Healthcare Mistreatment and Cultural Beliefs Impact HbA1c in Patients with Type 2 Diabetes Mellitus / La Negligencia Médica y las Creencias Culturales impactan BhA1C en Pacientes con Diabetes Mellitus tipo 2

Abstract The aim of this research was to examine the effects of healthcare mistreatment and cultural beliefs on psychological, behavioral, and biological phenomena relevant to treatment adherence and health outcome among patients with Type 2 Diabetes Mellitus (T2DM). The study was conducted in Chile, where the prevalence of T2DM is one of the highest in Latin America and is increasing at an accelerated rate. The research was guided by Betancourt's Integrative Model and bottom-up mixed-method cultural research approach. Consistent with the hypotheses of the study, the test of a structural equation model based on the Integrative Model, including exposure to healthcare mistreatment, diabetes-related cultural beliefs, psychological distress, and medical avoidance as determinants of HbA1c, a biological measure of diabetes control, fit the data. The fact that the analysis of structural equations accounted for significant variance in HbA1c provides supporting evidence for extending the Integrative Model, to explain biological phenomena based on cultural and psychological factors.

Resumen El propósito de este trabajo fue evaluar los efectos de la negligencia médica y las creencias culturales sobre fenómenos biológicos, conductuales y psicológicos relevantes para la adherencia al tratamiento y consecuencias de salud en pacientes con diabetes mellitus tipo 2 (DMT2). El estudio se llevó a cabo en Chile, donde la prevalencia de DMT2 es una de las más altas de América Latina y sigue en aumento de manera acelerada. La investigación se basó en el Modelo Integrativo de Betancourt y en el enfoque mixto-abajo-arriba de investigación cultural. Congruente con las hipótesis del estudio, el modelo de ecuaciones estructurales basado en el modelo integrativo, que incluyó la exposición a negligencia médica, creencias culturales vinculadas a la diabetes, estrés psicológico, y evitación médica como determinantes del HbA1c, una medición biológica de control diabético, mostró buen ajuste. El hecho de que el modelo de ecuaciones estructurales explique gran parte de la varianza del HbA1c aporta suficiente evidencia para ampliar el modelo integrativo en la explicación del fenómeno biológico con base en factores culturales y psicológicos.

Atribución de malos tratos en servicios de salud a discriminación y sus consecuencias en pacientes diabéticos mapuche / Healthcare mistreatment attributed to discrimination among mapuche patients and discontinuation of diabetes care

Background: The negative impact of perceived discrimination on health outcomes is well established. However, less attention has been directed towards understanding the effect of perceived discrimination on health behaviors relevant for the treatment of diabetes in ethnic minorities. Aim: To examine the effects of healthcare mistreatment attributed to discrimination on the continuity of Type 2 Diabetes (DM2) care among mapuche patients in a southern region of Chile. Material and Methods: A non-probabilistic sample of 85 mapuche DM2 patients were recruited from public and private health systems. Eligibility criteria included having experienced at least one incident of interpersonal healthcare mistreatment. All participants answered an instrument designed to measure healthcare mistreatment and continuity of diabetes care. Results: Healthcare mistreatment attributed to ethnic discrimination was associated with the discontinuation of diabetes care. Conclusions: Healthcare mistreatment attributed to discrimination negatively impacted the continuity of diabetes care, a fact which may provide a better understanding of health disparities in ethnic minorities.

Optimum management of pediatric patients with fever and neutropenia.

Fever with neutropenia is a common clinical problem in patients receiving cancer treatment. Prevention and optimum management of infectious complications is critical to the overall success of cancer therapy. This article provides an overview of the current status of this evolving subject. While the basic principles of rapid institution of broad spectrum antibiotics, early intervention with empiric antifungal therapy and continuation of antimicrobials during period of risk are unlikely to change, there is increasing interest in titrating this aggressive approach based on the projected risk of the development of a serious invasive infection. Oral antibiotic therapy and outpatient management are currently being studied in pediatric oncology patients, but even when successful these alternatives to the traditional "in hospital, parenteral antibiotic therapy" approach are unlikely to be applicable in all patient populations and clinical settings. While there is no replacement for clinical acumen and careful monitoring, judicious use of diagnostic resources such as blood cultures and imaging studies is a key component of optimum care. Selection of empiric antibiotics based on ongoing monitoring of antimicrobial susceptibility patterns is emphasized.