Saúde e discriminação no processo de envelhecimento LGBTQIA+ / Health and discrimination in the aging process LGBTQIA+ / Salud y discriminación em el processo de envejecimiento LGBTQIA+

Objetivo: Identificar as experiências e discriminações vividas pela população LGBTQIA+ em envelhecimento durante a prestação dos serviços de saúde. Método: Estudo exploratório de abordagem qualitativa, por meio da aplicação de um questionário com informações sociodemográficas e questões sobre experiências anteriores dentro de instituições de saúde e percepção do cuidado recebido. Resultados: Participaram nove pessoas, predominantemente, identificadas como homens cisgêneros; e, apenas um estava com idade entre 65 e 70 anos. Em sua maioria buscam o serviço de saúde duas vezes ao ano motivado principalmente por problemas particulares, do sistema respiratório, hipertensão arterial ou dores persistentes. Indicaram não haver desencorajamento para a procura de serviços e a maioria não relatou experiências de discriminação. Conclusão: A baixa frequência de discriminação pode indicar a dificuldade de caracterizar a exposição e/ou vivências por esta população. Sendo assim, devese buscar entender o que essa população considera discriminação por parte dos serviços de saúde a pessoas LGBTQIA + durante o processo de envelhecimento.

Objective: To identify the experiences and discrimination experienced by the aging LGBTQIA+ population during the provision of health services. Method: Exploratory study with a qualitative approach, through the application of a questionnaire with sociodemographic information and questions about previous experiences within health institutions and perception of care received. Results: Nine people participated, predominantly identified as cisgender men; and, only one was aged between 65 and 70 years. Most seek the health service twice a year motivated mainly by particular problems, the respiratory system, high blood pressure or persistent pain. They indicated that there was no discouragement to seek services and most did not report experiences of discrimination. Conclusion: The low frequency of discrimination may indicate the difficulty of characterizing the exposure and/or experiences of this population. Therefore, one should seek to understand what this population considers discrimination by health services to LGBTQIA+ people during the aging process.

Objetivo: Identificar las experiencias y la discriminación que vive la población LGBTQIA+ envejecida durante la prestación de los servicios de salud. Método: Estudio exploratorio con enfoque cualitativo, mediante la aplicación de un cuestionario con información sociodemográfica y preguntas sobre experiencias previas dentro de las instituciones de salud y percepción de la atención recibida. Resultados: Participaron nueve personas, predominantemente identificadas como hombres cisgénero; y, solo uno tenía entre 65 y 70 años. La mayoría acude al servicio de salud dos veces al año motivada principalmente por problemas particulares, del sistema respiratorio, hipertensión arterial o dolor persistente. Indicaron que no hubo desánimo para buscar servicios y la mayoría no reportó experiencias de discriminación. Conclusión: La baja frecuencia de discriminación puede indicar la dificultad de caracterizar las exposiciones y/o experiencias de esta población. Por lo tanto, se debe buscar comprender lo que esta población considera discriminación por parte de los servicios de salud a las personas LGBTQIA+ durante el proceso de envejecimiento.

Conocimientos, creencias y actitudes en padres mexicanos acerca del trastorno por déficit de atención con hiperactividad (TDAH) / Knowledge and beliefs in Mexican parents about attention deficit hyperactivity disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) generates controversy among the general population on its diagnosis and treatment. This could be explained by the sparse level of education about mental health, which affects the parent's knowledge and beliefs about this disorder. ADHD is highly prevalent and 3-5% of school-age children can be diagnosed. In Mexico it represents 1.5 million cases. It represents more than 30% of all cases in clinical pediatric settings. The reports in health services have shown that the time gap between symptoms identification and treatment is around 8 to 15 years. Moreover, only 25% of the affected children's parents recognize conduct or emotional problems on them and 13% receive mental health care. Attention seeking has been associated with higher severity of the disorder and parent's superior educational level. Despite the advances in the research on neurobiology and psychopharmacology, understanding of the social context that surrounds the disorder is incomplete. Comparatively little is known regarding how parents conceive the symptoms and causes of ADHD and how these parental views may relate to children's treatment. Understanding these factors is important due to the central role of parents in selecting and accessing treatments and service providers for children with ADHD. For parents and children, getting information about ADHD is a lottery that depends on which professional they see and what they read or gather from television and the Internet. Mental health professionals most give complete information to parents and children, so risks and benefits of the different treatments may be considered along with the family's needs, values and cultural background. A better understanding about the parent's knowledge, beliefs and attitudes regarding ADHD would help to improve the communication mechanisms between mental health professionals and parents during the treatment. Objective To describe the knowledge, beliefs and attitudes regarding ADHD in Mexican parents. Methods The study was approved by the local investigation review board. Informed consent was obtained and parents of children and adolescents diagnosed with ADHD were recruited at four mental health facilities (three public and one private) in two cities. Each parent completed the questionnaire of knowledge and beliefs about ADHD (CASE ADHD, parent's version). The questionnaire was created for this study as an instrument with three versions: a) Parents, b) Teachers, c) Health professionals. Results of parent's version were included in this report. This questionnaire incorporates information of other instruments such as Barkley's Evaluation Questionnaire and the one used in the National Colombian Survey for the Consensus of treatment of ADHD 2008. CASE ADHD includes three parts: 1. An identification record with the mother's or father's general data, 2. The ADHD Rating Scale-IV, and 3. A 36 multiple choice questionnaire related to six main areas: a) The caretaker report of symptoms and clinical characteristics related with ADHD, b) The knowledge about ADHD, c) The pathways to care report, d) The Beliefs about ADHD treatment, e) The professional mental health's performance, and f) The parent's perceptions about ADHD. The questionnaire must be completed with the assistance of a mental health professional. The average application time is 30 minutes. For statistical analysis central tendency measures were used; as means, standard deviations and percentages. Results The total sample was integrated by 288 parents of children or adolescents. The 80.1% of the questionnaires were fulfilled by the mother. The mean age of those who answered was 40.06 years, 25.4% reported to complete professional studies. The mean age of patients was 11.15 years (SD = 3.54), 58% were children and 74% were male, their ADHDRS-IV average score was 27.5 (SD = 14.03). Knowledge about ADHD. The 85.4% (N = 246) of the surveyed sample considered ADHD as a disease and 8.3% as a rearing difficulty. The 69.2% (N = 198) of parents said they knew what is ADHD, but only 62.1% reported to receive information by the physician or psychologist about this condition. Attitudes about ADHD. When questioned about what would they do if they suspected that their child had ADHD, 35.1 % (N = 101) would consult a psychiatrist, 21.2% a psychologist, and 12.2% a neurologist or pediatric neurologist. The 28% of parents were deemed unable to manage their child's behavior problem. When we asked about who is able to diagnose ADHD, 49.5% answered that the psychologist, 48.5% the psychiatrist and 19.8% that the pediatrician. The psychiatrist was considered able to treat this condition by 45.8% of the sample followed by psychologist (19.8%), and neurologist (10.4%). Beliefs about diagnosis and treatment. Nearly 63% of the sample (N = 183) considered that the best treatment for ADHD was the combined treatment; 16.3% preferred the psychological approach and psychopharmacology was chosen by only 6.6%. Almost half (48.5%, N= 129) of the sample considered that drug treatment only supports the psychosocial treatment and does not have a therapeutic effect by itself, 46.2% (N = 133) of the sample believed that <

Introducción A pesar de la evidencia científica acerca de las características neurobiológicas del Trastorno por Déficit de Atención e Hiperactividad (TDAH) que apoya el uso de medicamentos para su tratamiento, este padecimiento sigue generando controversia con respecto a su existencia, su persistencia a lo largo de la vida y su tratamiento óptimo. La prevalencia del TDAH a nivel mundial es alta. Los estudios epidemiológicos muestran que 3 a 5% de los niños en edad escolar pueden recibir este diagnóstico. En México se estima que hay aproximadamente 33 millones de niños y adolescentes, de los cuales 1.5 millones podrían ser diagnosticados con TDAH. En el contexto clínico, al menos 30% de los pacientes que acuden a valoración de primera vez en los servicios de psiquiatría infantil presentan problemas de inatención, hiperactividad o impulsividad. Algunos estudios epidemiológicos han mostrado que sólo el 25% de los padres de sujetos con síntomas de trastornos de conducta o del afecto consideraban que sus hijos necesitaban atención médica, y de ellos, el 13% acudió a los servicios de salud mental. La búsqueda de atención especializada se ha asociado con una mayor intensidad del trastorno y un mayor nivel educativo de los padres. Diversas publicaciones relacionadas con el tratamiento del TDAH a lo largo de la vida resaltan la importancia de la intervención multimodal, es decir, un tratamiento multidisciplinario que va más acorde al modelo biopsicosocial el cual, a su vez, se encuentra relacionado con los factores etiológicos y de pronóstico a mediano y largo plazo en el TDAH. En diversos estudios se ha subrayado la importancia de brindar educación adecuada sobre el trastorno y su tratamiento. También sugieren que un mejor entendimiento acerca de las creencias y conocimientos de los padres de niños y adolescentes con TDAH ayudará a mejorar los mecanismos de comunicación, atención y colaboración entre los distintos elementos participantes en el tratamiento del TDAH y reducirá el tiempo entre la identificación del problema y el inicio del tratamiento. Objetivo Describir los conocimientos, las creencias y actitudes de los padres de niños y adolescentes con TDAH acerca de la naturaleza de la enfermedad, la conducta en la búsqueda de atención médica y su tratamiento. Material y métodos La muestra fue conformada por padres de niños y adolescentes que habían recibido el diagnóstico de TDAH por un clínico calificado. Participaron cuatro centros de atención psiquiátrica, tres en la Ciudad de México y otro en la ciudad de San Luis Potosí. El instrumento principal (CASO ADH padres) es un cuestionario autoaplicable y fue escrito específicamente para este estudio. CASO ADHD es un instrumento con tres versiones: a) Padres, b) Maestros y c) Profesionales de la salud. En este estudio se exponen los resultados de la primera versión. Resultados La muestra total se conformó de 288 padres. El 69.2% dijo saber qué es el TDAH, 85.4% consideró al TDAH como una enfermedad y el 8.3% como una dificultad de la crianza; el resto lo consideró un mito, una moda, un invento de la industria farmacéutica o no existente. Alrededor del 63% de la muestra consideró que el mejor tratamiento para el TDAH sería el tratamiento combinado, el 16.3% prefirió el enfoque psicológico y sólo 6.6% eligió la psicofarmacología. Casi la mitad de la muestra, 48.5%, consideró que el tratamiento farmacológico solamente apoya al tratamiento psicosocial. La mayoría de los padres (60%) identificaron los síntomas de sus hijos en su propia conducta durante los años escolares. Conclusiones Es importante mejorar la cantidad y la calidad de educación acerca del TDAH y su tratamiento entre los padres de los pacientes, para que sus decisiones terapéuticas sean más informadas y tengan mejor efecto sobre el pronóstico del paciente.

La búsqueda de atención para la tuberculosis en Chiapas, México / Seeking tuberculosis care in Chiapas, Mexico

Objetivos. Analizar el proceso de búsqueda de atención a la tuberculosis y su influencia en la adherencia al tratamiento en Chiapas, dado que el diagnóstico temprano y la adherencia al tratamiento son los factores principales para el éxito de los programas de control de la tuberculosis. Métodos. Se realizó un estudio cualitativo mediante entrevistas grupales a 11 grupos de pacientes de las regiones Centro, Altos y Fronteriza del estado de Chiapas, México. Resultados. Se detectaron diferentes alternativas a las que los enfermos acuden para su atención. Los enfermos manifestaron un retraso importante en el diagnóstico por problemas del mismo enfermo y de la atención recibida en los servicios de salud. Las opciones de tratamiento que siguieron fueron el resultado de las percepciones que tienen sobre las causas de la enfermedad y de la diversidad de etnomedicinas legitimadas en las comunidades. Conclusiones. El poco conocimiento sobre la enfermedad propicia la elección de diferentes alternativas para su atención. El control de la tuberculosis requiere una utilización óptima de los servicios de salud en Chiapas y un programa de educación en materia de salud, tomando en cuenta la realidad social, cultural y económica en la que vive la población.

Objective. To analyze the process of seeking tuberculosis care and this process's impact on treatment adherence in the Mexican state of Chiapas, given that the two primary factors in successful tuberculosis (TB) control programs are early diagnosis and adherence to TB treatment. Methods. We conducted a qualitative study using group interviews with 11 groups of patients in three of the nine socioeconomic regions of the state of the Chiapas (Altos, Centro, and Fronteriza). Results. The patients applied a variety of approaches in seeking care. The patients reported considerable delays in diagnosis due to problems that the patients themselves had and because of shortcomings in the care they received from the formal health care system. The treatment options that they followed were the result of their perceptions of the causes of TB and of the variety of traditional medical practices accepted in their communities. Conclusions. The lack of knowledge about TB encourages people to consider various alternatives for their care. Tuberculosis control in Chiapas requires an optimal utilization of the health services that exist in the state as well as a program of health education. TB control in Chiapas must take into account the social, cultural, and economic reality of the population.