Understanding adherence of hypertensive patients in Mexico to an exercise-referral scheme for increasing physical activity

Among the strategies developed thus far for promoting physical activity (PA), exercise-referral schemes (ERs) have gained in popularity as an effective means of preventing secondary health conditions such as hypertension. However, information on the factors affecting adherence to these programs is limited. Using a mixed-methods approach, we undertook the present study to determine the factors associated with adherence to a specific ER aimed at increasing PA among the hypertensive patients in a Social Security institution in Mexico. Data were obtained through semi-structured questionnaires and interviews as well as from the clinical records of participants. For the quantitative component, multinomial regression analysis estimated the factors behind the varying levels of adherence. For the qualitative component, we performed a content analysis based on the health belief model. According to our findings, 80% of participants who began the ER exhibited high levels of adherence. Older age and being female were the key demographic characteristics of those showing increased adherence. Meanwhile, financial issues, the investment of time required, low perception of the benefits of PA, lack of confidence in being able to achieve changes in lifestyle, and a reluctance to acknowledge the seriousness of their health condition were the principal factors among those who did not join the program or exhibited low levels of adherence. Our findings can serve as a basis for designing PA interventions that take into account individual, cultural and administrative elements in their efforts to improve adherence to PA programs for those suffering from chronic conditions such as hypertension.

Vulnerability as a palimpsest: Practices and public policy in a Mexican hospital setting

Vulnerability is a concept associated with the effects of social inequities to access health care services. On a hospital level, vulnerable populations must be identified and favored over others. The aims of this study were the analysis of the conceptions and practices of social workers regarding vulnerable patients, and the identification of theoretical elements of vulnerability given by academics. Hospital ethnography and a focus group were implemented. Social workers related vulnerability to the social needs of each patient; however, they state that they have dilemmas to identify a person in a vulnerable condition; these dilemmas are related to social differences and deservingness. Academics indicated that the vulnerability should refer to the lack of access to health services offered by the institution. Academics agree with social workers regarding the importance of considering the overlapped social and individual circumstances in each patient to recognize their vulnerable condition, regardless of belonging to any of the pre-established vulnerable groups. Finally, taking into account the way of conceptualizing vulnerability and how public policy on the identification of vulnerable patients in the hospital has been implemented, these two elements are explained using the palimpsest model, which is a figure of thought that can be applied to analyze the sociocultural significance of this complex issue, as well as other social dynamics.

[The health of Mexicans living in localities with less than 100 000 inhabitants]

OBJECTIVE

To describe the health and nutritional status of Mexican population living in localities under 100 000 inhabitants (100k) in year 2018 in comparison it with a sample of similar characteristics in 2012.

MATERIALS AND METHODS

The more relevant results analyzed in 19 articles about health and nutrition of the population are presented. This included information on access and utilization of health services, health and nutrition status by age groups and households affected by food insecurity (FI).

RESULTS

Information was obtained about the health and nutrition status of the population from <100k localities, which is characterized by its higher poverty levels.

CONCLUSIONS

Great inequities prevails the health and nutrition conditions of the Mexican population. The findings are useful for the devel- opment of public policies capable of reducing health inequities conditions, in order to achieve social equity.

Factors that enable or limit the sustained use of improved firewood cookstoves: Qualitative findings eight years after an intervention in rural Mexico

Objective

The aim of this study was to analyze the factors enabling/limiting the use of improved cookstoves among rural fuel wood users from one mestizo and two indigenous communities eight years after an intervention in the state of Michoacan, in Mexico.

Methods

A qualitative study with an ethnographic perspective was conducted in 2013/2014 based on 62 interviews with women who had participated in an improved firewood cookstove program in 2005. Thematic qualitative content analysis was performed.

Results

Very few women from the indigenous communities were using the improved cookstove at the time of the study; the majority had dismantled or had ceased using it; whereas most of those from the mestizo community were using it for all of their cooking activities. In the indigenous communities, characterized by extended families, uptake of new technology was limited by traditional routine practices, rearrangement of rooms in the house, attachment to the traditional stove, a low- or non-risk perception of woodsmoke; gender relations, insufficient training, non-compliance with program recommendations and design-related aspects. Conversely, in the mestizo community, the uptake of the improved cookstove was favored by routine cooking practices in a nuclear family, a previous use of a raised cookstove and social representations on the health-disease-death effects of woodsmoke vs. the health benefits of cooking with improved stoves. The sociocultural dimension of communities and the cookstove design are aspects that either favor or limit the use of improved cookstoves in indigenous and mestizo populations.

Conclusions

Effective cookstove programs must take these elements into account from their early planning stages, and blend them into implementation and follow-up. Project communication, training and differentiated follow-up activities ensuring the operation and maintenance of the cookstove, should be designed according to the specific needs and traditions of each community; they should be based on the preferences and needs of the users.

Labor and delivery service use: indigenous women's preference and the health sector response in the Chiapas Highlands of Mexico

Background

Mexico has undertaken important efforts to decrease maternal mortality. Health authorities have introduced intercultural innovations to address barriersfaced by indigenous women accessing professional maternal and delivery services. This study examines, from the perspective of indigenous women, the barriers andfacilitators of labor and delivery care services in a context of intercultural and allopathic innovations.

Methods

This is an exploratory study using a qualitative approach of discourse analysis with grounded theory techniques. Twenty-five semi-structured interviews were undertaken with users and non-users of the labor and delivery services, as well as with traditional birth attendants (TBAs) in San Andrés Larráinzar, Chiapas in 2012.

Results

The interviewees identified barriers in the availability of medical personnel and restrictive hours for health services. Additionally, they referred to barriers to access (economic, geographic, linguistic and cultural) to health services, as well as invasive and offensive hospital practices enacted by health system personnel, which limited the quality of care they can provide. Traditional birth attendants participating in intercultural settings expressed the lack of autonomy and exclusion they experience by hospital personnel, as a result of not being considered part of the care team. As facilitators, users point to the importance of having their traditional birth attendants and families present during childbirth, to allow them to use their clothing during the attention, that the staff of health care is of the female sex and speaking the language of the community. As limiting condition users referred the different medical maneuvers practiced in the attention of the delivery (vaginal examination, episiotomy, administration of oxytocin, etc.).

Conclusions

Evidence from the study suggests the presence of important barriers to the utilization of institutional labor and delivery services in indigenous communities, in spite of the intercultural strategies implemented. It is important to consider strengthening intercultural models of care, to sensitize personnel towards cultural needs, beliefs, practices and preferences of indigenous women, with a focus on human rights, gender equity and quality of care.

Detección temprana de cáncer de mama y cervicouterino en localidades con concentración de población indígena en Morelos

Objetivo. Analizar la percepción de mujeres y proveedores de salud sobre cuándo y cómo realizar acciones para la detección temprana del cáncer de mama y cervicouterino en localidades de Morelos con presencia de población indígena. Material y métodos. Se entrevistó a 10 proveedores de salud y 58 usuarias en unidades médicas del primer nivel de atención de cinco localidades; luego se analizó la información con base en el paradigma de la teoría fundamentada. Resultados. El personal de salud está deficientemente familiarizado con los lineamientos oficiales para la detección de cáncer cervicouterino y de mama. Pocos practican sus labores bajo una perspectiva de sensibilización intercultural. Las usuarias tienen nociones imprecisas o equivocadas de las acciones de detección. Conclusiones. La necesidad de capacitación con apego a las normas es evidente. Urge asumir un abordaje con pertinencia cultural que permita la comunicación eficiente y alfabetización en salud para la detección oportuna de estos dos cánceres.

[Early detection of breast and cervical cancer among indigenous communities in Morelos, Mexico]

OBJECTIVE

To analyze the perception in relation to when and how to perform actions for the early detection of breast and cervical cancer among women and health care providers in communities with a high percentage of indigenous population in Morelos, Mexico.

MATERIALS AND METHODS

Ten health providers and 58 women users of health services were interviewed which have a first level of attention in five communities. The analysis was developed under the approach of the Grounded Theory.

RESULTS

Providers are poorly informed about current regulations and specific clinical indications for the detection of cervical and breast cancer. Few practice health literacy under intercultural sensitization. The users have imprecise or wrong notions of the early detection.

CONCLUSIONS

The need for training in adherence to norms is evident. It is urgent to assume a culturally relevant approach to enable efficient communication and promote health literacy for early detection of these two cancers.

Essential health care among Mexican indigenous people in a universal coverage context

OBJECTIVE

To analyze the influence of indigenous condition on essential health care among Mexican children, older people and women in reproductive age.

METHODS

The influence of indigenous condition on the probability of receiving medical care due to acute respiratory infection (ARI) and acute diarrheal disease (ADD), vaccination coverage; and antenatal care (ANC) was analyzed using the 2012 National Health Survey and non-experimental matching methods.

RESULTS

Indigenous condition does not influence per-se vaccination coverage (in < 1 year), probability of attention of ARI's and ADD's as well as, timely, frequent, and quality ANC. Being indigenous and older adult increases 9% the probability of receiving a fulfilled vaccination schedule.

CONCLUSION

Unfavorable structural conditions in which Mexican indigenous live constitutes the persistent mechanisms of their health vulnerability. Public policy should consider this level of intervention, in a way that intensive and focalized health strategies contribute to improve their health condition and life.

[Gender and work: the experience of providers of health services to indigenous women from Guerrero y Oaxaca]

The scope of this paper was to identify the role of gender for women as workers, through the perception and discourse of health service providers at the 'Health Centers for Indigenous Women' ("Casas de Salud de las Mujeres Indígenas") in Ometepec, Guerrero and Matías Romero, Oaxaca, Mexico. It is a qualitative study, based on a secondary analysis of the interviews conducted as part of the "Rescatando la experiencia de la Casa de la Mujer Indígena: sistematización y evaluación del proceso" project. A strong sense of the value of work and a strong commitment towards the community were identified. Guilt appears as the result of tension between work outside the home and the responsibilities as mothers and wives. The possibility of helping other women is a source of gratification that dissipates these conflicts; prestige and recognition are added to the benefits of their role. The labor experience of female workers in the "Casas de Salud de las Mujeres Indígenas" of Matías Romero, Oaxaca and Ometepec, Guerrero, described in this paper, reveals that it has very specific characteristics, which are difficult to replicate in other regions of the country. In future studies it is necessary to consider the different contexts of vulnerability.

A qualitative approach to the intangible cost of road traffic injuries

The consequences of fatal and non-fatal road traffic injuries (RTI) at the personal and household levels were analysed using qualitative interviews of 12 injured and of 12 relatives of people who died for this reason. Collisions change physical and mental health both of the injured and of their relatives. This leads to changes in daily activities and even to the redefinition of future life. RTI also changes the way people see and act in life, becoming an experience that teaches them. Survivors commonly transmit a road safety message afterwards. Changes in family life were evident (in extreme cases family's composition also changed), affecting intra-familial relationships. Associated unexpected and unplanned expenditures and loss of income have consequences in the short, medium and long term that unbalance household's economies and immerse people into a constant stress. Individuals and family's future plans are occasionally condition to whether they have or not debts. Household dependence in economic terms was sometimes observed, as well as uncertainty about future life and household's sustainability. Sometimes, households change and adapt their life to what they now are able to afford, having important repercussions in vital spheres.

Economic impact of fatal and non-fatal road traffic injuries in Guadalajara Metropolitan Area and Jalisco, Mexico

OBJECTIVE

To estimate the economic cost of fatal and non-fatal road traffic injuries (RTI) in Guadalajara metropolitan area (GMA) and Jalisco, Mexico during 2007.

MATERIALS AND METHODS

Using an incidence-based cost of illness analysis from a household perspective employing a bottom-up approach all direct medical and non-medical costs, and indirect costs were estimated for a sample of RTI people who sought care during 1 month in four different medical facilities. Individuals were surveyed just before discharge from emergency rooms (ER) and hospitalisation services. Hospitalised individuals were followed up at 8 weeks after discharge. Productivity loss was estimated with the human capital approach. Using estimated costs and administrative records of mortality and morbidity, the economic costs were dimensioned for GMA and for Jalisco. A multivariate and probabilistic sensitivity analysis was conducted to evaluate variations resulting from assumptions used.

RESULTS

297 injured were included in the study, 20% were hospitalised and 237 only received care at ER. A total cost of US$21190 was estimated in all injured receiving care at ER and $83309 for those hospitalised. Direct cost represents more than 30% of reported income in 8% of the ER users and 80% of hospitalised. Total economic cost was US$329,061,813 for GMA (discount rate of 3%), nearly 51% of the state total (US$650,908,924 or 1.3% of State GNP).

CONCLUSIONS

This estimation shows the high cost (both, direct and indirect) RTI impose in households affecting their economy and leading families to lose wealth assets, get in debt or impoverished.

[Health services in the Mixteca: use and conditions of affiliation in US-migrant and non-migrant households]

OBJECTIVE

To describe the socioeconomic and demographic characteristics of households in the Mixteca Baja and analyze differences in affiliation with health care programs and utilization, among members of households with migrants (HogMig) and without migrants (HogNoMig) to the United States.

MATERIAL AND METHODS

A cross-sectional, descriptive survey was used with heads of households in a representative sample from the Mixteca Baja of 702 homes with and without migrants to the US.

RESULTS

Members of HogMig had more personal and economic resources than those of HogNoMig; they also regularly received remittances. The majority of members of both HogMig and HogNoMig did not receive benefits from the Oportunidades program or health coverage through Seguro Popular, IMSS or ISSSTE. In general, while they used the local health clinic, they often preferred to pay for private practitioners. A small proportion of those covered by IMSS or ISSSTE reported very low utilization of the health services offered by those institutions.

Representations of eating and of a nutrition program among female caregivers of children under 5 years old in Tizimin, Yucatan, Mexico

This study was carried out between January and April 2008 with 14 caregivers of children younger than 5 years residing in Tizimín city, Mexico. It aimed to understand the social representations of eating and the Programa Oportunidades [Opportunity Program] held by caregivers taking into account their social and cultural context. This qualitative investigation with an ethnographic approach was based on participant observation and semi-structured interviews. Two empirical categories emerged: 1) feeding and 2) an aid. The first refers to the caregivers' representation of eating patterns of children younger than 5 years and the second reveals that the program is considered an aid, which favors and helps caregivers to meet part of their needs. The study achieved the proposed objectives since it enabled us to understand caregivers in the complex task of feeding these children and also to propose strategies in several spheres to improve infant nutrition.

Relación del personal de salud con los pacientes en la Ciudad de México

OBJETIVO: Analizar la calidad de la relación del personal de salud con los pacientes hospitalizados. MÉTODOS: Estudio cualitativo realizado de febrero a julio del 2005, en la Ciudad de México. Se aplicaron 40 entrevistas a profundidad a pacientes internados en un hospital de tercer nivel. Las categorías de análisis para explorar la percepción del trato entre los informantes fueron las siguientes: actitudes y acciones del personal médico y de enfermería, comunicación efectiva, grado de conocimiento del paciente y/o familiares sobre el diagnóstico, tratamiento clínico, evolución del agravo. RESULTADOS: En general, se encontró un alto grado de satisfacción con la atención médica. No obstante, los pacientes hospitalizados percibieron como inadecuado el trato cotidiano (no clínico) del personal médico y de enfermería del hospital, relacionado con la falta de confianza para solicitar información acerca de su padecimiento. El uso excesivo de tecnicismos por parte del prestador de servicios reforzó esta percepción de trato inadecuado. CONCLUSIONES: La percepción del trato inadecuado por el personal de salud fuera del ámbito técnico, mostró que la efectividad clínica no significa una plena calidad de la atención y que es necesario incorporar las necesidades y expectativas de trato no clínico de los pacientes a la eficiencia técnica y científica.

[What to do to avoid death by starvation? Domestic dynamics and childhood feeding practices in a rural area of extreme poverty in Mexico]

OBJECTIVE

To describe and compare household dynamics in terms of structure, beliefs and nutrition-related behavior in the homes of malnourished and well-nourished children less than five years of age.

MATERIAL AND METHODS

The authors carried out a qualitative ethnographic study using participant observation, and in depth interviews. Interviews were conducted with the child's caretaker or key informants, prior oral informed consent. Child care and childhood feeding practices at home and in the community were the focus of observations. The study included two periods of field work conducted in 2001, in three rural municipalities from the Río Balsas region, in Guerrero state, Mexico. The study's ethical and methodological aspects were approved by the National Research Commission of the Mexican Institute of Social Security.

RESULTS

Households were differentially characterized by number of members, composition, type of relationship, source of income, and interactions among household members and with the community.

CONCLUSION

Monoparental structures, in an early stage of the household cycle, give rise to conditions that render the child prone to malnutrition. Extended family structure represented more favorable household dynamics.

Políticas de salud bucal en México: Disminuir las principales enfermedades. Una descripción

Se presenta una breve descripción de lo que ha sido hasta ahora la historia de las políticas de salud bucal en México. Este trabajo no intenta ser exhaustivo, ni mucho menos un estudio sobre evaluación de políticas de salud bucal, pues se vería enfrentado a la fuerte limitación de la disponibilidad de información desarrollada en el área de la salud bucal. En primer lugar se abordan los inicios de la profesión dental y la forma en la que se desarrolló; su comienzo como una profesión dirigida al individuo y su posterior inmersión en el campo de la Salud Pública. Posteriormente se presentan datos de estudios epidemiológicos realizados en los últimos años, principalmente sobre caries dental en escolares. Termina esta parte tomando en cuenta la definición de salud de la Organización Mundial de la Salud (OMS), y se trata la importancia de la salud bucal como un elemento de la salud general y por ende del bienestar y de la calidad de vida del individuo. Más adelante se describe la política de salud bucal mundial, como marco de referencia para la política de salud en el país. Con relación a México, describimos cómo a través de los años esta política ha planeado e instaurado estrategias tendientes a lograr una mejora en la salud bucal de la población. Concluimos el trabajo con un análisis acerca de cómo ha impactado la política de salud bucal a la salud de ciertos grupos poblacionales. Se propone generar información epidemiológica confiable para poder hacer una evaluación de esta política, con una metodología estricta y adecuada.

[Aging experiences in rural Mexico]

OBJECTIVE

To explore the aging experience among men and women older than 60 years, living in rural areas from the states of Guerrero and Morelos, Mexico.

MATERIALS AND METHODS

A qualitative study was conducted in poverty-stricken, underserved communities with less than 2,500 inhabitants. Semi-structured interviews were applied to collect data.

RESULTS

The aging experience is different according to gender, being more positive for women. Loneliness, together with social networks and the health-illness process, make the difference in the aging experiences. The main fears associated with aging are loneliness, illness, poverty, and loss of independence.

CONCLUSIONS

Gender identity plays a central role in different aging experiences because the chances for development and accompanying responsibilities foster the inequality between men and women. It is necessary to improve institutional responses tailored to the specific needs of this population.

[Socioeconomic inequalities in oral health: dental caries in 6 to 12 year-old children]

OBJECTIVE

To explore the association between caries indices in primary and permanent dentition and socioeconomic indicators at the individual and ecologic levels in 6-12 year old children.

MATERIALS AND METHODS

A comparative analysis of two datasets depicting oral health status in Campeche, México, with 2,939 children distributed equally by age and sex, was carried out. Oral health indices were contrasted at different cut-off points in primary and permanent dentitions (dmft, DMFT, dmft+DMFT and SiC indices) with independent variables such as place of residence (urban, marginal-urban) and mother's highest level of schooling (years of formal education) as socioeconomic variables (SES), as well as other sociodemographic variables using models of binary logistic regression in STATA 8.2.

RESULTS

The mean age was 8.85 +/- 1.83 years and 56.6% were girls. Nine models were generated in which changes in socioeconomic variables were linked to changes in oral health features in this community (both in terms of prevalence and severity), except for DMFT > 0 at 12 years of age.

CONCLUSIONS

In general, children of lower SES had greater caries experience and higher caries severity, in both primary and permanent dentitions. The relationships between oral health disparities and independent variables were confirmed in children living in geographically contiguous areas.

[Menopause: social and practical representations]

OBJECTIVE

To characterize the meanings attributed to menopause, as a first approximation to the representational world of this event.

MATERIAL AND METHODS

A qualitative study was conducted between September and October 1998, in twenty women aged 45-65 years, residents of Cuernavaca and Emiliano Zapata, municipalities of Morelos state, Mexico. Twenty in-depth interviews were conducted using a guide, to collect data on sociodemographic variables, diagnosis, feelings and emotions, changes in life style, and physiological changes.

RESULTS

Findings show that menopause is represented as the end of fertility and the beginning of old age. Characterization of menopause is related to womanhood, body, and sexuality representations.

CONCLUSIONS

This paper analyzes women's practices related to life experiences such as medical visits. Implications of these findings are discussed using the social construction of meanings framework.

[The shamanic cure: a psychosocial interpretation]

The present paper is basically a theoretical analysis of the shamanic cure, which proposes communication as the basis of the healing process. This process is described as a communicative act focusing on the interpretation of symbolic elements. The context is the social dimension in which the process is inscribed, the linguistic mode employed, and the type of relationship established between the shaman, the patient and the people. We also recount the way in which a shared symbolic reality is built, and how the shaman's world view has important effects on people. The interpretative framework is the psychosocial focus and an explanation is offered in terms of the establishment of a communicative act as a scenario in which the symbolic reality is constructed, and in itself constitutes the cure into which the patient enters every session. The magical vision of shamanism is analyzed and its influence on the health-illness process.