Dominio cultural del autocuidado en diabeticos tipo 2 con y sin control glucémico en México / Cultural domain of self-care in type 2 diabetes patients with and without blood glucose control in Mexico

OBJETIVO: Analisar los principales elementos relacionados con el dominio cultural del autocuidado de la salud, entre pacientes con diabetes tipo 2 con y sin controle glucémico. MÉTODOS: Estudio descriptivo en 57 diabéticos controlados y 76 sin control glucémico, con promedio de 60 años de edad en una clínica del Seguro Social en México en 2003. Se aplicaron técnicas de antropología cognitiva de listas libres y cuestionario estructurado para obtener modelo semántico y promedio de conocimiento cultural a seis preguntas sobre su padecimiento por análisis de consenso. RESULTADOS: Los datos sociodemográficos de ambos grupos no mostraron diferencias significativas. Todos los modelos de respuesta comparados presentaron estructuras semánticas similares, con excepción a: "Qué se entiende como ejercicio" (p<0.05). El promedio de conocimiento cultural sobre los aspectos analizados fue similar en ambos grupos, solamente el nivel de conocimiento relacionado a "Cómo debe ayudar la familia a un adulto para estar sano" fue estadísticamente significativamente mayor en pacientes controlados. CONCLUSIONES: Los hallazgos muestran a diferente estructura semántica sobre la concepción del ejercicio entre los grupos de pacientes y la diferencia en el promedio de conocimiento cultural sobre el apoyo familiar para la salud de paciente. Estas informaciones deben ser tomadas en cuenta al elaborar programas educativos, de auto atención y atención médica adaptados a la cultura del paciente con diabetes tipo 2.

OBJECTIVE: To analyze the main elements related with the cultural domain of self-health care in type 2 diabetes patients with and without good blood glucose control. METHODS: Descriptive study comprising diabetes patients, 57 with and 76 without good blood glucose control, with an average age of 60 years, who attended a Social Security family clinic in Mexico in 2003. A cognitive anthropology approach using free lists and a structured questionnaire was applied and a semantic model and average cultural knowledge based on six questions about their illness was developed by consensus analysis. RESULTS: Sociodemographic information of both groups showed significant differences. The comparison of all semantic models revealed similar structures with the exception of "What do you understand exercise is" (p<0.05). The average cultural knowledge was similar in both groups except for that related to "How family can help an adult be healthy", which was statistically higher in those patients with good blood glucose control. CONCLUSIONS: The study findings show a different semantic structure on exercise conception between both diabetes groups studied as well as different average cultural knowledge on family support for patient's health. These findings should be taken into account in the development of education, self-care and medical care programs specific to the knowledge of type 2 diabetes patients.

Algunos aspectos antropológicos del encuentro médico-paciente con tuberculosis pulmonar en el occidente de México / Various anthropologic features of the physician-patient encounter with pulmonary tuberculosis in Western Mexico

The present work has as its purpose a description of the information exchanged during doctor-patient encounters immediately following diagnosis of pulmonary tuberculosis. To accomplish this nine such encounters were audiotape at two public health clinics in Guadalajara, Mexico. Communication of information and affect was evaluated by adapting the Roter interactional process analysis. Results show that the physician instructed the patient to behave in ways to prevent disease transmission while assuring patient recovery. Virtually lacking from these recordings is evidence of physician concern with the struggle patients experience to incorporate this regimen of directly observed therapy in to their daily lives. Because these sessions are managed by clinicians to encourage a unidirectional flow of information from physician to patient, the former fail to attain either patient cultural understanding of his/her disease process or comprehensive understanding of how he is affected she by the illness.