Emotional distress and its care in empowered indigenous women exposed to domestic violence and the demands of child rearing / Malestares emocionales y su atención en mujeres indígenas empoderadas expuestas a violencia doméstica y exigencias de crianza de los hijos

Abstract Introduction Indigenous girls and women in Mexico suffer emotional distress due to marital violence and adherence to gender roles. They are unlikely to denounce violence or treat their health in a timely manner. Women can cope with their distress by participating in empowerment processes. Objective Describe in indigenous empowered women the emotional distress caused by domestic violence in their childhood and the current demands of raising their children and the actions they take to cope with them. Method Qualitative and phenomenological qualitative research, in-depth interviews, and participant observation were conducted with nine migrant indigenous women to explore experiences during their upbringing, emotional reactions, and current mental health problems. Results The software Atlas. ti V 7 was used to undertake a theoretical categorization of the data. Findings included exposure to violence, the influence of a good mother, and past and present emotional distress overcome through empowerment and professional care. Discussion and conclusion Participating in urban empowerment activities enables participants to reflect on the violence experienced and the attendant distress, identify them as gender violence, and use them in their favor. They are strategic when coping with current distress due to the conflictive upbringing of their children, using psychological services and the urban upbringing prescriptions of children's rights, and incorporating indigenous parenting practices, which encourage community commitment, responsibility, and early self-sufficiency in children. Empowerment is suggested as an effective means of improving the health of indigenous women in Mexico.

Resumen Introducción En México, niñas y mujeres indígenas padecen malestares emocionales por la violencia conyugal y el cumplimiento de roles de género. No es común que se denuncie la violencia o se atienda oportunamente su salud. Las mujeres pueden emprender la atención de sus malestares al participar en procesos de empoderamiento. Objetivo Describir en mujeres indígenas empoderadas los malestares emocionales causados por la violencia doméstica en su niñez; por las exigencias actuales en la crianza de sus hijos/as y las acciones que realizan para atenderlos. Método Mediante una investigación cualitativa situada y fenomenológica, se realizaron entrevistas en profundidad y observación participante con nueve mujeres indígenas migrantes. Con estas herramientas se exploraron experiencias durante su crianza; reacciones emocionales y problemas actuales de salud mental. Resultados Mediante el software Atlas. ti V 7, se realizó una categorización teórica de los datos. Así se encontraron: exposición a la violencia; la influencia de la buena madre; malestares emocionales antiguos y actuales sobrellevados con el empoderamiento y la atención profesional. Discusión y conclusión Participar en actividades urbanas de empoderamiento lleva a las participantes a reflexionar sobre la violencia vivida y sus malestares asociados; resituarlos como violencia de género, y usarlos en su favor. Se muestran estratégicas al enfrentar malestares actuales por la conflictiva crianza de su hijos/as, usando servicios psicológicos y las prescripciones de crianza urbana del derecho infantil, e integrando prácticas de crianza indígenas, que estimulan el compromiso comunitario, responsabilidad y autosuficiencia temprana en los hijos/as. Se sugiere aprovechar la eficacia del empoderamiento para mejorar la salud de las mujeres indígenas del país.

Los niveles séricos de Interleucina 22 e Interleucina 6 disminuyen luego del tratamiento en pacientes con artritis reumatoidea / Interleukin 22 and Interleukin 6 Serum Levels Decrease After Treatment in Rheumatoid Arthritis Patients

Introducción: La artritis reumatoidea se caracteriza por inflamación de la membrana sinovial debido al infiltrado de células inmunitarias que secretan citocinas relacionadas a perfil Th17 como IL-22 e IL-6. La dinámica de estas citocinas durante el tratamiento permanece incomprendida. El objetivo fue evaluar los niveles séricos y en líquido sinovial (LS) de IL-22 e IL-6, correlacionarlos con diferentes parámetros bioquímicos y clínicos y medir sus cambios post-tratamiento. Material y métodos: Se estudiaron 77 pacientes con AR y 30 controles. A 30 pacientes se los evaluó nuevamente luego de 3 meses de tratamiento y a 12 se les extrajo LS. Se midió VSG, PCR, FR, anti-CCPhs, IL-22 e IL-6. Se evaluó la actividad con DAS28 y respuesta al tratamiento con criterios EULAR. Resultados: IL-22 e IL-6 fueron similares entre pacientes y controles. Sus niveles disminuyeron luego del tratamiento, principalmente en pacientes respondedores. IL-22 fue menor e IL-6 mayor en LS que en sangre. IL-6 correlacionó positivamente con PCR y anti-CCPhs. Los niveles de VSG, PCR y DAS28 fueron mayores en pacientes con valores dosables de IL-6 que en no dosables. Conclusión: En pacientes con valores basales dosables de IL-22 e IL-6, los niveles de estas citocinas podrían utilizarse como marcador adicional de respuesta al tratamiento.

Introduction: Rheumatoid arthritis is characterized by synovium inflammation due to the infiltration of immune cells that secrete Th17 cytokines like IL-22 and IL-6. The dynamics of these cytokines during the treatment remain unknown. The aim of this study was to evaluate the levels of IL-22 and IL-6 serum and synovial fluid (SF) in correlation with different biochemical and clinical parameters and treatment-associated changes. Material and methods: Seventy-seven RA patients and 30 controls were recruited. Thirty patients were evaluated after 3 months of treatment and SF was collected of 12 patients. ESR, CRP, RF, anti-CCP hs, IL-22 e IL-6 were measured. DAS28 was used to assess disease activity and response to treatment followed EULAR criteria. Results: There were not differences in serum IL-22 and IL-6 levels between patients and controls. Cytokine levels decreased after treatment, mainly in responder patients. IL-22 was decreased and IL-6 was increased in SF compared to serum. IL-6 correlated positively with CRP and anti-CCPhs. ESR, CRP and DAS28 were increased in patients with detectable IL-6 compared to those with undetectable IL-6. Conclusion: In patients with detectable serum IL-22 and IL-6 levels before treatment initiation, follow-up of cytokine levels could be an useful additional tool to evaluate treatment response.

El consumo de inhalables en las prácticas de socialidad de dos grupos de estudiantes de secundarias públicas / Inhalant use in the sociality practices of two groups of students at public middle schools

INTRODUCCIÓN: La extensión del consumo de inhalables hacia distintas poblaciones de México ocurre en el macrocontexto de la legalidad y la deficiente regulación sanitaria y policial de dichas sustancias, así como su gran disponibilidad y bajo costo, en combinación con los efectos placenteros de su inhalación, los cuales varían según el contexto y los usuarios. OBJETIVO: Aquí se describen las prácticas de coconstrucción de los contextos de consumo de inhalables. También, los efectos de éstos en dos grupos de estudiantes mexicanos de educación secundaria. MÉTODO: Se utilizó la metodología de la photo elicitation, analizando, en grupos de discusión, dos videograbaciones producidas por los mismos estudiantes, en las que consumen inhalables. RESULTADOS: Se realizó la categorización teórica de los datos con el software Atlas.ti. Se encontró que, a pesar de que los estudiantes inhalan tolueno, sólo una de las estudiantes experimentó mareo y dolor de cabeza, en tanto que otra compañera se sintió somnolienta. Sin embargo, el segundo video muestra que los estudiantes experimentaron la prendidez (euforia, desinhibición afectiva) y alucinaciones. El mareo, el dolor y la somnolencia parecen determinados mayormente por el consumo de tolueno y alcohol, pero los efectos disímiles, por la socialidad de los contextos de consumo del inhalable, la subjetivación de los estudiantes y su veteranía en el consumo. DISCUSIÓN Y CONCLUSIÓN: Se discute que los estudiantes prefieren el consumo de inhalables porque la "prendidez" fortalece su socialidad. Se concluye que conviene desalentar el consumo de inhalables incorporando la agencia y la subjetivación juvenil, sin desatender los factores macrosociales de la producción, comercialización y regulación de los inhalables.

INTRODUCTION: Inhalant use among various populations in Mexico occurs within the context of its legality, inadequate health regulation and supervision of its production and sales, high availability and low cost, combined with the pleasurable effects of inhaling, which vary according to the context and users. OBJECTIVE: This paper describes the social practices involved in the co-construction of inhalant use contexts of two groups of Mexican middle school students and their reported effects. METHOD: Photo elicitation methodology was used, with two videotapes produced by students on school sociality practices where inhalants we are used and then analyzed in discussion groups. RESULTS: The theoretical categorization of the data was performed using Atlas.ti software. It was found that although the students inhaled toluene, only one of the students experienced dizziness and headaches, while another classmate felt sleepy. The other video was different; students got high, experiencing euphoria, emotional disinhibition and hallucinations. Dizziness, pain and drowsiness seem largely determined by toluene and alcohol use, whereas the different effects appear to be caused by the sociality of the contexts of inhalant use, students' subjectivity and their length of consumption. DISCUSSION AND CONCLUSION: It is argued that students enjoy inhalant use because getting high reinforces their sociality. The article concludes that inhalant use should be discouraged by incorporating the agency and subjectivity of youth, without neglecting the macro-social factors involved in the production, marketing and regulation of inhalants.

Evaluación de la efectividad de una intervención interactiva para el manejo del estrés en profesionales de la salud / Evaluation of the efectiveness of an interactive intervention for stress management in health professionals

ANTECEDENTES: Los efectos del estrés dependen de la percepción de los estresores y de las habilidades para afrontar situaciones estresantes. OBJETIVO: Evaluar una intervención interactiva para desarrollar recursos y habilidades para un manejo adecuado del estrés en profesionales de la salud. MÉTODO: Esta intervención se probó utilizando un Cédula diseñada para evaluar componentes de Conocimientos, Habilidades y Actitudes sobre manejo del estrés, conformada por 17 afirmaciones para dimensión de Conocimientos, 11 sobre Habilidades para manejo del estrés; y 20 sobre Actitudes para reaccionar ante el estrés. Participaron 165 profesionales y pasantes de carreras afines. Se hicieron análisis estadísticos para comparar los puntajes de los tres componentes antes y después de la intervención utilizando la prueba t de Student, se aplicó la prueba de McNemar para comparar los resultados. RESULTADOS: Sobre la efectividad de la intervención, en los análisis de comparación de los puntajes, se encontraron diferencias estadísticamente significativas a favor de la intervención en los tres componentes: Conocimientos (t = -9.77, gl = 164, p = .000), Habilidades (t = -10.19, gl = 164, p = .000) y Actitudes (t = -4.80, gl = 164, p = .000).Los análisis por reactivo mostraron incrementos estadísticamente significativos en el número de respuestas correctas después de la intervención en los tres componentes. DISCUSIÓN Y CONCLUSIÓN: Los resultados de esta intervención interactiva fueron estadísticamente significativos en Conocimientos, Habilidades y Actitudes para manejo del estrés. Además de ser una intervención innovadora, breve, basada en la traslación del conocimiento (4 semanas), y disponible en Internet, la evidencia de su efectividad hace que se perfile como una herramienta válida para el manejo adecuado del estrés.

BACKGROUND: The effects of stress depend on the perception of stressors and a person's skills for coping with stressful situations. OBJECTIVE: Evaluate an interactive intervention to develop resources and skills for proper stress management among healthcare professionals. METHOD: This intervention was tested using a chart designed to evaluate the knowledge, skills and attitudes components of stress management, consisting of 17 statements about Knowledge, 11 about Stress management; 20 about Attitudes for reacting to stress. A total of 165 professionals and interns from related careers participated. Statistical analyses were conducted to compare the scores of the three components before and after the intervention using the Student's t test. McNemar's test was used to compare the results. RESULTS: In regard to the effectiveness of the intervention, an analysis of the comparison of scores found statistically significant differences in favor of intervention in the three components: Knowledge (t = -9.77, df = 164, p = .000), Skills (t = -10.19, df = 164, p = .000) and Attitudes (t = -4.80, df = 164, p = .000). The item analysis showed statistically significant increases in the number of correct answers after the intervention in the three components. DISCUSSION AND CONCLUSION: The results of this interactive intervention were statistically significant in Knowledge, Skills and Attitudes for stress management. In addition to being a brief, innovative intervention, based on knowledge translation (4 weeks) and available on the Internet, the evidence of its effectiveness suggests it is a valid tool for proper stress management.

Violencia en el entorno laboral del trabajo sexual y consumo de sustancias en mujeres mexicanas / Violence in the work environment of sex work and substance use in a group of Mexican women

Objetivo Conocer la violencia que viven las trabajadoras sexuales en el ejercicio de su actividad y si ésta se asocia con su consumo de alcohol y otras sustancias. Método Es un estudio de campo tipo no experimental, descriptivo, con una muestra no probabilística de 103 trabajadoras sexuales seleccionadas por conveniencia. Se utilizó un instrumento diseñado ex profeso, consistente en una entrevista semi-estructurada. Resultados El 50.8% trabajaba en un bar, el 39.0% en la calle y el 10.2% en un cabaret. Más de la mitad (52.4%) refirió haber vivido experiencias violentas en el lugar de trabajo; de éstas, el 95.8% sufrió violencia física, el 26.0% violencia sexual y el 24.0% violencia emocional. Respecto a los actores involucrados en episodios violentos, en el 97.9% de los casos fueron compañeras de trabajo, en el 77.2%, clientes; en el 30.2%, propietarios o empleados de los bares y en el 25.0%, la policía. El 98% de las trabajadoras sexuales reportaron haber consumido alcohol en el último mes, el 23.3% cocaína y el 11.7% mariguana. Cabe señalar que 40% fuma tabaco. El 75% de las trabajadoras sexuales se reporta como bebedora alta. El 97% informó que generalmente los clientes las presionan para beber alcohol y un porcentaje similar refirió que consumen por las exigencias de los encargados de los lugares de trabajo. Las experiencias de violencia en el trabajo se asociaron con el consumo de cocaína [χ²= 6.417, (100, 1) gl p<.05] y de tabaco [2=7.486 (100,1) gl p<.01]. Esta asociación se mantuvo si la violencia había ocurrido en el último mes. El consumo de alcohol se relacionó con las experiencias de violencia física [χ²=5.180 (100,1)gl p<.05], y de violencia emocional [χ²=4.514 (100,1)gl p<.05]. Discusión Los resultados muestran que la violencia es una experiencia frecuente en su ambiente de trabajo, y es ejercida por múltiples actores; destaca el que se mencione a otras trabajadoras sexuales como quienes la ejercen, lo que no se reporta en la bibliografía. El consumo de alcohol y otras drogas se asocia con esta violencia, por lo que debe explorarse más este vínculo en futuros estudios. Se discuten los hallazgos, haciendo recomendaciones para la atención de esta problemática en las mujeres.

Objective The aim of this paper is to explore in women sex workers the violence they experience in the exercise of their activity, and if it is associated with alcohol use and the consumption of other substances such as cocaine, mariguana and tobacco. Method This is a descriptive, non-experimental study, developed with a non-random sample of 103 sex workers selected for convenience type field. The selection criteria were being between 18 and 65 years of age, being a sex worker, and literate. An expressly designed instrument consisting of a semi-structured interview was used. Results Regarding the workplace, 50.8% of them worked in bars, 39.0% on the streets, and 10.2% in cabarets. More than a half reported having suffered violent experiences in the workplace; of these, 95.8% experienced physical violence, 26.0%, sexual violence, and 24.0%, emotional violence. Regarding the actors involved in violent episodes, they were other sex workers (97%), customers (77.2%), owners or employees of bars (30.2%), and police (25.0%). Regarding substance use, 98% of the sex workers reported having consumed alcohol in the past month; 23.3%, cocaine; and 11.7%, marijuana. Likewise, 40% smoked tobacco. Seventy-five percent of the sex workers reported being a high drinker. Most of the women reported that customers generally pressed them in to drinking alcohol and a high percentage reported that they consumed it because of the demands of bar or cabaret managers. The experiences of workplace violence were associated with cocaine use (χ2 = 6.417 [100, 1] df p <.05) and tobacco (χ2 = 7.486 [100.1] gl p <.01). This association remained if violence had occurred in the last month. Alcohol consumption was associated with experiences of physical violence (χ2 = 5.180 [100.1] gl p <.05), and emotional abuse (χ2 = 4.514 [100.1] gl p <.05). Discussion The results show that violence is a common experience in the work environment of these women, and that this is carried out by multiple actors. Findings highlight that sex workers point out to other sex workers as those who exercise more violence. High alcohol use and the use of other drugs are associated with this violence, requiring future studies to explore in-depth this link. The findings are discussed, with recommendations for the care of these problems in female sex workers.

Correlatos psicosociales de depresión y riesgo de suicidio en trabajadoras sexuales del Estado de Hidalgo, México / Social correlates of depression and suicide risk in sexual workers from Hidalgo, Mexico

Los datos disponibles sobre la salud mental en trabajadoras sexuales en México son escasos. Sin embargo la poca evidencia disponible muestra que las prevalencias de depresión y problemática suicida son mucho más elevadas que en la población general. El objetivo de este artículo es explorar los factores psicosociales que se relacionan con la depresión y el riesgo de suicidio en una muestra de 103 trabajadoras sexuales del Estado de Hidalgo, México. Los resultados muestran que las frecuencias de depresión y riesgo de suicidio fueron más elevadas que en las mujeres de la población general (39.8 y 3.0%, respectivamente). Las variables que predijeron estos malestares fueron la mala relación con la madre, los efectos perjudiciales del consumo de alcohol sobre la salud física y las actividades domésticas, la violencia de la pareja y la violencia sexual. Es necesario considerar estos resultados para propiciar acciones que reduzcan o eliminen la violencia de pareja, fomenten la adquisición de habilidades para el manejo de las consecuencias negativas de la violencia, así como implementar estrategias para reducir el daño ocasionado por el consumo de alcohol en este grupo poblacional en situación de vulnerabilidad.

Available data on mental health among female sex workers in Mexico are scarce. The scarce evidence shows that the prevalence of depression and suicidal problems is much higher than in the general population. The objective of this article was to explore the psychosocial factors associated with depression and suicide risk in a sample of 103 sex workers from the state of Hidalgo, Mexico. Among them, the frequency of depression and suicide risk was higher than for women in the general population (39.8% and 3.0%, respectively). The variables that predicted these illnesses were a bad relationship with the mother, the negative health effects due to alcohol use, partner violence, and sexual violence. It is necessary to consider these results to promote actions that reduce or eliminate partner violence, promote the acquisition of skills to manage the negative consequences of violence and implement strategies to reduce the harm caused by alcohol consumption in this vulnerable group of the population.

El Heberprot-P® en el tratamiento de úlceras del pie diabético / Heberprot-P in the treatment of diabetic foot ulcers

RESUMEN Fundamento: el Heberprot-P® (Heber Biotec S.A, Cuba) es un medicamento cubano, cuyo ingrediente farmacéutico activo es el factor de crecimiento epidérmico humano recombinante. Objetivo: enriquecer las evidencias sobre del uso exitoso de este medicamento en el tratamiento de las úlceras del pie diabético, en nivel primario de atención de salud. Método: de un universo de 73 pacientes con ulceras de miembros inferiores, el estudio se llevó a cabo en 30 que presentaban úlceras de pie diabético en estadios 3 y 4 de la clasificación de Wagner, atendidos en el Policlínico Julio Antonio Mella del municipio Camagüey, a los que se administraron varias dosis de 75 mg del medicamento mediante infiltración intralesional y perilesional. Se estudiaron las variables: necesidad de intervención quirúrgica, tiempo de epitelización y eventos adversos. Resultados: el tiempo de epitelización del 66, 6 % de los pacientes no superó los 50 días. Las reacciones adversas observadas fueron escalofríos y temblores en el 50 % de los pacientes. El resultado de la aplicación del Heberprot-P® se evaluó de satisfactorio en 29 pacientes. Conclusiones: los resultados obtenidos demuestran que es seguro y no representa ningún riesgo aplicar el tratamiento con Heberprot-P® a pacientes con úlceras de pie diabético en el nivel primario de atención de salud, quienes lograron un elevado porciento de epitelización de las lesiones. Además el estudio indica que esta estrategia podría tener un elevado impacto en la disminución de los ingresos en la atención secundaria y en la disminución de las amputaciones mayores.

ABSTRACT Background: Heberprot-P® (Heber Biotec SA., Cuba) is a Cuban drug whose active pharmaceutical ingredient is the human recombinant epidermal growth factor. Objective: to enrich the existing evidences of the successful use of this drug for diabetic foot ulcers treatment in primary health care. Method: the universe was comprised of 73 patients affected by ulcers of inferior limbs. The study included 30 patients with diabetic foot ulcers, 3 and 4 stages of Wagner’s classification, treated at Julio Antonio Mella Polyclinic, Camagüey, who received several doses of 75 mg of drug by intralesional and perilesional infiltration. The studied variables were: need of surgery, epithelization time and adverse events. Results: the epithelization time of 66, 6 % of the cases was less than 50 days. Chills and tremors were observed in 50 % of the cases. The use of Heberprot-P (Heber Biotec SA., Cuba) was satisfactory in 96, 7 % of the cases. Conclusions: results showed that the use of Heberprot-P® at primary health care level is safe and does not represent any risk for the treatment of patients who reached a high percent of epithelization. Also the use of this drug at primary health care level could diminish the number of secondary care admissions and major amputations associated with diabetic foot ulcers.

Principales problemas identificados en la investigación y atención de víctimas de la explotación sexual comercial infantil en México / Principal problems identified in research on and treatment of victims of the commercial sexual exploitation of children (CSEC) in Mexico

The purpose of this study is to identify and describe the actions designed to combat the commercial sexual exploitation of children (CSEC) which jeopardizes or affects the victims of exploitation. To this end, the paper analyzes the paradoxical results obtained in the research and actions to combat CSEC, implemented under the auspices of the institutions to promote research on CSEC and the prevention, protection and care of child victims of the phenomenon. These results were obtained by the research team when it systematized 16 CSEC diagnoses undertaken in various parts of the country and from the information derived from the fieldwork carried out between 2000 and 2005 by the Inter-Institutional Committees to combat CSEC and at the institutions for the protection and care of child victims of sexual exploitation. The fieldwork involved participant observation during the working meetings of the Inter-Institutional Committees and at the <

El objetivo del presente trabajo es identificar y describir las acciones en contra de la explotación sexual comercial infantil (ESCI) que ponen en riesgo o afectan a las víctimas de dicha explotación. Para ello, se documentan los resultados paradójicos obtenidos en la investigación y en las acciones contra la ESCI, implementadas bajo el auspicio de instituciones promotoras de la investigación de la ESCI y de la prevención, protección y atención a victimas infantiles del fenómeno. Estos resultados fueron obtenidos por el equipo de investigación al desarrollar una sistematización de 16 diagnósticos de la ESCI promovidos en diferentes partes del país, y al sistematizar la información del trabajo de campo desarrollado entre los años 2000 y 2005, en los comités interinstitucionales en contra de la ESCI, y en instituciones de atención de las víctimas infantiles de la explotación sexual. El trabajo de campo consistió en la realización de observación participante durante las reuniones de trabajo de los comités interinstitucionales y en los albergues de <

Inequidades de género, abuso de sustancias y barreras al tratamiento en mujeres en prisión / Gender inequities, substance abuse and treatment barriers in women in prison

The vast majority of women in Mexican prisons have several mental health disorders and addictions, as well as problems obtaining access to treatment for this type of problems. These women's personal background and prison conditions reflect the unresolved problems of the country, such as education and illiteracy, access to health and housing and inequity in the justice systems. The literature has shown that substance abuse affects female prisoners to a greater extent than other women, and that their disadvantaged socio-economic status makes them more likely to engage in and continue substance abuse. Other aspects that exacerbate this vulnerability are their low educational attainment, lack of job skills, and exposure to stigmatization and discrimination in addition to the physical and psychological consequences of addictive behavior. One aspect that has been internationally acknowledged is that gender inequities make women's health more vulnerable, particularly that of female prisoners, since they have greater health deficits and more treatment barriers. International literature has shown that female users of psychoactive substances in general face more barriers than men in seeking or continuing treatment. Research has also shown that the most common personal barriers in women are denial, shame and guilt. Likewise, women's anxiety and depressive disorders tend to be more prevalent and severe, which in turn prevents them from seeking help when they have substance abuse problems. The most common family-related barriers are the difficulty of attending treatment due to family, partner or childcare obligations, pregnancy or fear of losing custody of their children. The main barriers faced by women regarding treatment institutions are the insensitivity or inadequate training of the staff that work there, prejudice and negative attitudes towards women, lack of information on available treatment and extremely long waiting lists. As a result of the above, the aim of this study is to document the barriers to the treatment of addictions of female prisoners, a disadvantaged group that has rarely been studied in Mexico, in order to understand certain aspects related to this population's access to treatment and continuation of the latter. The design used for this research is an ex post facto, descriptive, non-experimental, cross-sectional field study. The sample consisted of 213 women, chosen for convenience, who met the following criteria: alcohol and drug users, ages 18 to 65, able to read and write and with no psychiatric disorders or handicaps that would prevent the interview. The women that participated in this study were drawn from two Mexico City prisons: the Centro Preventivo Femenil Oriente, which houses women that have been accused, tried and sentenced, and the Centro de Readaptación Social Femenil Tepepan, where the inmates are women who have been sentenced and also have psychiatric problems. The ethical care observed included informing the interviewees of the objectives of the study, voluntary participation, confidential handling of the information and the use of witnesses, as well as guaranteeing participants the right to abandon the study and not to answer questions they found uncomfortable. The instrument was designed as a semi-structured interview with 242 questions covering various areas including Allen's Questionnaire on Treatment Barriers. It can be self-administered by the respondents, has internal consistency, construct and content validity and was adapted by Romero (2002). Some of the respondents had to have the questionnaire read out to them because of their low educational attainment. This questionnaire consists of 41 items, 30 of which are divided into three categories: 1. characteristics of treatment services, 2. beliefs, feelings or thoughts, and 3. socio-environmental aspects. Each category also includes an open question to discover other types of barriers not included in the three categories. The results yielded the following socio-demographic profile of the interviewees: 45.5% were in the 28 to 40 year age group; and had had 6 or less years' education (41.3%) or completed junior high school (36.2%). The majority were single (48.6%) or common law (21.6%), while 50.7% had children under the age of 18. Certain other characteristics of this sample such as depression, violence and alcohol and drug use have been reported in other studies. Of the total group of women that had received treatment at some time in their lives, 52.6% (n = 112) mentioned some type of barrier to treatment for addictions. A total of 29.1% (n = 62) of these women mentioned some type of barrier to treatment for alcohol use, while 44.1 % (n = 94) cited some type of barrier to treatment for drug use. Lastly, 39.2% (n = 44) mentioned some type of barrier to treatment for both types of consumption. An analysis of the treatment sub-scale by socio-demographic variable showed greater difficulty in obtaining treatment among women ages 28 to 40 and among those with children under 18. Statistically significant differences were observed regarding the type of offense (robbery) and availability of treatment. As for the beliefs, feelings and thoughts sub-scale, statistically significant differences were found among women with children under 18 and those finding it hard to abandon consumption. The sub-scale related to situational aspects, such as rejection from friends, proved to be the main barrier to enter treatment and was statistically significant among single women. The results of this study pose challenges to the health and mental health service sector regarding the timely treatment and rehabilitation of marginalized women. Likewise, acknowledging gender inequities is crucial when it comes to designing health promotion strategies. Without this perspective, their effectiveness could be jeopardized and gender inequalities actually exacerbated.

La gran mayoría de las mujeres recluidas en las prisiones de México presentan una gran cantidad de trastornos de salud mental y adicciones, así como dificultades para acceder al tratamiento para este tipo de problemas. Los antecedentes personales y las condiciones de reclusión de estas mujeres reflejan los problemas no resueltos del país como son educación y analfabetismo, acceso a la salud, vivienda e inequidad en los sistemas de procuración de justicia. En la bibliografía se ha señalado que el abuso de sustancias afecta a las mujeres presas en mayor medida que a otras mujeres y que su situación socioeconómica desfavorable las hace más susceptibles de incidir y prevalecer en la conducta de abuso de sustancias. Otros aspectos que acentúan esta vulnerabilidad son el bajo nivel educativo, las pocas habilidades para el trabajo, la exposición a la estigmatización y la discriminación, además de las consecuencias físicas y psicológicas de la conducta adictiva. Un aspecto reconocido internacionalmente es que las inequidades de género vulneran de manera particular la salud de las mujeres, lo cual es aún más evidente en las mujeres presas, pues presentan mayores déficits en su salud y mayor número de barreras al tratamiento. Se ha documentado en la bibliografía internacional que las usuarias de sustancias psicoactivas en general se enfrentan a un mayor número de barreras que los hombres para buscar o seguir un tratamiento. Por lo anterior, el objetivo del estudio es documentar las barreras al tratamiento de adicciones de mujeres en prisión, una población desfavorecida poco estudiada en México a fin de entender algunos aspectos relacionados con el acceso a tratamientos de esta población y su permanencia en ellos. El diseño utilizado para esta investigación corresponde a un estudio de campo transversal no experimental, descriptivo, ex post facto. La muestra se conformó de 213 mujeres, seleccionadas por conveniencia, con los siguientes criterios: usuarias de alcohol y drogas, edad de 1 8 a 65 años, que supieran leer y escribir, sin trastorno psiquiátrico o discapacidad que impidiera la entrevista. Las mujeres que participaron en este estudio se seleccionaron de dos prisiones de la Ciudad de México: el Centro Preventivo Femenil Oriente, donde se encuentran mujeres indiciadas, procesadas y sentenciadas, y el Centro de Readaptación Social Femenil Tepepan, donde se encuentran mujeres sentenciadas y con problemas psiquiátricos. Los cuidados éticos observados en el estudio fueron: información de los objetivos a las entrevistadas, participación voluntaria, confidencialidad de la información, empleo de testigos, así como el derecho de abandonar el estudio y de no responder aquellas preguntas que les resultasen incómodas. El instrumento empleado tuvo un formato de entrevista semiestructurada con 242 preguntas que abarcan diversas áreas, entre ellas, el <

Epidemiología de la meningitis Venezuela 2010 / Epidemiology of meningitis in Venezuela 2010

Las meningitis en Venezuela constituyen un importante problema de salud pública, que afecta de manera especial a los niños menores de 5 años. Las vacunas antineumocócicas, antimeningocócicas, contra Haemophilus influenzae tipo b, así como la BCG, obligan a revisar la dinámica de la morbi-mortalidad en nuestro país. La etiología más frecuente es viral, seguida de las meningitis bacterianas y las tuberculosas, mientras que se conoce poco de la micótica y otras causas. Los sistemas de vigilancia epidemiológica muestran cifras altas de la incidencia de las meningitis que ameritan acciones más enérgicas de salud pública para vigilar, prevenir y mejorar los Programas Nacionales de Inmunizaciones y sus coberturas, además de tratar médicamente las meningitis en cualquiera de sus causas infecciosas

Meningitis constitutes an important public health problem in Venezuela that affects children, specially under 5 years of age. Antimeningococcal, anti-pneumococcal, vaccines against Haemophilus influenzae type b and BCG induce pediatricians to review the dynamics of the morbidity and mortality of these diseases. The most common etiology is the viral followed by bacterial meningitis followed by tuberculosis, while little is known of the fungal or other causes. Epidemiological surveillance systems show high figures of the incidence which warrant a more intense public health action to monitor, prevent and improve national programs of immunization and their vaccine coverage, and to treat medically any infectious cause of meningitis

An inexpensive antigen for serodiagnosis of Chagas’ Disease

In this prospective study we evaluated the performance characteristics of a specific and sensitive antigen preparation (AgA) used in an enzyme-linked immunosorbent assay (ELISA) for the detection of anti-Trypanosoma cruzi antibodies in serum samples, for Chagas’ disease diagnosis. The antigen production was achieved by combination of nutritional stress and autoclaving the parasites. Specificity and sensitivity were evaluated in two separate tests, using 152 sera from healthy individuals and 175 sera from Chagas’ patients (70 by xenodiagnosis). Cross-reactivity was tested using 289 sera from patients who had a parasitological diagnosis of a disease known to induce antigenic responses towards T. cruzi. All of these sera were tested with our AgA-ELISA and with 3 commercial diagnosis kits. To evaluate the agreement of results between our AgA-ELISA and a “gold standard” test for Chagas, we tested 566 sera from an endemic area. Results: sensitivity and specificity were 100 percent; cross-reactivity was the lowest compared with commercial kits. Overall agreement with the gold standard test was excellent (kappa=0.92). AgA-ELISA exhibits levels of sensitivity, specificity and cross-reactivity comparable or superior to those shown, obtained with the commercial kits used in our country, while being at least 10 times less expensive. This balance between diagnostic accuracy and cost makes AgA-ELISA useful for blood bank screening in poor regions of the world suffering from Chagas’ disease. Further validations of this antigenic formulation in other countries are necessary.

Este estudio fue realizado para evaluar las características de sensibilidad y especificidad de una formulación antigénica (AgA), producida a bajo costo, para detectar anticuerpos dirigidos a Trypanosoma cruzi, en muestras de suero de pacientes con enfermedad de Chagas. El AgA fue producido por el efecto combinado de estrés nutricional y autoclave de los parásitos. La especificidad y sensibilidad fueron evaluadas en dos estudios separados, con 152 sueros de individuos sanos y 175 de pacientes Chagásicos. La reactividad cruzada con 289 sueros de pacientes con diagnóstico parasitológico de enfermedades con anticuerpos que reaccionan con antígenos de T. cruzi. Estos sueros fueron evaluados con AgA-ELISA y con tres estuches comerciales. 566 muestras de suero provenientes de un área endémica, fueron empleadas para estudiar la concordancia entre nuestro diagnostico y una prueba designada por nosotros como patrón oro estándar. Resultados: la sensibilidad y especificidad fue de 100 por ciento. El AgA presento el más bajo porcentaje de reactividad cruzada, respecto a los estuches comerciales evaluados. La concordancia con la prueba patrón oro, en Venezuela, fue excelente (kappa=0,92). En conclusión, Aga-ELISA, presentó niveles de sensibilidad, especificidad y de reactividad cruzada, comparables o superiores a los obtenidos por los tres estuches comerciales mas empleados en el país, pero con costos de producción al menos 10 veces menor. Este balance conveniente, favorece su potencial uso para el despiste en los bancos de sangre de los países pobres y endémicos para la enfermedad de Chagas. Futuras validaciones de esta formulación en otros países es necesaria.

Epidemiología: [revisión] / Epidemiology: [review]

Las enfermedades diarreícas, constituyen un problema mundial, con altas tasas de morbilidad y mortalidad, especialmente en países en vías de desarrollo. Venezuela presentó, en el año 2008, 1.768.509 casos de diarrea, con un 40 por ciento en menores de 5 años. El total de muertes en menores de 5 años en el período 2000-2007 fue de 9311, siendo la tercera causa en este grupo de edad. Entre las bacterias, el género Salmonella, es el más frecuentemente aislado en brotes epidémicos. En niños menores de 6 años. E.coli enteropatógena fue el agente principal, seguido por E.coli enteroinvasiva, Aeromonas sp., salmonella sp y Shigella. Campylobacter es una de las bacterias más frecuentemente en las heces de los lactantes y niños en países en desarrollo. En algunos países, tener en cuenta al Vibrium Cholera y en diarreas nosocomiales al Clostridium difficile. En lactantes y preescolares la etiología viral es la más frecuente y el rotavirus el agente más común, causando aproximadamente 15000 muertes anuales en la región de las Américas. Otros virus causantes de diarreas , son los calicivirus y los adenovirus. Los factores de riesgo están relacionados con el medio ambiente, estilos de vida, factores dependientes de la biología humana y de los sistemas de servicios de salud. Las medidas de prevención y control epidemiológico más importantes son la promoción de la lactancia materna, hábitos adecuados de higiene y saneamiento ambiental, uso adecuado de antibióticos, terapia de rehabilitación oral e intravenosa, inmunizaciones, mejoría de las condiciones socio sanitarias y sistemas eficientes de vigilancia epidemiológica.

Diarrheal diseases constitute a global problem, with high rates of morbidity and mortality, particulary in developing countries. Venezuela, for 2008, presented 1.768.509 cases of diarrhea, with 40% in children under 5 years. The total number of dealths in children under years of age in the period 2000-2007 was 9311, being the third learding cause in this age group. Among causing bacterias, Salmonella in the most isolated in outbreaks. In children under 6 years, E.Coli was the principal agent, followed by E.coli., enteroinvasive, Aeromonas sp., Salmonella sp, and Shigella. Campylobacter is one of the most common bacterial in the feces of infants and children in developing countries. In some countries, Vibrium Cholera and Clostridium difficile should be considered. In infants and preshool children, viral etiology is the most frequent and rotavirus the most common agent, causing about 15000 deaths annually in the region of the Americas. Other viruses that cause diarrhea are the calciviruses and adenoviruses. Risk factors are related to the environment, lifestyles, factors dependent on human biology and health care systems. The most important prevention and control measures are the promotion of breastfeeding, proper habits of hygiene and sanitation, proper use of antibiotics, oral and intravenous rehydration therapies, immunization, improvement of sanitary conditions and efficient surveillance systems.

Comportamiento biomecánico de cavidades clase I y II para amalgama y resina, analizado por el método de elementos finitos / Biomechanical behavior of Class I and II cavity preparations for amalgam and composite aAnalyzed with the finite element method

Antecedentes: A través del tiempo, teóricamente se han establecido parámetros de diseños de cavidades ideales; sin embargo, no se ha hecho un análisis biomecánico que muestre cuál es la mejor alternativa. Objetivo: Identificar el diseño cavitario que ofrece mejor distribución de esfuerzos en cavidades clase I y II obturadas con amalgama o resina, a partir de un análisis de elementos finitos. Método: Se realizó un modelo tridimensional de la corona de un premolar superior con cavidades clase I o II, obturadas con amalgama o resina, variando la dirección de las paredes. Se aplicó una fuerza de 291,36 newtons (N) en cinco puntos de contacto y se observó la distribución de los esfuerzos y sus magnitudes. Resultados: Para cavidades clase I se obtuvo una mejor distribución de esfuerzos, al utilizar paredes divergentes para obturaciones en amalgama y convergentes para resina, mientras en cavidades clase II ocurrió lo contrario. La concentración de esfuerzos es mayor con resina que con amalgama y coincide con los puntos de contacto. También se encontró mayor concentración de esfuerzos en la restauración que del tejido dentario, tanto para amalgama como para resina. Conclusiones: Desde el punto de vista biomecánico, la variación en la dirección de las paredes cavitarias influye en la distribución de los esfuerzos y sus magnitudes en el diente, pero no parece ser un factor determinante del éxito o fracaso de una restauración, teniendo en cuenta las condiciones empleadas en este estudio.

Background: Through time, some parameters for cavity design have been established theoretically but there is no biomechanical analysis that shows which one is the best alternative. Purpose: Identify through the finite element method the cavity design that offers a better distribution of efforts in cavities class I and II for amalgam or composite. Method: A three dimensional model of the crown of a second superior premolar with cavities class I or II restored with amalgam or composite was realized, varying the direction of the cavity walls. A force of 291.36 N was applied in the five contact points and the distribution of efforts and its magnitude was observed. Results: For cavities class I, a better distribution of efforts was obtained when using divergent walls for restorations in amalgam and convergent for composite, while in cavities class II the opposed occurred. The concentration of efforts was greater with composite than with amalgam and it coincided with the dental contact points. It was also found a greater concentration of efforts in the restoration material than in the dental structure, for amalgam and for composite. Conclusions: From the biomechanical point of view, the cavity walls direction have influence in the distribution of efforts and its magnitudes in the tooth but do not seem to be a determining factor for the success or failure of the restoration considering the conditions included in this study.

Problemas y dilemas éticos en la investigación de la explotación sexual comercial de niñas y niños / Ethical problems and dilemmas in research on the commercial sexual explotation of children

The article begins by defining commercial sexual explotation of children (CSEC) as an exercise of power that commercializes the sexual abuse of children and adolescents so that the exploiters, nearly always adult men, will obtain financial profit or some type of social, psychological or other satisfaction. Victims of CSEC are girls and, to a lesser extent, boys. In any case, they are persons under the age of 18, who have been stripped of their right to be respected and protected from slavery and sexual abuse, discrimination, sickness and crime. This usurpation of rights occurs in certain businesses in the sexual industry (such as prostitution in bars, saloon bars, eateries, brothels, hotels and in the journals, videos and websites on the Internet run by pornographers and child molesters) and the street sex market (including prostitution in streets, squares, beaches, and parks). The main thrust of this article is to analyze some of the problems derived from the failure to comply with the principles of research ethics when studying commercial sexual exploitation (CSEC) in the sex industry and street sex market in Mexico. Research about CSEC started during the 90's focusing on the sex industry and street market in Mexico City and Guadalajara, Jalisco. By the end of that decade the National System for the Integral Development of Families (NSIDF) created a program against CSEC, with social research being one of its core objectives. A brief analysis is conducted of the problems derived from the failure to comply with ethical standards in the early covert research on CSEC in Mexico. It reports that this type of research encourages protection of the researcher without obtaining informed consent, respecting the dignity, confidentiality or anonymity of victims or providing any type of protection for the victims from any type of damage caused by their participation in the research. Most of the research projects focus on detecting victims in the sex industry and the stress sex market in various cities throughout the country. To this end, various methods and techniques have been used that require compliance with basic ethical standards in the relationship between researchers and key informants and in the reports by responsible researchers. Although it might be said that projects review and approval by an ethics committees implicitly assume compliance, there is still a considerable amount of studies without manifest ethic support. This article also discusses the fact that the de-contextualized application of the principles of research ethics to CSEC studies does not suffice to solve the previous problems, and may create ethical dilemmas in CSEC research. It also specifically describes one of the dilemmas faced in the authors' own research. Although a certain percentage of the research related to the issue is obviously reviewed and approved by an ethics committee that implicitly acknowledges this compliance, there continues to be a considerable number of studies with no manifest ethical support. Researchers responsible for the detection of and interviews with victims of CSEC also seek to defend themselves without protecting any of the latter. For example, many researchers act as clients in order to go unnoticed by exploiters and record the presence of teenagers in bars, saloon bars and diners without offering them any form of protection. These researchers never report that the victims interviewed have been informed of their right to refuse to answer or to leave whenever they wish. Ten years ago one researcher decided to penetrate a network that exploited adolescents. He managed to know the procedures followed to contact, enroll and coerce victims, as well as the commercial sex activities. Some authors consider that the violation of informant's rights in social research can be avoided by applying the universal principles of ethics in scientific research. However, the application of such principles seems to be insufficient to solve the wide range of ethical problems that raise in frequent and deep social relationships to informants. Applying the universal principles out of context would also obstruct the development of ethical validated social sciences such as participant observation, and generate other problems. For instance, the application of the principle of anonymity to protect the informant's identity when the participants wish to have their real names used on research reports, can make participants feel disappointed and stolen when reading their own experiences being reported under somebody else's name. This might persuade them to participate in other research projects. The article ends by describing the lessons learned during this work. Recommendations include protecting the physical, social and psychological welfare of the persons studied and those with whom one works, finding out about the social context where one's fieldwork is conducted; adopting a rights and gender approach; avoiding research solely designed to detect victims without offering them protection; detecting victims within the context of inter-institutional coordination (State Prosecutor's offices, Municipal and State DIF Systems and welfare organizations run by civilians), and rescue and protection programs that will guarantee the restoration of their rights and ensure the research team's welfare. At the very least, they should be quite clear that their own safety should always take precedence over their research.

En este artículo se define primero la explotación sexual comercial infantil (ESCI) como un ejercicio de poder que mercantiliza el abuso sexual de niñas, niños y adolescentes, con el fin de que los explotadores, casi siempre hombres adultos, obtengan alguna ganancia financiera o alguna satisfacción social, psicológica o de cualquiera otra especie. Las víctimas de la ESCI son niñas y, en menor medida, niños. En cualquier caso se trata de personas menores de 18 años de edad, usurpadas de su derecho a ser respetadas y protegidas contra la esclavitud y el abuso sexual, la discriminación, las enfermedades, la delincuencia, entre otros. Esta usurpación de derechos ocurre en algunos negocios de la industria sexual (la prostitución en bares, cantinas, fondas, casas de cita, hoteles y en las revistas/videos/sitios de la WEB de pornografía, pederastas, etc.) y del mercado callejero del sexo (la prostitución en las calles, plazas, playas, jardines, etc.). El propósito del artículo es analizar algunos problemas derivados del incumplimiento de los principios de la ética de la investigación al estudiar la explotación sexual comercial infantil (ESCI) en la industria sexual y el mercado callejero del sexo en México. De esta manera se hace un rápido análisis de los problemas derivados del incumplimiento de los estándares éticos en las primeras investigaciones encubiertas sobre la ESCI en México. Se reporta que este tipo de investigaciones privilegia la protección del investigador sin obtener el consentimiento informado, sin respetar la dignidad, la confidencialidad ni el anonimato de las víctimas y sin brindarles algún tipo de protección contra cualquier tipo de daño producido por su participación en la investigación. La mayoría de las investigaciones se centra en la detección de víctimas en la industria sexual y en el mercado callejero del sexo de diferentes ciudades del país. Para tal efecto se han ocupado métodos y técnicas que exigen el cumplimiento de estándares éticos básicos en la relación de los investigadores con los informantes clave y en el reporte de los investigadores responsables. Asimismo se discute que la aplicación descontextualizada de los principios de la ética de la investigación a los estudios de la ESCI no es suficiente para resolver los problemas anteriores y que puede generar dilemas éticos en la investigación de la ESCI. De manera específica se expone uno de los dilemas enfrentados en el propio trabajo de investigación de los autores. Es innegable que se podría asumir que cierto porcentaje de investigaciones relacionadas con el tema pasa por la revisión y aprobación de un comité de ética que da cuenta implícitamente de ese cumplimiento. Sin embargo, aun así persiste un número considerable de estudios que no tiene ningún respaldo ético manifiesto. Los investigadores responsables de la detección y las entrevistas a las víctimas de la ESCI también buscan salvaguardarse sin proteger a ninguna de ellas. Por ejemplo, muchos investigadores actúan como clientes para pasar desapercibidos ante los explotadores y registrar la presencia de adolescentes en bares, cantinas y figones sin ofrecer a ellas algún tipo de protección. Los investigadores nunca reportan que las víctimas entrevistadas hayan sido enteradas de que tenían derecho a negarse a contestar o a retirarse cuando lo decidieran. Finalmente se exponen las lecciones aprendidas en dicho trabajo, las cuales recomiendan proteger el bienestar físico, social y psicológico de las personas a las que se estudia y con las que se trabaja; conocer el contexto social donde uno hace su trabajo de campo; adoptar un enfoque de derechos y de género; evitar las investigaciones que persigan como único fin detectar a víctimas sin ofrecerles protección; realizar la detección de victimas en el contexto de programas de coordinación interinstitucional (ministerios públicos, sistemas estatales y municipales DIF; organismos asistenciales de la sociedad civil), de rescate y de protección que garanticen la restitución de sus derechos, y proteger el bienestar del equipo de investigación. Por lo menos debe quedar claro al investigador que su propia seguridad debe estar en todo momento por encima de la realización de las tareas de investigación.

Severe hypertension and hypokalemia as first clinical manifestations in ectopic Cushing's syndrome / Hipertensão grave e hipocalemia como primeiras manifestações clínicas em casos de síndrome de Cushing ectópica

Ectopic ACTH production occurs in about 10 percent of all cases of Cushing's syndrome, and about 25 percent of cases of ACTH-dependent Cushing's syndrome. Diverse tumor types are able to produce ACTH ectopically, including small cell lung carcinoma. Ectopic ACTH secretion by malignant neoplasm has been reported to have earlier and more aggressive metabolic effects. We report a 59-year-old male patient with severe hypertension, metabolic alkalosis and hypokalemia as the first clinical manifestations of an ACTH-secreting small cell lung carcinoma, although the typical phenotypic features of Cushing's syndrome were not present. Ectopic Cushing's syndrome should always be ruled out in patients with severe hypertension and hypokalemia.

A produção de ACTH ectópico ocorre em aproximadamente 10 por cento dos casos de síndrome de Cushing, e em aproximadamente 25 por cento dos casos de síndrome de Cushing dependentes de ACTH. Diversos tipos de tumores são capazes de produzir ACTH ectopicamente, incluindo carcinoma pulmonar de células pequenas. Relatórios indicam que a secreção de ACTH ectópico por neoplasma maligno causa efeitos metabólicos prematuros e mais agressivos. Apresentamos um paciente, 59 anos, com hipertensão grave, alcalose metabólica e hipocalemia, tendo estas como as primeiras manifestações clínicas de um carcinoma pulmonar de células pequenas com secreção de ACTH, embora as características fenótipas típicas da síndrome de Cushing não estavam presentes. A síndrome de Cushing ectópica deveria ser excluída sempre em pacientes com hipertensão grave e hipocalemia.

Racionamiento vía listas de espera: medidas de mejora y posibles implicaciones / Rationing through waiting lists: measuring improvement and possible implications

En este trabajo se discuten las principales estrategias que se han planteado en la gestión sanitaria para mejorar la situación de las listas de espera. En primer lugar, se describen aquellas medidas que tratan de mejorar los indicadores tradicionales de las listas de espera (tiempo de espera y tamaño de la lista), distinguiendo entre aquéllas que tratan de incidir en el incremento de la oferta y las que tratan de controlar la demanda. En segundo lugar, se analizan aquellas medidas que no implican necesariamente una mejora en los indicadores tradicionales, pero sí consiguen mejoras significativas en la calidad de la espera. Para cada una de las estrategias se muestran tanto sus efectos esperados como otros efectos colaterales que alertan sobre su eficacia a la hora de mejorar la situación de las listas de espera.

This paper analyzes the main policy initiatives for improving waiting lists in health care. The authors begin by describing strategies to reduce either waiting time or length of the list. They distinguish between demand-side and supply-side strategies. They proceed to discuss policies for improving the "quality" of waiting time. For each policy, they present both the expected effect and the indirect effects that can reduce its effectiveness for improving waiting list conditions.

Uso de drogas en la Ciudad de México: Sistema de Reporte de Información en Drogas (Srid)

Resumen: Introducción. El Sistema de Reporte de Información en Drogas (SRID) proporciona un panorama diagnóstico de los cambios ocurridos en el consumo de drogas en la Ciudad de México. Se actualiza dos veces al año (junio y noviembre), y sus resultados dan una estimación de la trayectoria del problema desde una perspectiva de salud. El SRID inició su funcionamiento en 1986 y sus resultados sirven además de fundamento para diseñar programas de prevención adecuados a la población mexicana. Objetivo. Presentar una síntesis de los resultados más relevantes del consumo de sustancias en la Ciudad de México recopilados por el SRID entre 1987 y 2005, en instituciones de salud y de justicia. Quienes se benefician de la información que se obtiene son: - Las autoridades a cargo de diseñar políticas y acciones de intervención en virtud de que el SRID funciona como un sistema de monitoreo permanente, así como de alerta temprana. - Los investigadores, dado que el SRID funciona como ventana para identificar las áreas donde es necesario mayor conocimiento desde una perspectiva de salud. - El público en general, para quien el SRID es una herramienta que describe la evolución y el estado actual de las tendencias de la farmacodependencia. Método. La información se obtiene de una cédula individual sobre consumo de drogas, que se aplica dos veces por año en 44 instituciones del sector salud y procuración de justicia. El diseño de la muestra es no probabilístico de tipo intencional. Resultados. La información analizada corresponde a 19350 casos identificados entre 1987 y 2005. Lo más destacado de las tendencias de consumo de sustancias ha sido el notable incremento de la cocaína durante el periodo evaluado. Igualmente significativa ha sido la tendencia a la baja del consumo de inhalables, que se hizo más evidente a partir de 1999. El consumo de mariguana, una de las tres drogas consumidas con más frecuencia en el país, ha mostrado cierta estabilidad al igual que el resto de las sustancias evaluadas. Conclusiones. El mayor número de usuarios de cocaína son adolescentes. Asimismo, respecto a los patrones de consumo, llama la atención que el perfil del usuario para todas las drogas estudiadas sea alto: 20 o más veces por mes, en 45% de los casos. Ambas situaciones son objeto de preocupación por los efectos físicos y emocionales de las sustancias, y porque no se observan indicadores que sugieran un decremento en el consumo.

Summary: Introduction. The Information Reporting System on Drugs (IRSD) provides diagnostic information about changes in drug use in Mexico City. This information is updated twice a year (June and November), and an estimation of the main trends of drug use is thus obtained. The IRSD was implemented in 1986, and its results offers grounds for the design of preventive programs suited for the Mexican population from a health perspective. Objetive. To present a synthesis of the most relevant results of substance use in México City compiled by the IRSD between 1987 and 2005. The following are the benefit from data obtained: - Authorities in charge of designing policies and intervention actions, by virtue of which the SRID works as a system of permanent monitoring and early warning. - Investigators, since the SRID works as a window to identify the areas where greater knowledge is necessary. From a health perspective, the public in general, for whom the SRID is a tool that describes the evolution and current state of drug tendencies. Method. The information is obtained from an individual schedule on drug use that is applied twice a year in 44 agencies of the health and law enforcement sector. The design of the sample is non probabilistic. Results. In the period 1987-2005, 19350 cases have been evaluated. The most outstanding trend in substance use has been the remarkable increase of cocaine from 1987 to 2005. Equally significant has been the decrease tendency of solvents-inhalants use, which has become more evident since 1999. Marihuana use is among the three most used drugs in the country. It shows a trend to remain stable as is the case for the other substances evaluted. Conclusions. Most cocaine users are adolescents. At the same time, 45% of the users of all the substances have a use pattern defined as "high": 20 or more times a month. Both situations are a matter of concern due to the important physical and psychological consequences of substance use. In addition, up to this moment, there is no indication suggesting that the level of use will decrease.

La importancia del apoyo social para el bienestar físico y mental de las mujeres reclusas

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Abstract: Introduction. Social support has been useful as a key axis for different approaches on how positive human relations and social networks help the individual to achieve states of relative well-being and overcome stressful events which they have to cope with in their lives. This is particularly important in the case of imprisoned women, who generally lack social support, since many of them are abandoned by their relatives and friends with the consequent impact that this has on their physical and emotional well-being. Support from family and friends during imprisonment can imply an enormous difference in the living conditions of imprisoned women. It has been proved that the social support individuals receive through their social networks is a key factor for their well-being, specially at times of stress, transition or crisis, and protects them from the emergence of physical and psychic disorders. For these reasons, the objective of this article is to identify the main sources of social support in convicted women at two penitentiary centers in Mexico City and to determine whether the presence or absence of social support has an impact on their physical and mental well-being. Method. This is a descriptive field study carried out at two women's prisons in Mexico City: The East Preventive Center for Women and the Tepepan Center of Social Readjustment for Women. The type of sampling was non-probabilistic and selected by convenience. The final sample comprised of a total of 212 women. This study included current and lifetime female abusers of alcohol, tobacco and drugs, aged between 18 and 65, who could read and write. The exclusion criteria used were having a psychiatric disorder or a physical disability that would prevent them from completing the interview. The instrument used for compiling the information was a semi-structured interview consisting of 62 pages on various areas from the lives of female prisoners. The following sections of the questionnaire were analyzed for this article: a) sociodemographic characteristics, b) social networks, c) depression, and d) perception of physical and emotional health. The procedure followed to gather information on the female prisoners began with the establishment of an agreement with the General Administration of Prevention and Social Readjustment of the Federal District. Through this agreement, the mental health team, comprising psychiatrists, psychologists and anthropologists -previously trained in the use of a structured interview-, were granted access to the correctional facility. The interviews were carried out after the women had given their informed consent and told of the objectives of the study. The interviews lasted two hours on average, although on some occasions they took up to four sessions of two hours. The field work lasted two years. Results. Socio-demographic profile: The majority of the interviewees were under 40 years old (84%). They had low schooling (with only 41% having completed elementary school), were unmarried (48.6%), and most of them did not live either with a partner or an offspring (40.5%). A total of 58.6% had left home when they were young and nearly 40% lived on the streets. Before being admitted to the institution, they had been shopkeepers (29.5%), employees (21.9%), housewives (13.8%), manual workers(7.1%) and informal workers (5.7%). Contact with relatives and friends in the past month: A high number of the women in prison reported not having received any visits during the past month, with only a small percentage receiving daily visits. Almost 60% of the women declared not receiving any visits from significant figures, such as their partners or children. Frequency of visits and perception of physical and mental health: A third of the women rated their physical and mental health as not so good. When frequency of visits was linked to the women's perception of health, it was found that women, who had not received any visits over the past month, tended to evaluate their physical health more negatively (bad-mediocre) than those who received visits (43.5% versus 38.5%). A similar percentage was observed in the evaluation of their mental health (47.8% versus 45.3%). Frequency of visits and depression: When relating the frequency of visits to the presence and/or absence of depression, it was found that women who had not received visits during the past month experienced more depressive episodes (72.7% versus 61.1%). Nevertheless, these differences were not significant. Discussion. One of the most outstanding aspects observed in this study was the high level of abandonment suffered by the inmates, which confirms findings from other studies about women being abandoned by their loved ones more often than men after commiting a crime. The study found that in terms of accessibility, the physical location of penitentiary centers, is not a factor that fully explains the abandonment suffered by these women, since most of the inmates' relatives and friends live in the same city and even in the same neighborhood where the penitentiary center is located. A high presence of present depressive episodes was also observed in female prisoners, both among those who reported receiving visits and those who did not. A possible answer here is that imprisonment itself is a highly stressful event for those undergoing it and the support received from relatives and friends is not enough to offset the effects of confinement. Conclusions. The results of this study indicate there is a certain positive association between the social support female prisoners received from relatives and friends and their physical and mental well-being. Nevertheless, this cannot be considered a causal relationship, a conclusion which agrees with other reports regarding the positive influence of social support on prisoners' well-being. However, it is also suggested that this is a complex relation that must be investigated more in depth, since this support does not necessarily has the same effect on all individuals. One of the main recommendations deriving from these results is the need to make prisoners' relatives aware of the importance of promoting and maintaining a continuous and permanent contact with them, since this type of support usually brings about an enormous benefit for their physical and emotional well-being. It is also necessary for penitentiary institutions to reconsider the suspension of visits as a means of punishment and control, since this entails a series of negative consequences for the internal population and the institution itself.

Experiencias de violencia física ejercida por la pareja en las mujeres en reclusión

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Abstract: Violence against women is an everyday problem which is expressed in various ways, whether physically, sexually or emotionally, and it may occur at either public or private level. The subject of violence against women has been regarded as a worldwide priority, since it obstructs every area of women's development. Society has acknowledged the fact that this violence "prevents the achievement of the objectives of equality, development and peace and that it violates, reduces or prevents (women's) enjoyment of human rights and fundamental liberties. A recent report by the Johns Hopkins School of Public Health and the Center for Health and Gender Equity shows that at least one out of every three women has been physically mistreated, forced to engage in sexual relations or suffered some type of abuse in the course of their lives. In Mexico as in other countries, violent behavior has been regarded as "natural" in relation to the way how to treat women; norms and everyday life have kept it hidden. Epidemiological surveys, however, show figures that reflect the scope of the problem, which in turn has meant that it is now considered as a serious health problem. Consequently, approaching the issue of intra-familial violence compels one to consider a characteristic cultural aspect: the questionable fact of referring to its existence solely within the private sphere. It is felt that what goes on inside a home is an intimate affair and that outsiders should not be aware of this, far less intervene. The same happens when one discusses the violence experienced by women living in prison, since they often continue to experience violence or abuse when they receive their conjugal visits; or else at the hands of other prisoners or from the institute itself and no-one seems willing to intervene. Women living in a penitentiary environment designed essentially for men, occupy a secondary position and are marginalized as regards planned work, cultural, sports, and recreational programs, partly due to the fact that the prison population is thought to be primarily male (1990 to 1994 reports). As Barquín notes, most women in prison experienced violence from their parents or witnessed their mothers being mistreated, and therefore became used to this type of behavior and more tolerant of it. This does not mean that these experiences should be regarded as the reason why women commit a crime or the main cause why they were admitted to the penal system. The cycle of violence that begins in the family is perpetuated in marriage and would appear to be completed in prisons, recommencing when women are released from prison. Being deprived of freedom as a result of imprisonment, together with the abuse that take place in jail appear to be a further link in the chain of multiple types of violence which constitute the path for some part of this population. Human Rights Watch is an organization that has undertaken specialized research in prisons since 1987 and in its 1988 report points out that Venezuelan prisons housed a total population of 25381 individuals, 4% of which were women. This same source reported that drug-related crimes led to a 55% increase in the jail population. In 1991, the percentage of female prisoners held in US state prisons for violent crimes was 32.2%, although that the majority had been imprisoned for non-violent crimes. Donzinger points out that the majority of women prisoners that had been sentenced for the murder of someone close to them had been victims of mistreatment or sexual abuse at some time in their lives, and thus violence against women should become an important issue for the authorities, as it is one of the most outstanding problems that reflects the current situation of the living conditions in prison centers. Given the importance that has violence against women in general, and the lack of statistical indicators on the issue of women in prison, the main objective of this paper was to describe the types of physical violence exercised by the partners of 213 women, interviewed at a Preventive Center and at Social Re-adaptation Center, in order to determine the scope of the problem and to propose intervention strategies. A non-probabilistic sample of 213 women, selected for reasons of convenience, was used. A specially designed instrument was used, consisting of a semi-structured interview with 242 questions, covering the following areas of the lives of the women interviewed: demographic data, school history, current family, family of origin, legal status, previous history of imprisonment, work experience, social networks depression, suicide risk, anguish, alcohol consumption variables, alcohol consumption measurement, variables for measuring the use of medical and non-medical drugs, scale of motives for consumption, treatment barriers, intimate relationships and sexuality, sexual abuse, violence/victimization, criminal violence, post-traumatic stress, prison environment, general health, and life styles and impulsiveness. The most important demographic characteristics of women found were: most were in the group aged from 28 to 40 year (45.5%), had six years or less of schooling (41.3%), secondary school (36.2%) and high school or technical college (16.4%) and were single (48.6%) or living with their partners (21.6%) while 50.7% had children under the age of 18. Of the 213 women interviewed, only 161 reported having suffered violence at the hands of their partners; 29.2% had experienced 1 to 5 acts, 23.4% had experienced 6 to 10, and 23.4% had been the object of 11 to 17 acts of violence. Statistics presented in this article in various research studies on family violence in most countries only show a small part of all the violence produced in families, and the results found in this research show that violence is higher among the group of female prisoners. One should not forget that prison reflects an exercise of the system that performs a marginalizing function, as it includes the poorest women from the most disadvantaged sectors, with low educational level. As Lima suggests, women are doubly stigmatized in prison, as they suffer first as women and second as criminals, not only because they belong to an underprivileged group in every social aspect, but because they belong to the group that has violated the classic image of women imposed by society, a fact for which they are severely punished, while the violence and abuse they have suffered is ignored.