practice in continuous education and human resources formation. Even though these instruments are capable of discriminating high clinical aptitude, they cannot be used to account for this non-significant advantage, because educational activities are conceived as the consumption of information and not as the acquisition of it from each one's experience. Overall, 58% of the family physicians showed a low level of clinical aptitude. Such a result reflects a poor ability to integrate daily experience
A socio-spatial analysis of social exclusion and inequity in health in Mexico [Exclusi�n social e inequidad en salud en M�xico: Un an�lisis socio-espacial]
No full textObjective: Determining the relationship between social exclusion and health inequity at state and municipal level in Mexico during recent years. Methods: Adjusted mortality rates were calculated for 2005 (related to transmissible illnesses in childhood, pregnancy, childbirth and being produced by causes considered potentially avoidable); rates were calculated by states, for states grouped in quartiles according to marginalisation level and for municipalities grouped according to degree of marginalisation. Indicators such as rate ratio, Gini coefficient and the inequities in health index (IHI) were used for measuring such inequity, Results: A clear excess of mortality was observed in the states grouped in the 4th quartile (highest marginalisation) in relationship to the 1st quartile (lowest marginalisation); conversely, resources and health services in the 1st quartile were evidently higher than those in the 4th quartile. The Gini coefficient reached its highest value in the mortality rate for nutritional anaemia (0.44). Excess mortality was evident in those municipalities considered as having very high marginalisation; the highest IHI was observed in the states located in the 4th quartile (Chiapas, Oaxaca and Guerrero) when analysing mortality related to childhood, pregnancy, childbirth and potentially avoidable mortality. Conclusions: Notorious health inequality exists in Mexico, associated with high prevalent levels of social exclusion in different areas of the country. Deep structural changes are needed to modify this situation, promote social development and lead to reducing the unfair disadvantages to which important population groups are exposed
A socio-spatial analysis of social exclusion and inequity in health in Mexico [Exclusión social e inequidad en salud en México: Un análisis socio-espacial]
No full textObjective: Determining the relationship between social exclusion and health inequity at state and municipal level in Mexico during recent years. Methods: Adjusted mortality rates were calculated for 2005 (related to transmissible illnesses in childhood, pregnancy, childbirth and being produced by causes considered potentially avoidable); rates were calculated by states, for states grouped in quartiles according to marginalisation level and for municipalities grouped according to degree of marginalisation. Indicators such as rate ratio, Gini coefficient and the inequities in health index (IHI) were used for measuring such inequity, Results: A clear excess of mortality was observed in the states grouped in the 4th quartile (highest marginalisation) in relationship to the 1st quartile (lowest marginalisation); conversely, resources and health services in the 1st quartile were evidently higher than those in the 4th quartile. The Gini coefficient reached its highest value in the mortality rate for nutritional anaemia (0.44). Excess mortality was evident in those municipalities considered as having very high marginalisation; the highest IHI was observed in the states located in the 4th quartile (Chiapas, Oaxaca and Guerrero) when analysing mortality related to childhood, pregnancy, childbirth and potentially avoidable mortality. Conclusions: Notorious health inequality exists in Mexico, associated with high prevalent levels of social exclusion in different areas of the country. Deep structural changes are needed to modify this situation, promote social development and lead to reducing the unfair disadvantages to which important population groups are exposed
Clinical aptitude of family physicians to detect familial dysfunction in family medical units from Guadalajara, Mexico [Aptitud clínica de los médicos familiares en la identificación de la disfunción familiar en unidades de medicina familiar de Guadalajara, México]
No full textIntroduction: Familles function as dynamic systems, where the different members stimulate each other to achieve common objectives. Family development is thus conceived as a chain of changes, in form and function, which follow evolution stages. The balance of positive and negative forces inside the family is translated into an evolution, and so the ability to respond to internal or external changes is vital to avoid discrepancies or clashes between the tasks and roles of the different family members. In this sense, family physicians must be able to identify any potential dysfunction or difficulty inside the family, and to facilitate the compatibility of tasks in order to reestablish the continuity and good functioning of the family. The family physicians' clinical aptitude is made up of a series of abilities intended to identify any signs and symptoms of dysfunction. They must also be skilled in using auxiliary resources for the diagnosis and treatment of all these. Such an aptitude is measured by a structured and validated instrument. Material and methods: This is an observational, prospective and comparative research of a 450 family physicians sample from 23 first level family health care medical clinics from the National Social Security Institute (Instituto Mexicano del Seguro Social: IMSS). All family physicians working at the clinics were included, excepting those who were at the time on vacation, worked the night shift, attended the ER, were absent or refused to participate. Clinical aptitude for family dysfunction was measured in three areas: 1. Identification of risk factors for family dysfunction; 2. Diagnosis with an integral point of view and 3. Proposal, identification and guidance, which describes a physician's ability to judge decisions taken on case reports and to propose alternative actions. Other variables taken into account were sex, age, specialty, years of experience, shift, clinic and type of contract. Instruments. The instrument was designed to integrate theory and practice. It was conformed by real case reports, which were condensed, divided in sections, and followed by a series of questions with three possible answers: «true», «false» or «I don't know». In total, there were 187 questions, 94 of which were true and 93, false. Correct answers accounted for one point, while incorrect ones rested one point; «I don't know» answers had no effect on the results. There were 42 lines to explore risk factors; 24 to explore the use of diagnostic resources; 19 to explore the use of therapeutic resources; 36 to evaluate a physician's knowledge of family sociology; 42 to assess family psychology, and 24 designed to evaluate proposal abilities. It was all validated and standardized with a group of post-graduate medical residents in Family Medicine from Mexico City. The Richardson K index was 0.90. Clinical aptitude was measured using an ordinal scale, where a random level «1» was defined by 140 points. A descriptive and inferential statistical analysis was used with median, percentage, Mann-Whitney's and Kruskal-Wallis' tests. All this was then processed with the EPI INFO-6 and SPSS Plus software packages. Ethical considerations. This is a risk-free research, as established in the Health Research section of the Mexican Health Law. Nevertheless, a signed acceptance form was required from all participants. Results: Table 1 shows the general characteristics of the study sample. In turn, table 2 presents clinical aptitude to identify family dysfunction, sorted by clinic. Clinics B and D had, respectively, a median of 105 and 102, with similar ranges. There were no statistically signicant differences among the sub-indexes of each clinic. The diagnosis median was higher than that for guidance. Table 3 reveals a high level of clinical aptitude in 3% of the physicians, an intermediate level in 25%, a low level in 58%, and a random-defined level in 14%. There were no significant differences when clinical aptitude was correlated with sex, shift, type of contract, specialty and years of experience. Discussion. The main objective of a family dysfunction diagnosis is to reestablish the normal flow of a family's vital cycle with the support of a specialized physician. It has been reported that clinical aptitude measurement is useful to discriminate and establish the aptitude level of experiment and non-experiment physicians with the aim of creating educational opportunities. A slight advantage, with no significant difference, was appreciated in physicians who attended patients in their offices, which suggests they are in a better position to gain a higher level of trust from their patients. This is due to the fact that they attend a regular set group of patients assigned to their offices. Since the education of family physicians is aimed at offering an integral care to families, family dysfunction recognition is essential. Results also suggest a non-significant advantage from family physicians with curricular education (not all family physicians working at the IMSS have a degree in Family Medicine). Experienced physicians (10 to 19 years on the job) showed another non-significant advantage, which pointed to the value of clinical practice. This is a powerful reason to promote continuous educational programs for family physicians. Family physicians who worked the morning shift showed a non-statistical advantage over their afternoon shift counterparts. This could be explained by the fact that educational and other institutional activities are more likely to take place in the morning. The educational model of family physicians should promote the physicians' involvement in understanding how to become active elements in gathering their own knowledge. Such a model should promote physicians' initiatives for the development of an experience based on constructive critic. The current health care model is mainly focused on a biological interpretation of the health-disease process. However, this is only a partial approach which prevents the implementation of an integral clinical practice. From our research, we expect changes in institutional health care orientation and a reframing of the curricula of general and family physicians'. Although the acquisition of clinical aptitude requires the physicians' experience and involvement in developing their own knowledge, our results do not reflect this ideal condition. This is due to the low percentage of clinical aptitude, which correlates with an evident inability for research and interpretation. Half of the physicians were capable of elaborating diagnostic hypothesis and two thirds of them showed a adequate use of diagnostic resources, such as clinical tests, functional family diagnostic instruments and a guide to conform an integral family workup. All these should be useful educational tools to establish the social functions diagnosis of a family's members, together with their formal and informal roles and their importance in the health-disease process. Guidance requires the ability to judge decisions taken by other professionals and make suggestions for alternative actions in case reports. This latter skill includes the use of therapeutic resources for only less than half of the physicians know how to properly use these resources. The use of instruments to measure aptitude, competency and work performance is a growing practice in continuous education and human resources formation. Even though these instruments are capable of discriminating high clinical aptitude, they cannot be used to account for this non-significant advantage, because educational activities are conceived as the consumption of information and not as the acquisition of it from each one's experience. Overall, 58% of the family physicians showed a low level of clinical aptitude. Such a result reflects a poor ability to integrate daily experience
Adolescent homicides in Mexico, 1979-2005 trends and socio-geographical variations [Homicidios de adolescentes en México, 1979-2005: Evolución y variaciones sociogeográficas]
No full textThis study analyzes the evolution of adolescent homicide rate (10-19 years old) in Mexico between 1979 and 2005, and its socio-geographic variations for the biennial 2004-2005. Mortality databases available in the National System of Health Information were used. Results indicate that the adolescent homicide rate has substantially diminished, but it is higher than the rate of most of industrialized countries. The rate reduction in men has been higher than in women, and more than 50% of the homicide has been by firearms. Drug traffic is the variable that better explains the interstate variations in homicide rate for the group from 15 to 19 years of age, but for the 10-14 age group is scholar desertion the variable that better explains the variations in firearms homicide rate
Adolescent homicides in Mexico, 1979-2005 trends and socio-geographical variations [Homicidios de adolescentes en México, 1979-2005: Evolución y variaciones sociogeográficas]
No full textThis study analyzes the evolution of adolescent homicide rate (10-19 years old) in Mexico between 1979 and 2005, and its socio-geographic variations for the biennial 2004-2005. Mortality databases available in the National System of Health Information were used. Results indicate that the adolescent homicide rate has substantially diminished, but it is higher than the rate of most of industrialized countries. The rate reduction in men has been higher than in women, and more than 50% of the homicide has been by firearms. Drug traffic is the variable that better explains the interstate variations in homicide rate for the group from 15 to 19 years of age, but for the 10-14 age group is scholar desertion the variable that better explains the variations in firearms homicide rate
Demographic characteristics, social inequality and inequity in Mexican childhood health [Contexto demogr�fico, desigualdad social e inequidad en salud de la ni�ez en M�xico]
No full textObjectives Demographically describing the present and future for Mexican children to correlate aspects regarding demographic and social equity during childhood and describing the challenges these variables represent for Mexican children during the next few years. Methods The present and future scenario for Mexican childhood was evaluated using existing population projections. Mortality rates were estimated from avoidable causes during childhood per Mexican state, per state grouped by quartile depending on their marginalisation level and by municipality grouped according to their degree of marginalisation. The Gini coefficient was used for measuring inequality. Results Even though the absolute numbers of children in Mexico will tend to decrease in the future, the number will remain high until 2025. A greatest numbers of children were living in states having the highest degree of social marginalisation. Avoidable mortality was higher in these states compared to states having lower marginalisation. The Gini coefficient was highest concerning mortality rate caused by acute respiratory infection (0.34). Excess of avoidable mortality was evident in municipalities having high and extremely high marginalisation. Conclusions Conditions related to demographic ageing and childhood diseases coexist in Mexico. Inequity in children's health is evident; it is related to high levels of social marginalisation. In-depth structural changes are needed to change this situation which will lead to reducing some Mexican populations' unjust social disadvantages
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