Conducta del enfermo ante el dolor crónico / Illness behavior in chronic pain

OBJETIVO: Describir la "conducta de enfermedad" en pacientes con dolor crónico. MATERIAL Y MÉTODOS: Durante el año 2000 se realizaron entrevistas semiestructuradas a 53 pacientes en una institución del tercer nivel de atención. Allí se exploró su interpretación y respuesta inicial al dolor crónico y prácticas subsecuentes hasta sentirse satisfechos con el diagnóstico recibido. RESULTADOS: La conducta de enfermedad estuvo determinada por la intensidad, discapacidad y creencias de las causas del dolor, recomendaciones de las redes de apoyo, la calidad y satisfacción con los sistemas de atención. En términos de la toma de decisión, la primera opción fue acudir al sector popular, y consultar al médico general, para finalmente acudir a un tercer nivel de atención ("con el especialista"). CONCLUSIONES: La conducta de enfermedad es un proceso en el que se utilizan los diferentes sectores de la atención por parte de los mismos sujetos y que es determinado por el resultado de la atención brindada.

OBJECTIVE: To describe the illness behaviour in patients with chronic pain. MATERIAL AND METHODS: We conducted semi-structured interviews to 53 patients during 2000, in a tertiary care center. We explored their initial interpretations, responses and subsequent practices to chronic pain, until they received a diagnosis that satisfied them. RESULTS: Illness behaviour was determined by pain intensity and disability; beliefs regarding pain causes, trust in social networks, and quality and satisfaction with the health care systems. In terms of the decision to seek care, the first option was to go to the popular sector, followed by consulting a general physician, and as last resort, to go to a tertiary care center ("with a specialist"). CONCLUSIONS: Illness behaviour should be conceptualized as a process, which combines the use of different health care sectors by the same subjects, as a result of care provided sequentially by each previous sector.

An intercultural comparison of home case management of acute diarrhea in Mexico: implications for program planners

Background. The objetive was to assess the extent to which similarities in cultural beliefs and practices related to home management of diarrhea would permit general recommendations to improve the content of health care messages. Methods. We studied six communities in Mexico, covering rural and urban conditions, different ethnic groups, and different socioeconomic levels. Systematic data collection relied on open-ended, face-to-face interviews with mothers of children under 5 years of age who had an episode of diarrhea. Similarities among communities were assessed by means of a quadratic assignment procedure applied to signs, symptoms, and treatment matrices. Significant similarity among most of the communities sustained use of a global composite matrix to represent all communities. Results. We suggest specific recommendations to promote sound home management of diarrhea based on significant correlations among signs and symptoms with treatments. Signs and symptoms include those promoted by the National Program for the Control of Diarrheal Diseases(diarrhea, fever, vomiting) and others commonly mentioned by mothers (stomachache, sadness, restlessness, refusal to eat). Similarly, recommendations to use home based treatments based on beliefs related to their use may include the feeding of rice water, soups, and broth to a child who is sad, or rice-gruel and teas for a child with a fever. Conclusion. Our study supports that there are enough similarities among mothers' beliefs and practices for the care of acute diarrhea in childhood to support general recommendations at the program level

Etnografía de la infección respiratoria aguda en zona rural del altiplano mexicano / Ethnography of acute respiratory illnesses in a rural zone of the Mexican central highlands

Objetivo. Identificar los términos utilizados por las madres para referirse a enfermedades, signos y síntomas relacionados con infecciones respiratorias aguda, así como los signos de alarma que las motivan a buscar atención médica; asimismo, describir prácticas comunes de manejo de la enfermedad en el hogar. Material y métodos. Se trata de un estudio etnográfico en seis comunidades rurales del altiplano mexicano. Se entrevistó a 12 informantes clave, a seis madres de niños fallecidos por infección respiratoria aguda, y a 24 madres de niños menores de cinco años, con diversas técnicas etnográficas para complementar la información obtenida ("triangulación"). Resultados. Las enfermedades comúnmente identificadas incluyeron gripa, anginas, tos, bronquitis, pulmonía, neumonía y "broncomonía". Los síntomas clave para el diagnóstico fueron escurrimiento de moco nasal, dolor de garganta, tos, dolor de cabeza o de cuerpo, calentura, "hervor" de pecho, y referencias a que el niño "está molesto o llorón", y se pone morado o le hace falta el aire. La taquipnea fue referida como "respira fuerte", "respira mucho", "respira rápido" y "tiene sesido", el tiraje, "se le hunde el pecho", el estridor, como "quejido o ronquido de pecho"; la sibilancia, como "ronquido de pecho", y para la cianosis, "se pone morado". Entre los tratamientos ofrecidos en el hogar destacan el uso de tés, aplicación de sebo o pomada en pecho y espalda. No fue común la autoprescripción de antibióticos pero sí la de antipiréticos. La mayoría de las madres reconoció enfermedades leves y, en menor proporción, graves. Ante un caso grave de insuficiencia respiratoria aguda, la opción más frecuentemente elegida fue acudir a la clínica del proyecto; en segundo lugar al médico particular en la cabecera municipal, y al hospital de la Secretaría de Salud en la Jurisdicción. La cercanía y el menor costo fueron razones frecuentemente aducidas para estas elecciones. Conclusiones. Esta información puede resultar útil para mejorar la comunicación con las madres

Methodological issues for eliciting local signs/symptoms/illness terms associated with acute respiratory illnesses

Acute respiratory infections (ARI) are among the principal causes of mortality of children under 5 years of age. Most deaths are due to pneumonia. which, when timely identified and properly treated, could be avoided. An effective case management scheme, based on early recognition of pneumonia and prompt antibiotic treatment, relies on early recognition of alarm signs by mothers and community health workers. For mothers to undestand and act on advice from health workers, language and concepts commonly used by mothers should be utilized. The present study was carried out to compare the relative effectiveness of two different methods to elicit local terms used by mothers to refer to ARI symptoms/signs/treatments. A comparison was made among the terms elicited by a free listing o common terms mentioned by mothers in relation to ARI, and the terms they recognized when looking at a video that showed children with different ARI signs. The video was shown in a community and a clinical setting, in order to identify strengths and weaknesses of showing it in these settings. The video elicited more signs dealing with serious illness, respiratory distresss and general malaise, but missed non-visual signs, such as fever, lack of appetite or pain. Also, mothers tended to be distracted by trivial signs, such as skin color. Free listing was easier to administer and elicited more non-life-threatenin symptoms/signs, but mothers were more prone to drift away and mention terms not related to respiratory illness. Showing the video in the clinic elicited more medical-related terms, and was easier to show than in the community. In conclusion. choice of either of the two methods depends on the researcher's purpose. Using both methods produced a larger list of terms associated with ARI