Lesiones musculoesqueléticas en cuidadores adultos mayores / Musculoskeletal injuries in elderly caregivers

Introducción: los escasos estudios sobre la salud de los cuidadores no profesionales se han enfocado más en las repercusiones del cuidado en su salud mental que en el estudio de lesiones musculoesqueléticas (LME), no obstante que el cuidado puede provocar el desarrollo de LME por las características personales del cuidador o debidas al medio que los rodea. Objetivo: identificar los factores asociados a LME en cuidadores adultos mayores en un hospital de segundo nivel en México y conocer su prevalencia. Material y métodos: estudio analítico observacional; se aplicó un cuestionario a 283 cuidadores adultos mayores y sus dependientes. El instrumento incluyó 62 variables relacionadas con los factores ambientales, inherentes al cuidado, personales y el sitio de lesión musculoesquelética. El análisis estadístico fue de tipo descriptivo y analítico (modelo multivariado). Resultados: la prevalencia de LME en cuidadores adultos mayores fue de 34.6%. Se encontraron como principales factores asociados ser del sexo femenino, tener alguna comorbilidad, duración del cuidado superior a 13 horas diarias por más de 13 meses, un área física reducida al brindar cui- dados y el aislamiento social; tales factores incrementaron entre 1.9 y 12 el riesgo de sufrir alguna lesión. Las LME se produjeron principalmente en el nivel lumbar de la columna vertebral. Conclusiones: este es el primer reporte en México que identifica tanto la prevalencia de LME en cuidadores adultos mayores como los factores asociados a ellas.

Background: The scarce studies regarding the non-professional caregivers health have focused more on the repercussions of care on their mental health than on the study of musculoskeletal injuries (MSI), despite the fact that care can cause the development of MSI, due to the personal characteristics of the caregiver or the environment that surrounds them. Objective: To identify the factors associated with MSI in elderly caregivers in a second-level hospital in Mexico and to know its prevalence. Material and methods: Analytical observational study; a questionnaire was administered to 283 elderly caregivers and their dependents. The survey included 62 variables related to environmental factors, factors inherent to care, and personal factors, in addition to the site of MSI; statistical analysis was descriptive and analytical (multivariate model). Results: Prevalence of MSI in older adult caregivers was 34.6%. Main factors associated were being female, having some comorbidity, duration of care greater than 13 hours a day for more than 13 months, a physical area reduced to provide care and social isolation. These factors increased between 1.9 and 12 the risk of suffering an MSI. Musculoskeletal injuries occurred mainly at the lumbar level of the spine. Conclusions: This is the first report in Mexico that identifies the prevalence of MSI in older adult caregivers and the factors associated with them.

Mortalidad juvenil, marginación social e inequidad en salud en México / Youth mortality, social marginalization and health inequity in Mexico

Resumen Este estudio busca determinar las diferencias en la mortalidad juvenil en México según causas seleccionadas, por sexo y niveles de marginación municipal extremos en dos trienios (2004-2006 y 2015-2017) y establecer una relación entre las diferencias encontradas, el entorno social y la disponibilidad de recursos de salud. Utilizando datos oficiales, se calcularon los Años de esperanza de vida perdidos (AEVP) entre 0 y 85 años -y los AEVP por el grupo de edad de 15-29 años- para 15 de las principales causas de muerte en México en ambos trienios; los AEVP se calcularon por municipios agrupados en dos categorías: alta y muy alta marginación (AyMAM) y baja y muy baja (ByMBM). Las muertes violentas (especialmente los homicidios) son las principales causas de muerte en mujeres y hombres jóvenes en todo México, independientemente del nivel de marginación, y aumentaron entre los dos trienios estudiados; los hombres de 15 a 29 años en municipios con AyMAM tuvieron un exceso de AEVP en comparación con aquellos en municipios con ByMBM en trece de las 15 causas analizadas en 2004-2006 y en todas las causas en 2015-2017, mientras que para las mujeres la cifra fue de trece de 15 en cada trienio. Esto refleja las desventajas injustas a las que están expuestos los jóvenes en los municipios de AyMAM.

Abstract This study seeks to determine the differences in youth mortality in Mexico based on selected causes by sex and extreme levels of municipal marginalization in two triennia (2004-2006 and 2015-2017) and to establish a relationship between the differences found, the social environment and the availability of health resources. Using official data, years of life lost (YLL) between 0 and 85 years old and YLL for the 15-29-year-old age group were calculated for 15 of the main causes of death in Mexico in both triennia; the YLL was calculated for municipalities grouped into two categories: high and very high marginalization (HaVHMA) and low and very low marginalization (LaVLMA). Violent deaths (especially homicides) are the main causes of death in young women and men throughout Mexico, regardless of the level of marginalization, and increased from the first to second triennia studied. Men aged 15 to 29 years in HaVHMA municipalities had an excess YLL compared to those in LaVLMA municipalities in 13 of the 15 causes analyzed for 2004-2006 and in all causes for 2015-2017; for women, excess was observed for 13 of 15 causes in each triennium. These findings reflect the unfair disadvantages to which young people are exposed in HaVHMA municipalities.

Mortality from diabetes mellitus and its impact on life expectancy at 60 years of age in Mexico / Mortalidad por diabetes mellitus y su impacto en la esperanza de vida a los 60 años en México

ABSTRACT OBJECTIVES To analyze the behavior of mortality from diabetes mellitus (DM) for both sexes in Mexico from 1998 to 2018, and its impact on life expectancy (LE) from 60 to 85 years of age in the three-year periods 1998-2000 and 2016-2018, compared with other causes of death, as well as to determine the loss of years of life expectancy associated with DM in each three-year period. METHODS The current study is observational and descriptive. Age-adjusted rates of mortality from DM were calculated for each sex from 1998 to 2018. Sex-specific life tables were constructed for 1998-2000 and 2016-2018, and both LE between 60 and 85 years, and years of life expectancy lost (YLELL) due to DM and selected causes between both ages were calculated. RESULTS Between 1998 and 2018, the adjusted DM-resulting male mortality rate grew 55% in the population aged 60 and over, while the female mortality rate grew 20%. Between 1998-2000 and 2016-2018, male LE for 60-85 age group decreased 0.22 years, while female LE increased 0.24. In 2016-2018, DM was responsible for 1.30 YLEL among men of 60 to 85 years (19% of the total YLEL), and 1.24 YLEL for women (24% of the total), more than the other causes analyzed. CONCLUSIONS The increase in mortality from DM has substantially contributed both to reduce LE of older adult men, and to slow the increase of LE among women aged 60 years and older so far this century. Thus, preventive policies should be implemented since early ages to reduce the high levels of overweight and obesity in the country and, therefore, the significant population ratio suffering from DM.

RESUMEN OBJETIVOS Analizar el comportamiento de la mortalidad por diabetes mellitus (DM) para ambos sexos en México entre 1998 y 2018 y su impacto sobre la esperanza de vida (EV) entre los 60 y 85 años de edad en los trienios 1998-2000 y 2016-2018 - en comparación con otras causas de muerte -, así como determinar la pérdida de años de esperanza de vida asociados a la DM en cada trienio. MÉTODOS El presente estudio es observacional y descriptivo. Se calcularon tasas de mortalidad por DM ajustadas por edad para cada sexo entre 1998 y 2018. Se construyeron tablas de vida por sexo para 1998-2000 y 2016-2018 y se calculó tanto la EV entre 60 y 85 años, como los años de esperanza de vida perdidos (AEVP) por DM, y causas seleccionadas, entre ambas edades. RESULTADOS Entre 1998 y 2018 la tasa ajustada de mortalidad masculina por DM creció 55% en la población de 60 y más, y la femenina 20%. Entre 1998-2000 y 2016-2018, la EV masculina entre 60 y 85 años se redujo 0,22 años, en tanto la femenina aumentó 0,24. En 2016-2018 la DM fue responsable, para los hombres, de 1,30 AEVP entre 60 y 85 años, (19% del total de AEVP) y para las mujeres 1,24 AEVP (24% del total), más que el resto de causas analizadas. CONCLUSIONES El incremento de la mortalidad por DM ha contribuido de manera sustancial tanto a reducir la EV de los hombres adultos mayores, como a ralentizar el aumento de la EV de las mujeres de 60 años y más en lo que va de siglo. Así, resulta necesario implementar políticas preventivas desde edades tempranas que permitan reducir los altos niveles de sobrepeso y obesidad existentes en el país, y por ende, la notable proporción de población que padece DM.

Mujeres víctimas de homicidio en el Área Metropolitana de Guadalajara, México: magnitud, características y distribución espacial / Female homicide victims in the Metropolitan Area of Guadalajara, Mexico: magnitude, characteristics and spatial distribution

Resumen: Introducción: En un contexto generalizado de violencias contra las mujeres, desde hace 15 años se ha mantenido una tendencia exponencial de homicidios en dicho sector poblacional en México. Metodología: Este estudio se llevó a cabo para identificar la magnitud y características de mujeres víctimas de homicidio, agente causal, día, hora y lugar donde ocurrió la agresión, no la muerte; así como comparar, por vecindario y municipio, la distribución espacial de 141 homicidios en el Área Metropolitana de Guadalajara (AMG) durante los años 2013 y 2018. Resultados: Con base en estos años, se identificó que la tasa de mortalidad aumentó de 2.29 (2013) a 3.48 (2018) homicidios por 100 mil mujeres en el AMG; este fue mayor en los municipios Tlajomulco de Zúñiga (2013) y San Pedro Tlaquepaque (2018). Para ambos años se identificaron dos vecindarios, localizados al sur del AMG, donde ocurrieron, en promedio, más víctimas de homicidio, principalmente en fin de semana, entre las 16 y 02 horas, y con armas de fuego. Además, la vivienda representó el lugar donde se cometió la mayoría de las agresiones fatales contra mujeres, cuya edad osciló entre 30 y 44 años (35.2 % en 2013 y 43.1 % en 2018). Conclusiones: Más allá del aumento de la magnitud de homicidios de mujeres, las estrategias para erradicar violencias, que generalmente anteceden la agresión, continúan sin funcionar adecuadamente; ni si quiera para evitar que las víctimas sean asesinadas en el lugar que históricamente ha sido el de mayor riesgo, es decir, la vivienda.

Abstract Introduction: In a general context of violence against women, an exponential trend in homicides in this population sector in Mexico has been maintained for 15 years. Methods: This study was carried out to identify the magnitude and characteristics of female homicide victims, causal agent, day, time and place where the aggression occurred, not death; as well as compare, by neighborhood and municipality, the spatial distribution of 141 homicides in the Metropolitan Area of Guadalajara (MAG) during 2013 and 2018. Results: Based on these years, it was identified that the mortality rate increased from 2.29 (2013) to 3.48 (2018) homicides per 100 thousand women in the MAG; this was higher in Tlajomulco de Zúñiga (2013) and San Pedro Tlaquepaque (2018) municipalities. For both analyzed years, two neighborhoods were identified, located south of the MAG, where,on average, more homicide victims occurred, mainly on weekends, between 4 pm and 2 pm, and with firearms. In addition, the house represented the place where most of the fatal aggressions against women were committed, whose age ranged from 30 to 44 years (35.2 % in 2013 and 43.1 % in 2018). Conclusion: Beyond the increase in the magnitude of female homicide victims, the strategies to eradicate violence, which generally precede the aggression, continue to not function properly; not even to prevent victims from being killed in the place that historically has been the most at risk, that is, living place.

Embarazos adolescentes y representaciones sociales (León, Guanajuato, México, 2016-2017) / Adolescent pregnancies and social representations (León, Guanajuato, Mexico, 2016-2017) / Gravidez na adolescência e representações sociais (León, Guanajuato, México, 2016-2017)

Resumen (analítico): La intencionalidad del embarazo se ha tratado de explicar desde diversos marcos teóricos, pero no siempre se considera el contexto cultural; por ello persisten complicaciones conceptuales y metodológicas. A lo largo de este estudio se pretendió identificar las representaciones sociales que las adolescentes de León (Guanajuato, México) tienen del embarazo no deseado y no planeado, estudio basado en el enfoque teórico de las representaciones sociales, con el uso de técnicas asociativas derivadas de la antropología cognitiva, específicamente listados libres y comparación de pares. Participaron 72 mujeres de 15 a 19 años. Las representaciones sociales del embarazo no planeado se centraron en aspectos económicos y emocionales negativos; el embarazo no deseado se asoció con aspectos emocionales negativos (sentimientos de enojo y culpa por la situación), además de que se consideró el aborto como solución.

Abstract (analytical): A number of authors have tried to explain the intentionality of pregnancy from different theoretical frameworks, however the cultural context is not always considered, and as a result conceptual and methodological complications persist. This study aims to identify the social representations that adolescents in León, Guanajuato construct in relation to their unwanted and unplanned pregnancies. This study is based on the theoretical approach of social representations and uses associative techniques derived from cognitive anthropology, specifically free listings and peer comparison. 72 women aged 15 to 19 participated. The social representations of unplanned pregnancy focused on negative economic and emotional aspects. Social representations of unwanted pregnancies were associated with negative emotional aspects (feelings of anger and guilt towards the situation), and abortion was considered as a solution.

Resumo (analítico): A intencionalidade da gravidez tem sido tratada para explicar a partir de vários referenciais teóricos, no entanto, o contexto cultural nem sempre é considerado, por isso persistem complicações conceituais e metodológicas. Este estudo tem como objetivo identificar as representações sociais que adolescentes em León, Guanajuato, têm de gravidez indesejada e não planejada. Estudo baseado na abordagem teórica das representações sociais, com o uso de técnicas associativas derivadas da antropologia cognitiva, especificamente listagens livres e comparação de pares. Participaram 72 mulheres com idades entre 15 e 19 anos. As representações sociais da gravidez não planejada focaram aspectos econômicos e emocionais negativos; a gravidez indesejada foi associada a aspectos emocionais negativos (sentimentos de raiva e culpa pela situação) e o aborto foi considerado uma solução.

Homicidio juvenil en México y su impacto en la esperanza de vida masculina: variaciones geográficas y factores asociados / Youth homicide in Mexico and its impact in male life expectancy: geographical variations and associated factors

RESUMEN Se analiza el impacto del homicidio juvenil (entre 15 y 29 años) en la esperanza de vida masculina en México y sus 32 estados en los trienios 2004-2006 y 2014-2016, y se identifican los factores que mejor explican las variaciones en los años de esperanza de vida masculina perdidos (AEVMP) por homicidio juvenil a nivel estatal en 2014-2016. A partir de datos oficiales, se calcularon la esperanza de vida temporaria masculina (EVTM) entre 0 y 85 años y los años de esperanza de vida masculina perdidos, total y por homicidio juvenil. Mediante un análisis de regresión lineal, se identificaron factores asociados con las variaciones de los años de esperanza de vida masculina perdidos por homicidio juvenil entre estados. La esperanza de vida temporaria masculina decreció entre ambos trienios en el país y en 25 estados, mientras que los años de esperanza de vida masculina perdidos por homicidio juvenil se incrementaron en 31 estados, en ocho de ellos la cifra fue superior a 0,5 en 2014-2016. Factores como la presencia del narcotráfico, de armas de fuego ilegales y la percepción de inseguridad explican las variaciones de los años de esperanza de vida masculina perdidos por homicidio juvenil entre estados en 2014-2016.

ABSTRACT This study analyzes the impact of youth homicide (between 15 and 29 years of age) on male life expectancy in Mexico and its 32 states in the periods 2004-2006 and 2014-2016, and identifies the factors that best explain the variations in the years of male life expectancy lost (YMLEL) due to youth homicide at the state level in 2014-2016. Based on official data, male temporary life expectancy (MTLE) between 0 to 85 years of age and years of male life expectancy lost, in total and due to youth homicide, were calculated in each three-year period. Through a linear regression analysis, factors associated with the variations of the years of male life expectancy lost due to youth homicide among states were identified. The male temporary life expectancy decreased between the three-year periods in the country and in 25 states; years of male life expectancy lost due to youth homicide increased in 31 states, in eight of them with a figure higher than 0.5 years in the 2014-2016 period. Factors such as the presence of drug trafficking, illegal firearms and the perception of insecurity explain the variations in the years of male life expectancy lost due to youth homicide within the Mexican states in the 2014-2016 period.

El incremento de la mortalidad por armas de fuego y su relación con el estancamiento de la esperanza de vida en México / The increase of firearm mortality and its relationship with the stagnation of life expectancy in Mexico

Resumen Este estudio analiza la mortalidad por armas de fuego (AF) en México y su impacto en la esperanza de vida (EV) - comparado con otras causas de muerte- entre los trienios 2000-2002 y 2010-2012 e identifica el papel de los grupos de edad en la pérdida de años de EV por esta causa. A partir de datos oficiales se elaboraron tablas de vida abreviadas para México, por sexo, para ambos trienios; esto permitió calcular la EV temporaria entre 15 y 75 años y los años de esperanza de vida perdidos (AEVP) entre ambas edades, por causa. Entre los hombres, la mortalidad por AF pasó de ser la causa que menos AEVP provocó en 2000-2002 a ser la principal causa de AEVP entre 15 y 75 años en 2010-2012. Entre las mujeres, fueron los AEVP por esta causa los que relativamente más crecieron. En ambos sexos el mayor aumento de los AEVP por AF fue entre 20 y 34 años. Los hallazgos indican que el aumento de la mortalidad por AF, sobre todo entre los jóvenes, ha contribuido sustancialmente al estancamiento de la esperanza de vida, e incluso a su descenso entre los hombres. Esto refleja que la violencia ligada a las AF no es solo un problema de seguridad sino también un problema de salud colectiva que debe ser afrontado de forma interdisciplinaria e intersectorial si se pretende incrementar la esperanza de vida del país.

Abstract This study analyzes firearms mortality (FA) and their impact on life expectancy in Mexico -compared to other causes of deaths- during the three-year periods 2000-2002 and 2010-2012 and the weight of the different age groups in years of life expectancy lost (YLEL) due to this cause. Based on official death and population data, abridged life tables in Mexico were constructed for the three-year periods studied. Temporary life expectancy and YLEL for aged 15 to 75 by selected causes and age groups were calculated in each three-year period. Among men, FA mortality went from being the cause less YLEL caused in 2000-2002 to be the main cause of YLEL between 15 and 75 years in 2010-2012. Among women, YLEL for FA mortality had a higher relative growth. In both sexes, the greatest increase in YLEL by FA mortality was between 20 and 34 years. Findings indicate that the increase in FA mortality, especially among young people, has substantially contributed to the stagnation of life expectancy in recent years, and even his decline in the case of men. This reflects that violence linked to the FA is not only a security problem but also a collective health problem that must be copied in an interdisciplinary and intersectoral form if it is to increase the life expectancy of the country.

Mortalidad por violencias y su impacto en la esperanza de vida: una comparación entre México y Brasil / Violence deaths and its impact on life expectancy: a comparison between Mexico and Brazil

Resumen A partir de datos oficiales, se analizó la mortalidad por violencias (MV):homicidio, suicidio, eventos de intención no determinada e intervención legal, en Brasil y México y su impacto en la esperanza de vida (EV) entre los trienios 2002-04 y 2012-14, y se identificó los grupos etarios en los años de esperanza de vida perdidos (AEVP) por estas causas. Se construyeron tablas de vida abreviadas para los dos países, por sexo, para ambos trienios; esto permitió calcular la EV temporaria entre 0 y 80 años y los AEVP entre ambas edades, por causa. Entre los hombres, los homicidios fueron la principal causa de AEVP en ambos trienios en Brasil (1,5 años), y la segunda en México en 2012-14 (1 año). La MV provocó alrededor del 16% de los AEVP en Brasil y del 13% en México en 2012-14. Entre las mujeres, fueron los AEVP por homicidios y suicidios los que relativamente más crecieron en ambos países, aunque la MV causó apenas 3% del total de AEVP en 2012-14. En los dos países y en ambos sexos los AEVP por violencias fueron más altos entre 15 y 29 años. Así, en México el aumento de la MV, sobre todo en jóvenes, ha contribuido al estancamiento de la EV, en especial la masculina, mientras que en Brasil las altas tasas de MV en ambos trienios no han favorecido un mayor incremento de la EV.

Abstract Using official data, this study analyzed violent deaths (homicide, suicide, events of undetermined intent and deaths due to legal intervention) in Brazil and Mexico in the three-year periods 2002-2004 and 2012-14, the impact of these causes of death on life expectancy in both countries and the role of the different age groups in years of life expectancy lost (YLEL). Abridged life tables were constructed for both countries for both periods. Temporary life expectancy and YLEL between zero and 80 years by selected causes and age groups were calculated for each triennium. The leading cause of YLEL among men was homicide in both periods in Brazil (1.5 years) and in the second period in Mexico (one year). Violent deaths (VD) accounted for around 16% of YLEL in Brazil and 13% in Mexico in 2012-2014. Among women, YLEL due to homicides and suicides showed the greatest relative increase in both countries, although VD accounted for barely 3% of total YLEL. The highest percentage of YLEL due to VDwas found among the 15 to 29 year age groups in both countries and for both sexes. The increase in rates of VD in Mexico, above all among young people, has curbed further increases in life expectancy in recent years, especially among men. Likewise, the high rates of VD in Brazil in both periods have hindered the growth of life expectancy.

Competencia clínica de médicos de seguridad social guatemaltecos para manejar hepatitis virales en atención primaria / Clinical competences for human viral hepatitis treatment of primary healthcare physicians from the Guatemalan social security system

RESUMEN Objetivo Medir la competencia clínica para el diagnóstico y manejo de hepatitis virales en médicos de primer nivel de atención a la salud. Metodología Se efectuó un estudio transversal en el que usando un instrumento previamente validado se midió la competencia y posteriormente se comparó entre médicos adscritos a diversas unidades médicas de atención primaria a la salud (UMAPS) del Instituto Guatemalteco de Seguridad Social (IGSS). La información fue analizada mediante estadística descriptiva e inferencial no paramétrica. Se evaluaron 104 médicos de 5 UMAPS del IGSS. Resultados Se encontró un nivel muy bajo de competencia clínica para el diagnóstico y tratamiento de las hepatitis virales, dentro de un intervalo de 9 a 62 puntos obtenidos en el instrumento que tiene un valor máximo teórico de 88, sin encontrar diferencias estadísticamente significativas entre UMAPS. Conclusiones: Se requiere educación continua en los médicos de las UMAPS del IGSS para mejorar sus competencias en hepatitis virales.(AU)

ABSTRACT Objective To measure the clinical competence for diagnosis and treatment of human viral hepatitis in primary health care physicians. Methodology Cross-sectional study in which a previously validated instrument to measure competences was used, and subsequent comparison between physicians at various primary health care units (PHCT) from the Guatemalan Institute of Social Security (GISS). This information was analyzed using descriptive and non-parametrical statistics. 104 physicians, from 5 PHCT ascribed to GISS were analyzed. Results A low level of clinical competence for diagnosis and treatment of human viral hepatitis in this physicians group was found, within a range of 9 to 62 points obtained through an instrument with a maximum theoretical value of 88; no significant statistical difference between PHCT was found. Conclusions PHCT physicians from require continuing education to improve their clinical competence on human viral hepatitis.(AU)

Violencia y salud pública en la prensa escrita de Guadalajara, México / Violence and public health in the written press of Guadalajara, Mexico

Esta investigación busca describir cómo la prensa escrita de Guadalajara, México, representa la violencia y su vinculación con la salud pública. Para ello, se realizó un análisis de contenido mixto de las noticias de violencia publicadas en las secciones locales de los cuatro periódicos de mayor circulación de Guadalajara durante el periodo del 1 al 15 de septiembre de 2013. Se revisaron 1.465 notas locales, en las que se identificaron 399 noticias de violencia, de las cuales solo 103 mencionaban aspectos sanitarios en sus contenidos, en su mayoría referentes a los servicios médicos. En sus contenidos, la prensa no identificó la violencia como un problema de salud prioritario, sino como un asunto de inseguridad que afecta a la comunidad.

This study seeks to describe how violence and its link to public health is represented in the written press of Guadalajara, Mexico. To this end, we carried out a mixed-content analysis of news pieces on violence published in the local sections of the four newspapers with greatest circulation in Guadalajara from the period of September 1 to 15, 2013. A total of 1,465 local news stories were reviewed, of which 399 were identified as being about violence. Of these, only 103 included healthcare aspects in their contents, generally making reference to medical services. The contents of these press articles did not identify violence as a critical public health issue, but rather as a safety issue affecting the community.

Acoso escolar en la zona metropolitana de Guadalajara, México: prevalencia y factores asociados / Bullying in the metropolitan area of Guadalajara, Mexico: prevalence and associated factors

Este estudio tiene como objetivos determinar la prevalencia de víctimas de acoso escolar en alumnos de escuelas secundarias públicas de la zona metropolitana de Guadalajara, México, e identificar factores asociados al hecho de ser víctima en el período 2009-2011. Se realizó un estudio de tipo transversal analítico. Se diseñó una muestra probabilística polietápica de escuelas secundarias públicas y se estudiaron 1.706 alumnos entre 11 y 16 años. Se aplicó un instrumento con cuatro apartados que permitió identificar a las víctimas de acoso y se utilizó un modelo de regresión logística para medir la asociación entre los factores analizados y el ser víctima de acoso. La prevalencia de acoso escolar fue del 17,6% (IC95% 15,8; 19,5). Factores de carácter personal, como sentir que no es aceptado por el grupo o no pasar mucho tiempo con amigos, fueron los que tuvieron una asociación más fuerte y estadísticamente significativa con el hecho de ser víctima de acoso en la escuela.

This paper seeks to determine the prevalence of victims of school bullying among youth enrolled in public secondary schools in the metropolitan area of Guadalajara, Mexico and to identify the factors associated with being a victim of bullying in the period 2009-2011. An analytic cross-sectional study was carried out. A multistage probability sampling was designed for the public secondary schools, in which 1,706 students between 11 and 16 years old were studied. A questionnare with four sections was applied in order to identify victims of bullying. A logistic regression model was then used to measure the association between the factors analyzed and being a victim of bullying. The prevalence of school bullying was 17.6% (95% CI 15.8; 19.5). Personal factors, such as the feeling of not being accepted by peers or not spending much time with friends, were the factors with the strongest statistically significant association with being a victim of bullying.

Estudo multicêntrico da mortalidade por homicídios em países da América Latina / Multicentric study of deaths by homicide in Latin American countries

Realizou-se um estudo epidemiológico descritivo da mortalidade por homicídios em países da América Latina (Argentina, Brasil, Colômbia e México) de 1990 a 2007. Analisam-se óbitos por causas externas e homicídios, codificados nas 9ª. e 10ª. revisões da Classificação Internacional de Doenças/CID, considerando-se sexo, faixa etária e meio usado na agressão. Apresentam-se números, proporções e taxas ajustadas de mortalidade por homicídios. Usou-se o modelo de regressão linear na tendência das taxas de homicídios por grupos etários. No período, os países contabilizaram 4.086.216 mortes por causas externas e 1.432.971 homicídios. Na Argentina as causas externas cresceram 54,5%, mas diminuíram nos demais (37% no México; 31,8% na Colômbia e 8,1% no Brasil). As razões de mortalidade por homicídios para ambos os sexos foram de 9,1 na Colômbia, 4,4 no Brasil e 1,6 no México, tomando-se as taxas da Argentina como referência. A evolução das taxas de homicídios por faixa etária e sexo mostrou-se distinta nos países: em todos os grupos etários foi crescente no Brasil e decrescente na Colômbia. Destaca-se a necessidade de se priorizar os jovens do sexo masculino nas políticas públicas de atenção e prevenção e da região adotar políticas inclusivas, ampliar e consolidar sua democracia e os direitos dos seus habitantes.

This article is a descriptive epidemiological study of deaths by homicide in Latin American countries (Argentina, Brazil, Colombia and Mexico) from 1990 to 2007. Deaths due to external causes and homicides, as codified in the 9th and 10th revisions of the International Classification of Diseases/ICD, were analyzed considering sex, age and manner of assault. The numbers, ratios and adjusted rates for deaths by homicide are presented. A linear regression model was used to ascertain the trend of homicide rates by age group. During the period, 4,086,216 deaths from external causes and 1,432,971 homicides were registered in these countries. Deaths from external causes rose 54.5% in Argentina but fell in the other countries (37% in Mexico, 31.8% in Colombia, and 8.1% in Brazil). The ratio for deaths by homicide for both sexes was 9.1 in Colombia, 4.4 in Brazil and 1.6 in Mexico, using the Argentinian rates as a benchmark. There were differences in the evolution of homicide rates by age and sex in the countries: the rate rose in Brazil and fell in Colombia for all age groups. The need to prioritize young males in public policies related to health care and prevention is stressed, as well as the need for the region to adopt inclusive policies and broaden and consolidate democracy and the rights of inhabitants.

Mortalidad por homicidios en México: tendencias, variaciones socio-geográficas y factores asociados / Deaths by homicide in Mexico: trends, socio-geographical variations and associated factors

Este estudio analiza la tendencia de las tasas de homicidio (total y por arma de fuego) en México entre 1990 y 2009 e identifica las variables que mejor explican las variaciones geográficas de las tasas en el bienio 2008-2009. Se calcularon tasas de homicidios, ajustadas por edad, para ambos sexos entre 1990 y 2009, y para cada estado en 2008-2009. El análisis de regresión lineal múltiple fue usado para identificar factores asociados a las variaciones interestatales de las tasas de homicidio. Los resultados muestran que la tasa de homicidio disminuyó entre 1992 y 2007, pero se ha duplicado en los últimos dos años (de 7.6 a 16.6 por 100,000). En 2009, la tasa de homicidio masculina fue cerca de 9 veces mayor que la tasa femenina y casi dos tercios de los homicidios fueron por arma de fuego. El análisis multivariado revela que la impunidad, el narcotráfico, el consumo de alcohol y drogas y la deserción escolar -por ese orden- son factores claves para entender las variaciones geográficas de las tasas de homicidio en México en 2008-2009. Así, para reducir los homicidios y las variaciones espaciales de la tasa, se necesita no solo combatir a los cárteles de la droga sino sobre todo implementar reformas estructurales en el sistema de procuración de justicia y disminuir las disparidades socioeconómicas entre los estados.

This study seeks to analyze the trend of homicide rates (total and by firearm) in Mexico between 1990 and 2009 and identify the variables that best explain the geographical variations of these rates in the 2008-2009 two-year period. Homicide rates, adjusted for age, were calculated for both sexes between 1990 and 2009 and for each state in 2008-2009. Factors associated with the interstate variations in the homicide rates were identified using multiple linear regression analysis. Results show that the homicide rate in Mexico decreased between 1990 and 2007, but doubled over the last two years (from 7.6 to 16.6 per 100,000). In 2009, the male homicide rate was almost 9 times higher than the female rate and about two-thirds of homicides involved firearms. Multivariate analysis reveals that impunity, drug trafficking, alcohol and drug consumption and school dropout in basic education - in that order - are key factors for understanding the geographical variations in homicide rates in Mexico in 2008-2009. Findings suggest that to reduce the number of homicide victims and spatial variations in the rate, it is necessary not only to fight the drug cartels, but above all to implement structural reforms in the criminal justice system and reduce the socioeconomic disparities among states.

Impacto de la violencia homicida en la esperanza de vida masculina de México / Impact of homicide on male life expectancy in Mexico

Objetivo. Determinar el impacto de la violencia homicida en la esperanza de vida masculina (EVM) de México y sus 32 estados durante los trienios 1998–2000 y 2008–2010, así como el grado de participación de los diferentes grupos etarios en la pérdida de años de EVM por esta causa. Métodos. A partir de datos oficiales sobre defunciones y población, se construyeron tablas abreviadas de mortalidad masculina para México y sus estados en los trienios estudiados. Se calcularon la esperanza de vida temporaria masculina y los años de esperanza de vida perdidos (AEVP) en el grupo etario de 15 a 75 años, por causas seleccionadas (homicidios, diabetes mellitus y accidentes de transporte) y por grupos de edad en cada trienio. Resultados. Entre 1998–2000 y 2008–2010 se incrementaron los AEVP por homicidio a nivel nacional y en 19 estados; en cuatro de ellos, la cifra de AEVP en 2008–2010 superó los dos años, destacándose el caso de Chihuahua, con 5,2 años. De 18 estados donde la esperanza de vida temporaria masculina disminuyó entre los dos trienios, en 14 aumentaron los AEVP por homicidio. En 2008–2010 los homicidios fueron responsables del mayor porcentaje de AEVP masculinos en el grupo etario de 20 a 44 años. Los AEVP por homicidio en el grupo de 15 a 44 años de edad se incrementaron entre ambos trienios. Conclusiones. El aumento de la violencia homicida, especialmente entre los jóvenes, es un freno para el incremento de la esperanza de vida masculina en México. En varios estados, como Chihuahua y Durango, esta violencia parece ser la principal responsable del descenso de la esperanza de vida masculina entre los 15 y 75 años de edad.

Objective. To determine the impact of homicide on male life expectancy in Mexico and its 32 states during the three-year periods 1998–2000 and 2008–2010 and the weight of the different age groups in years of life expectancy lost (YLEL) due to this cause. Methods. Based on official death and population data, abridged tables for male mortality in Mexico as a whole and its states were created for the three-year periods studied. Health-adjusted life expectancy and YLEL for men aged 15 to 75 were calculated by selected causes (homicide, diabetes mellitus, and traffic accidents) and age groups in each three-year period. Results. In the years between the 1998–2000 and 2008–2010 periods, YLEL due to homicide increased both nationally and in 19 states. In four states, the YLEL in 2008–2010 exceeded two, with the state of Chihuahua standing out at 5.2 years. In 14 of the 18 states where health-adjusted life expectancy among men declined between the two three-year periods, the YLEL due to homicide increased. From 2008 to 2010, homicides were the leading cause of YLEL among men aged 20–44. YLEL due to homicide among those aged 15–44 increased between the two three-year periods. Conclusions. The increase in the rate of homicidal violence, especially among young people, is impeding an increase in male life expectancy in Mexico. In several states, such as Chihuahua and Durango, this violence appears to be the main reason for the decline in life expectancy among men aged 15 to 75.

Contexto demográfico, desigualdad social e inequidad en salud de la niñez en México / Demographic characteristics, social inequality and inequity in Mexican childhood health

Objetivos Caracterizar demográficamente el presente y futuro de la población infantil en México; relacionar condiciones demográficas y equidad social en la niñez y delinear los desafíos que éstas representan para la población infantil mexicana en los próximos años. Métodos A partir de las proyecciones de población existentes se analizó el escenario presente y futuro de la población infantil en México. Se calcularon tasas de mortalidad por causas evitables en la infancia, por estados, por estados agrupados en cuartiles según nivel de marginación y por municipios agrupados según grado de marginación. Para medir la inequidad, se utilizó el coeficiente de Gini Resultados Aunque disminuirá a futuro, el número absoluto de niños en México seguirá siendo elevado hacia 2025; el mayor número de niños reside en los estados con mayor marginación social. Existe un claro exceso de mortalidad evitable en dichos estados en relación con los de menor marginación. El Coeficiente de Gini alcanza su valor más alto en la tasa de mortalidad por infecciones respiratorias agudas (0,34). El exceso de mortalidad evitable es evidente en los municipios de alta y muy alta marginación. Conclusiones Coexisten en México demandas relacionadas con el envejecimiento demográfico, pero también con el notable peso que mantendrá en los próximos años la población infantil; es notoria la inequidad en salud en la niñez, asociada a los altos niveles de marginación social; para modificar esta situación se necesitan profundos cambios estructurales que permitan reducir las desventajas injustas a las que están expuestos importantes núcleos poblacionales del país.

Objectives Demographically describing the present and future for Mexican children to correlate aspects regarding demographic and social equity during childhood and describing the challenges these variables represent for Mexican children during the next few years. Methods The present and future scenario for Mexican childhood was evaluated using existing population projections. Mortality rates were estimated from avoidable causes during childhood per Mexican state, per state grouped by quartile depending on their marginalisation level and by municipality grouped according to their degree of marginalisation. The Gini coefficient was used for measuring inequality. Results Even though the absolute numbers of children in Mexico will tend to decrease in the future, the number will remain high until 2025. A greatest numbers of children were living in states having the highest degree of social marginalisation. Avoidable mortality was higher in these states compared to states having lower marginalisation. The Gini coefficient was highest concerning mortality rate caused by acute respiratory infection (0.34). Excess of avoidable mortality was evident in municipalities having high and extremely high marginalisation. Conclusions Conditions related to demographic ageing and childhood diseases coexist in Mexico. Inequity in children's health is evident; it is related to high levels of social marginalisation. In-depth structural changes are needed to change this situation which will lead to reducing some Mexican populations' unjust social disadvantages.

Efecto de una intervención psicoeducativa para disminuir el Síndrome Burnout en personal de confianza de la Comisión Federal de Electricidad / Effect of a psycho-educative intervention to decrease Burnout Syndrome on confidence employees working for the CFE (Federal Electric Comission)

Modern life imposes several different labor demands on human beings; thus, bringing about stressing situations. All those events perceived as threatening bringing about tension are called stressors. A stressing situation comes about when there exists a discrepancy between environment demands and adequate resources to cope with them. All these factors lead to physiological, cognitive and motor responses which enhance perception and create the need of better solutions to allow appropriate adaptation behaviors. When stress is present at the workplace in a recurrent fashion, it is known as Labor Stress (LS), an alarming circumstance affecting individuals and organizations. Main causes of LS are: physical conditions, schedule, work position, interpersonal relations and other organizational variables. Labor Stress is a public health and a labor health problem, for it is related to an increase in labor accident, morbidity and absenteeism rates; thus, generating negative attitudes that yield economic loss to institutions. The Burnout Syndrome (BS) is a response to chronically labor stress manifested through emotional exhaustion, depersonalization, as well as hostile and aggressive attitudes toward workmates and service users, resulting in a feeling of poor personal development. Objective Assess the effect of a psycho-educative intervention to decrease BS in managing or directive employees from one sector of CFE Guadalajara, Jalisco, Mexico. Materials and methodology A quasi-experimental study was carried out; this included measurements prior and after educative intervention carried out on confidence employees from CFE Guadalajara from February through September 2005. The study sample was made up of 29 managing or directive employees, conforming four groups; one random-selected group received educative intervention; the other three were control groups; different questionnaires were applied: personal data, psycho-social factors and BS through the Maslach Burnout Inventory Scale (MBI). From a participative-educational view point, encouraged by the Pan-American Health Organization (PHO), the educative intervention sought health promotion through the betterment and consistency of mental and physical wellbeing. All BS concepts as well as psychological factors were analyzed. Other workshop included the development of preventing, coping and treatment strategies at individual and social levels. Finally, a corrective program directed to decreasing psychological risk factors in the organization was encouraged. Also, a post-intervention assessment was applied. Results Subjects had an average age of 31.5 ± 6.8 years; 52% were females; group 1 decreased for all indicators; emotional exhaustion from 71% to 29%; depersonalization from 43% to 14%; lack of personal development from 57% to 14%. However, no significant difference was found in both groups by sex. Discussion In personnel with specific responsibilities, obligations, opportunities, challenges and rewards based on their performance work environment often drives them to frustration and despair. When the employee believes that gives more than he receives, he becomes emotionally exhausted and more even if he do not have the resources to cope with the prospect of work. Also, it is documented that at younger age there is an increased risk of presenting the Burnout. This is because interpersonal relationships are more contentious because of the lack of experience in management. In the series reported, on both groups we were not able to document this relationship, but still, there is a lack of an international consensus to recognize this as a risk factor. Mingote describes that when the employee has less than five years working, they are often idealistic, utopian dreamers, unlike those with more than ten years in the job and are in risk of experiencing monotony at work, loss of interest and the downgrade. Also, this type of workers is subject to overtime. This excess produces physical and mental stress and leads to lower feelings of personal accomplishment. Even though there could be resources for coping with the monotony at work and that provides resources for better interpersonal communication and support networks at work. If the worker feels happy with the work carried out, and feels as an autonomous decision maker able to practice his skills, then he will have the protective factors to cope with the Syndrome of Burnout at work and it is unlikely that he will found in his work a monotonous and a routine activity with little opportunity to practice their skills. The emotional exhaustion related to fatigue and tiredness are caused by excessive wear at work and very demanding work environments with little autonomy and control of work situations. Depletion causes difficulties with daily responsibilities, these factors are related to the work system and the social interactions in the workplace, which after the educative intervention modifies the emotional exhaustion level in the experimental group (29% of group). The depersonalization causes people to be treated as objects (coldness and insensitivity) causing the worker indifference and little empathy with the task of work. Although the level of depersonalization was low in the groups, it decreased in the experimental group, which may be caused by the coping mechanisms embedded in the educational intervention. The lack of personal accomplishment includes the limitations to understand the feelings and emotions of fellow workers and also have a positive influence for them to create pleasant environments (these completion rates increased in the intervention group). In developing countries, there is now general agreement on the importance of the behaviors and lifestyles in the generation of health problems as well as the importance of early healthy lifestyles. All countries have agreed to launch health and educational programs to prevent the modification of human behavior. This study provides a useful educational methodology that responds to how to bring workers to participate in their care, as well as a significant contribution to addressing a problem of this magnitude and importance to public health and health services in Latin America. Conclusion The psycho-educative program sensitized employees when developing strategies to decrease and control labor stressors that affects them, the same stressors that bring about BS.

La vida actual impone diversas demandas a los seres humanos provocando en ellos situaciones de estrés. Estos sucesos son percibidos como amenazantes, llegan a ocasionar tensión y se denominan estresores. La situación de estrés se presenta al existir una discrepancia entre las demandas del medio y los recursos para enfrentarlo; esto ocasiona en el organismo respuestas fisiológicas, cognitivas y motoras que agudizan la percepción y, de esta manera, originan una mayor búsqueda de soluciones; entre ellas las conductas de adaptación. Cuando el estrés está presente en el área de trabajo de forma recurrente se le conoce como Estrés Laboral (EL), circunstancia alarmante que afecta al individuo y a la organización. Las principales fuentes de EL son: condiciones físicas, horario y puesto de trabajo, además de las relaciones interpersonales y otras variables organizacionales. Ese síndrome representa un problema de salud pública y de salud laboral, ya que se relaciona con un aumento en la tasa de accidentes laborales. Además genera ausentismo laboral que se traduce en pérdidas económicas para las instituciones. El Síndrome de Burnout (SB), es una respuesta al estrés laboral crónico que se manifiesta a través del agotamiento emocional, despersonalización, actitudes hostiles y agresivas con sus compañeros y usuarios del servicio, que finaliza en un sentimiento de pobre realización personal. El objetivo de este estudio fue evaluar el efecto de una intervención psicoeducativa para disminuir el Burnout en el personal directivo de un Sector de la Comisión Federal de Electricidad en Guadalajara, Jalisco. Se realizó un estudio cuasi experimental con una medición pre y post a la intervención educativa. Ésta se efectuó en el personal de confianza de la Comisión Federal de Electricidad de Guadalajara, Jalisco; durante los meses de febrero a septiembre del 2005. La muestra de trabajadores se integró por 29 sujetos que ejercen un puesto directivo, conformando cuatro grupos; un grupo elegido al azar recibió la intervención educativa y los otros fueron de control. A los grupos se les aplicaron diferentes cuestionarios: 1. Datos personales, 2. Factores psicosociales, 3. Escala de Maslach Burnout Inventory para medir el síndrome de Burnout (MBI). Desde la perspectiva de la educación participativa que impulsa la Organización Panamericana de la Salud (OPS), la intervención educativa buscó la promoción de la salud por medio de diversos talleres con el fin de mejorar y mantener su bienestar físico y mental. En uno de los talleres se analizaron los conceptos del Síndrome de Burnout y sus factores psicosociales. Posteriormente se analizaron los factores que modulan y desencadenan el síndrome. Otro taller consintió en desarrollar estrategias de prevención, afrontamiento y manejo del Burnout a nivel individual y social. Fina l mente se impulsó un programa correctivo orientado a disminuir los factores de riesgo psicosocial de la organización y se aplicó la evaluación postintervención. Se muestra una edad promedio de 31.5±6.8 años, el 52% fueron del sexo femenino. El grupo uno disminuyó en todos los indicadores: agotamiento emocional de 71 % a 29%, la despersonalización de 43% a 14%, la falta de realización personal de 57% a 14%. Sin embargo, no se encontraron diferencias significativas en ambos sexos. El programa psicoeducativo sensibilizó al personal para fomentar el desarrollo de estrategias para disminuir y controlar los estresores laborales que les afectan, mismos que originan el Síndrome de Burnout.

Exclusión social e inequidad en salud en México: un análisis socio-espacial / A socio-spatial analysis of social exclusion and inequity in health in Mexico

Objetivo Determinar la relación existente entre exclusión social e inequidad en salud a nivel estatal y municipal en México en años recientes. Métodos Se calcularon tasas estandarizadas de mortalidad relacionadas con enfermedades trasmisibles en la infancia, el embarazo y el parto así como producto de causas que podrían considerarse potencialmente evitables; estas tasas se calcularon por estados, por estados agrupados en cuartiles según nivel de marginación y por municipios agrupados según grado de marginación. Para medir la inequidad, se utilizaron indicadores como la razón de tasa, el coeficiente de Gini y el índice de inequidades en salud (INIQUIS) Resultados Se observa un claro exceso de mortalidad en los Estados agrupados en el Cuartil IV (mayor marginación) en relación con el Cuartil I (menor marginación) y a la inversa, los recursos y servicios disponibles en el Cuartil I son mayores que los existentes en el Cuartil IV. El Coeficiente de Gini alcanza su valor más alto en la tasa de mortalidad por anemias nutricionales (0,44). El exceso de mortalidad es evidente en los municipios considerados como de muy alta marginación; el INIQUIS más elevado se observa en los Estados ubicados en el Cuartil IV, sobre todo Chiapas, Oaxaca y Guerrero. Conclusiones Existe en México una notoria inequidad en salud, asociada a los altos niveles de exclusión social; para modificar esta situación se necesitan profundos cambios estructurales que impulsen el desarrollo social, y permitan reducir las desventajas injustas a las que están expuestos importantes núcleos poblacionales del país.

Objective Determining the relationship between social exclusion and health inequity at state and municipal level in Mexico during recent years. Methods Adjusted mortality rates were calculated for 2005 (related to transmissible illnesses in childhood, pregnancy, childbirth and being produced by causes considered potentially avoidable); rates were calculated by states, for states grouped in quartiles according to marginalisation level and for municipalities grouped according to degree of marginalisation. Indicators such as rate ratio, Gini coefficient and the inequities in health index (IHI) were used for measuring such inequity, Results A clear excess of mortality was observed in the states grouped in the 4th quartile (highest marginalisation) in relationship to the 1st quartile (lowest marginalisation); conversely, resources and health services in the 1st quartile were evidently higher than those in the 4th quartile. The Gini coefficient reached its highest value in the mortality rate for nutritional anaemia (0.44). Excess mortality was evident in those municipalities considered as having very high marginalisation; the highest IHI was observed in the states located in the 4th quartile (Chiapas, Oaxaca and Guerrero) when analysing mortality related to childhood, pregnancy, childbirth and potentially avoidable mortality. Conclusions Notorious health inequality exists in Mexico, associated with high prevalent levels of social exclusion in different areas of the country. Deep structural changes are needed to modify this situation, promote social development and lead to reducing the unfair disadvantages to which important population groups are exposed.

Stress-associated factors in Mexican dentists

Dentistry is considered a stressful profession, since dentists are exposed to potential stressors during their practice. Therefore, the objective of this study was to identify chronic stress levels and their association with different risk factors among dentists working at public health institutions in Guadalajara, Mexico. The study was observational, cross-sectional and one of association. The universe of this study was composed of 256 dentists that were obtained by means of a census technique. The instrument used for the analysis carried out in the year 2006 was the Stress Syndrome Inventory, performed with concurrent validation. Information was processed for the analysis, and chronic stress levels were identified with a bivariate analysis. Association strength was measured with OR, and confusion factors were controlled with a multivariate logistic analysis. Based on the obtained results, it was concluded that female dentists have a greater risk of developing a high chronic stress level with an adjusted OR of 1.84, meaning that the risk for women is 1.84 times greater than that of men.

Aptitud clínica de los médicos familiares en la identificación de la disfunción familiar en unidades de medicina familiar de Guadalajara, México

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Abstract: Introduction Families function as dynamic systems, where the different members stimulate each other to achieve common objectives. Family development is thus conceived as a chain of changes, in form and function, which follow evolution stages. The balance of positive and negative forces inside the family is translated into an evolution, and so the ability to respond to internal or external changes is vital to avoid discrepancies or clashes between the tasks and roles of the different family members. In this sense, family physicians must be able to identify any potential dysfunction or difficulty inside the family, and to facilitate the compatibility of tasks in order to reestablish the continuity and good functioning of the family. The family physicians' clinical aptitude is made up of a series of abilities intended to identify any signs and symptoms of dys-function. They must also be skilled in using auxiliary resources for the diagnosis and treatment of all these. Such an aptitude is measured by a structured and validated instrument. Material and methods This is an observational, prospective and comparative research of a 450 family physicians sample from 23 first level family health care medical clinics from the National Social Security Institute (Instituto Mexicano del Seguro Social: IMSS). All family physicians working at the clinics were included, excepting those who were at the time on vacation, worked the night shift, attended the ER, were absent or refused to participate. Clinical aptitude for family dysfunction was measured in three areas: 1. Identification of risk factors for family dysfunction; 2. Diagnosis with an integral point of view and 3. Proposal, identification and guidance, which describes a physician's ability to judge decisions taken on case reports and to propose alternative actions. Other variables taken into account were sex, age, specialty, years of experience, shift, clinic and type of contract. Instruments. The instrument was designed to integrate theory and practice. It was conformed by real case reports, which were condensed, divided in sections, and followed by a series of ques-tions with three possible answers: «true¼, «false¼ or «I don't know¼. In total, there were 187 questions, 94 of which were true and 93, false. Correct answers accounted for one point, while incorrect ones rested one point; «I don't know¼ answers had no effect on the results. There were 42 lines to explore risk factors; 24 to explore the use of diagnostic resources; 19 to explore the use of therapeutic resources; 36 to evaluate a physician's knowledge of family sociology; 42 to assess family psychology, and 24 designed to evaluate proposal abilities. It was all validated and standardized with a group of post-graduate medical residents in Family Medicine from Mexico City. The Richardson K index was 0.90. Clinical aptitude was measured using an ordinal scale, where a random level «1¼ was defined by <60 points; a low «2¼ level by 60-99 points; an intermediate «3¼ level by 100-139 points, and a high «4¼ level by >140 points. A descriptive and inferential statistical analysis was used with median, percentage, Mann-Whitney's and Kruskal-Wallis' tests. All this was then processed with the EPI INFO-6 and SPSS Plus software packages. Ethical considerations. This is a risk-free research, as established in the Health Research section of the Mexican Health Law. Ne-vertheless, a signed acceptance form was required from all participants. Results Table 1 shows the general characteristics of the study sample. In turn, table 2 presents clinical aptitude to identify family dysfunction, sorted by clinic. Clinics B and D had, respectively, a median of 105 and 102, with similar ranges. There were no statistically significant differences among the subindexes of each clinic. The diagnosis median was higher than that for guidance. Table 3 reveals a high level of clinical aptitude in 3% of the physicians, an intermediate level in 25%, a low level in 58%, and a random-defined level in 14%. There were no significant differences when clinical aptitude was correlated with sex, shift, type of contract, specialty and years of experience. Discussion. The main objective of a family dysfunction diagnosis is to reestablish the normal flow of a family's vital cycle with the support of a specialized physician. It has been reported that clinical aptitude measurement is useful to discriminate and establish the aptitude level of experiment and non-experiment physi-cians with the aim of creating educational opportunities. A slight advantage, with no significant difference, was appreciated in physicians who attended patients in their offices, which suggests they are in a better position to gain a higher level of trust from their patients. This is due to the fact that they attend a regular set group of patients assigned to their offices. Since the education of family physicians is aimed at offering an integral care to families, family dysfunction recognition is essential. Results also suggest a non-significant advantage from family physicians with curricular education (not all family physicians working at the IMSS have a degree in Family Medicine). Experienced physicians (10 to 19 years on the job) showed another non-significant advantage, which pointed to the value of clinical practice. This is a powerful reason to promote continuous educational programs for family physicians. Family physicians who worked the morning shift showed a non-statistical advantage over their afternoon shift counterparts. This could be explained by the fact that educational and other institutional activities are more likely to take place in the morning. The educational model of family physicians should promote the physicians' involvement in understanding how to become active elements in gathering their own knowledge. Such a model should promote physicians' initiatives for the development of an experience based on constructive critic. The current health care model is mainly focused on a biological interpretation of the health-disease process. However, this is only a partial approach which prevents the implementation of an integral clinical practice. From our research, we expect changes in institutional health care orientation and a reframing of the curricula of general and family physicians'. Although the acquisition of clinical aptitude requires the physicians' experience and involvement in developing their own knowledge, our results do not reflect this ideal condition. This is due to the low percentage of clinical aptitude, which correlates with an evident inability for research and interpretation. Half of the physicians were capable of elaborating diagnostic hypothesis and two thirds of them showed a adequate use of diagnostic resources, such as clinical tests, functional family diagnostic instruments and a guide to conform an integral family workup. All these should be useful educational tools to establish the social functions diagnosis of a family's members, together with their formal and informal roles and their importance in the healthdisease process. Guidance requires the ability to judge decisions taken by other professionals and make suggestions for alternative actions in case reports. This latter skill includes the use of therapeutic resources for only less than half of the physicians know how to properly use these resources. The use of instruments to measure aptitude, competency and work performance is a growing practice in continuous education and human resources formation. Even though these instruments are capable of discriminating high clinical aptitude, they cannot be used to account for this non-significant advantage, because educational activities are conceived as the consumption of infor mation and not as the acquisition of it from each one's experience. Overall, 58% of the family physicians showed a low level of clinical aptitude. Such a result reflects a poor ability to integrate daily experience.

Smoking, exposure to secondhand smoke, and smoking restrictions in Tijuana, Mexico

OBJETIVO: Calcular la prevalencia del consumo de tabaco, de la exposición a humo ajeno o ambiental y de la existencia de medidas restrictivas contra el tabaquismo en el hogar y en el lugar de trabajo entre residentes de Tijuana, una de las ciudades más grandes de México. MÉTODOS: Esta encuesta domiciliaria transversal se llevó a cabo en Tijuana, Baja California, México, durante 2003 y 2004. Una muestra poblacional de 400 adultos residentes de Tijuana respondió a una encuesta sobre el tabaquismo y 397 de las encuestas se sometieron a análisis. RESULTADOS: Cerca de 22,9% (intervalo de confianza de 95% [IC95%]: 18,7% a 27,1%) de los adultos residentes de Tijuana declararon que fumaban en el momento de la encuesta y 53,9% (IC95%: 48,8% a 58,9%) declararon estar expuestos crónicamente a humo ajeno o ambiental. Alrededor de 44,4% (IC95%: 37,9% a 50,9%) de los adultos en Tijuana dijeron que había reglamentos contra el tabaquismo en su lugar de trabajo, mientras que en 65,8% (IC95%: 61,0% a 70,6%) de los hogares de Tijuana no se fumaba dentro del hogar. CONCLUSIONES: Los resultados subrayan la necesidad de incrementar las medidas para el control del tabaquismo, especialmente las orientadas a hacer cumplir los reglamentos existentes contra la contaminación ambiental por humo de tabaco, todo a fin de extender la protección contra dicha contaminación más allá de los entornos privados a los públicos y frenar la epidemia de tabaquismo en Tijuana y en otras partes de México.