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)

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

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.

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.

Complete home smoking bans and antitobacco contingencies: a natural experiment.

INTRODUCTION: The California antitobacco culture may have influenced home smoking bans in Mexico. Based on the Behavioral Ecological Model, exposure to socially reinforcing contingencies or criticism may explain adoption of home smoking bans in Tijuana, Mexico, approximating rates relative to San Diego, California, and higher than those in Guadalajara, Mexico. METHODS: A representative cross-sectional population survey of Latinos (N = 1,901) was conducted in San Diego, Tijuana, and Guadalajara between June 2003 and September 2004. Cities were selected to represent high-, medium-, and low-level exposure to antitobacco social contingencies of reinforcement in a quasiexperimental analysis of possible cultural influences across borders. RESULTS: Complete home smoking ban prevalence was 91% in San Diego, 66% in Tijuana, and 38% in Guadalajara (p < .001). Sample cluster-adjusted logistic regression showed significantly lower odds of complete home smoking bans in Guadalajara (odds ratio [OR] = .048) and in Tijuana (OR = .138) compared to San Diego after control for demographics. Odds of complete home smoking bans in both Guadalajara and Tijuana in comparison with San Diego were weakened when mediators for bans were controlled in predictive models. Direction of association was consistent with theory. When theoretical mediators were explored as possible moderators, weak and nonsignificant associations were obtained for all interaction terms. Bootstrap analyses demonstrated that our multivariable logistic regression results were reliable. CONCLUSIONS: Results suggest that California antismoking social contingencies mediate complete home smoking bans in all 3 cities and may account for the greater effects in Tijuana contrasted with Guadalajara.

[The family dysfunction as a risk factor of obesity in Mexican school children]. / La disfunción familiar como factor de riesgo para obesidad en escolares mexicanos.

BACKGROUND: it has been demonstrated that children obesity is a multifactorial disease and probably, the alteration of the family dynamic is another potential risk factor. The objective was to identify the association between obesity and family dysfunction in school children who attend to a family medicine unit. METHODS: case and control study at Mexican Social Security Institute in Guadalajara, Jalisco, Mexico. Sociodemographic factors and family dynamic of obese and non-obese subjects (n = 452) of six to nine years old from nuclear families were achieved. RESULTS: the association between family dysfunction and obesity was [OR = 1.63 (1.08-2.46), p = 0.01]. Area II, Identity formation, and area VI, Discipline and methods, showed a lower score in cases of children with obesity (p < 0.001 and p = 0.005, respectively). In a logistic regression model family dysfunction [RM 1.79 (1.19, 2.71), p = 0.005] and low literacy of mothers [RM 1.61 (1.06, 2.45), p = 0.02)] were risk factors for obesity in school children. CONCLUSIONS: the results showed an association between family dysfunction and obesity in school children. We suggest to consider it in the prevention of obesity in Mexican school children.

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

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.

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.

Home smoking bans and secondhand smoke exposure in Mexico and the US.

OBJECTIVE: This study examines the association between home smoking ban status and home secondhand smoke exposure (SHSE) among Mexican-descent adults and children in three cities representing different levels of exposure to the California Tobacco Control Program. METHOD: From 2003-2004, a cross-sectional tobacco survey was conducted with a population-based sample of Mexican-descent adults in San Diego, California (N=1103) and Mexican adults in Tijuana (N=398) and Guadalajara (N=400), Mexico. RESULTS: After adjustment for demographic, behavioral, cultural, and contextual covariates, a complete home smoking ban was associated with Mexican American and Mexican adults and children being less likely to experience SHSE in the home compared to their counterparts with partial or no smoking restrictions. The association was significant across the three survey sites, but stronger in San Diego than in any of the two Mexican cities. CONCLUSION: Home smoking bans reduce the risk of home SHSE among Mexican Americans and Mexicans, regardless of the smoking status of the household residents and other individual and environmental variables. Even if household residents continue smoking and communitywide tobacco control efforts are suboptimal, the promotion of home smoking bans can protect adults and children from home SHSE.

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.

Crossing borders: the impact of the California Tobacco Control Program on both sides of the US-Mexico border.

We examined the association between exposure to the California Tobacco Control Program and tobacco-related behaviors and perceptions among adults of Mexican descent. Three cross-sectional population-based surveys were conducted among adults in cities that represent full, partial, and no exposure to the program: San Diego, Calif, Tijuana, Mexico, and Guadalajara, Mexico, respectively. After we controlled for socioeconomic differences, we found significantly different rates of smoking, exposure to environmental tobacco smoke, and smoking bans in the 3 cities. We also observed a parallel gradient of cross-city differences in theoretical mediators of tobacco control. This suggests a significant association among the California Tobacco Control Program, tobacco-control outcomes, and theoretical mediators of these outcomes. Similar programs should be implemented in other regions; they have widespread effects on social norms and behaviors related to smoking and environmental tobacco smoke and can help achieve tobacco control across nations.

[A socio-spatial analysis of social exclusion and inequity in health in Mexico]. / Exclusión Social e Inequidad en Salud en México: Un Análisis Socio-espacial.

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 marginalization level and for municipalities grouped according to degree of marginalization. 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 marginalization) in relationship to the 1st quartile (lowest marginalization); 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 marginalization; 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.

Correlates of home smoking bans among Mexican-Americans.

PURPOSE: This study examines the individual and environmental correlates of home smoking bans among a population-based sample of Mexican-Americans. Design. A telephone survey on tobacco use and home policies was conducted using stratified, random sampling of listed phone numbers. SETTING: Surveys were completed by telephone in San Diego, California. SUBJECTS: The sample consisted of San Diego adult residents of Mexican descent (N=1103). MEASURES: The interview included questions on home rules regarding smoking in the household and a number of potential correlates, based on the Behavioral Ecological Model (BEM). This model emphasizes the influence of family, social, and cultural factors on health behaviors. RESULTS: Overall, 90.6% of all respondents reported a ban on smoking in the home. Multivariate analyses indicated that home bans on smoking are more likely among individuals that do not smoke, live with children, are more acculturated to U.S. society, report greater aversion to ETS, and/or report more social pressure against indoor smoking. In contrast, smoking bans are less likely among Mexican Americans who live with smokers. CONCLUSIONS: Individual and environmental factors play a protective role by increasing the likelihood of smoking bans in the home of Mexican-descent individuals. These factors should be considered for the design of interventions to sustain and promote the adoption of smoking bans in the home among this and other populations.

Smoking, exposure to secondhand smoke, and smoking restrictions in Tijuana, Mexico / Tabaquismo, exposición a humo ajeno y medidas restrictivas contra el tabaquismo en Tijuana, México

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.

Objective. To estimate the prevalence of tobacco use, exposure to secondhand smoke, and smoking restrictions in the home and workplace among residents of Tijuana, one of Mexico's largest cities. Methods. This cross-sectional household survey was conducted in Tijuana, Baja California, Mexico, during 2003 and 2004. A population-based sample of 400 Tijuana adult residents responded to a tobacco survey, and 397 of the surveys were analyzed. Results. About 22.9% (95% confidence interval (CI): 18.7%­27.1%) of Tijuana adults reported current smoking, and 53.9% (95% CI: 48.8%­58.9%) reported chronic exposure to secondhand smoke. Approximately 44.4% (95% CI: 37.9%­50.9%) of Tijuana adults had a nonsmoking policy in their workplace, while 65.8% (95% CI: 61.0%­70.6%) of Tijuana households were smoke-free. Conclusions. The results underline the need for increased tobacco control efforts, particularly stricter enforcement of existing passive smoking regulations, in order to expand protection from secondhand smoke from private settings to public ones and to curb the tobacco epidemic in Tijuana and elsewhere in Mexico

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

OBJECTIVE: To estimate the prevalence of tobacco use, exposure to secondhand smoke, and smoking restrictions in the home and workplace among residents of Tijuana, one of Mexico's largest cities. METHODS: This cross-sectional household survey was conducted in Tijuana, Baja California, Mexico, during 2003 and 2004. A population-based sample of 400 Tijuana adult residents responded to a tobacco survey, and 397 of the surveys were analyzed. RESULTS: About 22.9% (95% confidence interval (CI): 18.7%-27.1%) of Tijuana adults reported current smoking, and 53.9% (95% CI: 48.8%-58.9%) reported chronic exposure to secondhand smoke. Approximately 44.4% (95% CI: 37.9%-50.9%) of Tijuana adults had a nonsmoking policy in their workplace, while 65.8% (95% CI: 61.0%-70.6%) of Tijuana households were smoke-free. CONCLUSIONS: The results underline the need for increased tobacco control efforts, particularly stricter enforcement of existing passive smoking regulations, in order to expand protection from secondhand smoke from private settings to public ones and to curb the tobacco epidemic in Tijuana and elsewhere in Mexico.

[Regional variations in homicide mortality in Jalisco, Mexico]. / Variaciones regionales de la mortalidad por homicidios en Jalisco, México.

The present study describes regional variations in homicide rates in Jalisco State, Mexico, in 1989-1991, 1994-1996, and 1999-2000, analyzing the trends by gender and socioeconomic stratum. Using mortality data generated by the National Institute for Statistics, Geography, and Information Technology, homicide rates adjusted by age and gender were calculated, along with rate/female rate ratios; rate ratios by socioeconomic stratum and 95% confidence intervals were also calculated. According to the results, the homicide rate showed: a downward trend in the 1990s; a regional homicide mortality pattern, with the highest rates in peripheral regions, considered among the poorest areas in the State; municipalities with the lowest socioeconomic conditions also presenting a statistically significant excess homicide mortality; and an evident over-mortality from homicide among males. The results point to tasks and challenges for public health and law enforcement institutions, including the need to implement different inter-institutional policies that take into consideration the characteristics of homicide and violent crime in Jalisco.

Variaciones regionales de la mortalidad por homicidios en Jalisco, México / Regional variations in homicide mortality in Jalisco, Mexico

El presente estudio busca describir las variaciones regionales de la mortalidad por homicidios en el estado de Jalisco, México, en 1989-1991, 1994-1996 y 1999-2000, analizando a su vez el comportamiento de la tasa de homicidios según género y estratos de bienestar socioeconómico. A partir de la información sobre mortalidad generada por el Instituto Nacional de Estadística, Geografía y Informática, se calcularon tasas ajustadas por edad y género e índices de sobremortalidad masculina. Además, se calcularon razones de tasa y su intervalo de confianza (95 por ciento). Los resultados reflejan que la tasa de homicidios presenta una tendencia decreciente en los años 90; que existe un patrón regional de la mortalidad por homicidios, observándose las tasas más altas en regiones periféricas del estado consideradas entre las más pobres; que los municipios ubicados en el estrato de bienestar más bajo presentan un exceso de mortalidad por homicidios estadísticamente significativo, y que hay una evidente sobremortalidad masculina por esta causa. Aspectos como los antes descritos implican tareas y desafíos para la salud pública y para los organismos encargados de preservar la ley y el orden, entre ellos la necesidad de implementar políticas intersectoriales diferenciadas, que tomen en consideración las particularidades que rodean al homicidio y al crimen violento en Jalisco

Cementerios y salud pública en Guadalajara / Cementeries and public health in Guadalajara

Introducción: el presente estudio tiene el objetivo de dar cuenta de la institucionalización de la muerte a través del tiempo en los cementerios de la ciudad de Guadalajara.Diseño: descriptivo.Material y método: revisión de escritos y documentos localizados referentes a Campos Santos y Cementerios, en los archivos públicos y eclesiásticos de la ciudad de Guadalajara. Jalisco. México.Resultados: la influencia religiosa y familiar en la disposición de los cadáveres durante la colonia, se ve sustituida por la intervención del Estado en forma de control de los cuerpos muertos a través de una legislación influenciada por los conocimientos de la época.Discusión: en los cementerios en la ciudad de Guadalajara, hasta mediados del siglo XX, las representaciones y la legislación, cambiaron poco en términos de controlar, organizar y secuenciar la vida y la muerte de los ciudadanos. Sin embargo, a inicios del actual siglo XXI, la modernidad con sus contradicciones, se revierte al Estado controlador de los cuerpos muertos, en cuanto otros procesos, como el de urbanización-industrialización, que reclaman espacios para los cuerpos de los vivos.Actualmente las estrategias del Estado para disponer los cadáveres, se orientan hacia la minimización del cuerpo, sin perder el control.

Factores de riesgo del peso al nacer desfavorable en área periférica de Guadalajara, México / Risk factors for unfavorable birth weight in areas surrounding Guadalajara, Mexico

Busca identificar la incidencia del peso al nacer desfavorable (PND) - <3000 gramos -, los factores asociados a esta condición, y la probabilidad que tiene un niño de nacer con un peso inferior a 3000 gramos en presencia o ausencia de los factores de riego identificados, en áreas periféricas de la Zona Metropolitna de Guadalajara (ZMG), México. Para ello, se seleccionó una muestra de nascidos vivos en 1991, hijos de madres derechohabientes del Instituto Mexicano del Seguro Social (IMSS) residentes en Tlaquepague y Tonalá (municipios conurbados a la ZMG); el diseno de la muestra fue probabilístico y polietápico, siendo representativo de la población estudiada. Se seleccionaron aleatoriamente, en primer lugar, Unidades de Medicina Familiar de las zonas estudiadas, y posteriormente, consultorios en cada una de las Unidades elegidas. De estos consultorios fueron estudiados todos los nascidos vivos: el total de recién nacidos en la muestra fue 141. A las madres de los infantes seleccionados se les aplicó un cuestionario con diferentes módulos, por parte de trabajadoras sociales especialmente capacitadas para ello. A través del empleo de la regresión logística, se estimaron "odds ratios" (OR), con intervalos de confianza (IC) de 95 por cento, para establecer la posible asociación entre los factores analizados y el peso al nacer inferior a 3000 gramos. También se claculó la probabilidad de que un niño tuviera PND en presencia o ausencia de los factores de riesgo identificados. Los resultados ponen de manifiesto que el 22 por cento de los infantes estudiados nacieran con un peso inferior a 3000 gramos; como factores de riesgo del PND fueron identificados la edad de la madre igual o superior a 35 anos (OR 18,47,IC1.8683.54), el trabajo materno fuera del hogar (OR3.14,IC 1.15-8.59), el bajo peso materno (OR 5.04, IC 1.04-24,47), y la captación tardia del embarazo (OR 2.64, IC 1.02-6.84). En presencia de todos los factores de riesgo identificados, la probabilidad de que un niño nazca con menos de 3000 gramos es sumamente elevada -0,97-, y en ausencia de estos dicha probabilidad se reduce substancialmente-0.04-. Los resultados evidencian la magnitud del problema estudiado, pero tembién, la posibilidad de implementar acciones oportunas por parte de los servicios de salud, en tanto los factores de riesgo identificados permiten predecir, con relativa certeza, el nacimiento de un niño con menos de 3000 gramos de peso.

Factores maternos asociados a la duración de la lactancia en áreas periféricas de Guadalajara, México / Maternal factors related to duration of breast-feeding in areas surrounding Guadalajara, Mexico

Este estudio pretende caracterizar la duración de la lactancia materna en madres derechohabientes del Instituto Mexicano del Seguro Social residentes en Tlaquepaque y Tonalá, áreas conurbadas a la ciudad de Guadalajara, México; identificar posibles factores maternos asociados al destete precoz, y determinar su importancia social. Para ello, se seleccionó una muestra de niños de un mes a un año de vida nacidos en estas áreas entre mayo de 1990 y abril de 1991, y sus respectivas madres. El muestreo fue probabilístico y polietápico, y se seleccionaron al azar unidades de atención primaria de salud de las áreas analizadas, consultorios de medicina familiar de dichas unidades, y por último, a todos los niños con las características mencionadas en cada consultorio elegido. Después de visitar 166 viviendas, se entrevistaron 141 madres, 91 por ciento del tamaño muestral previsto (155). Para realizar la entrevista, se elaboró un cuestionario con 33 preguntas. Las encuestadoras fueron trabajadoras sociales previamente capacitadas para realizar dicho trabajo, que se llevó a cabo entre junio y julio de 1991. Mediante modelos de regresión logística se estimo el riesgo relativo (RR) asociado a cada variable y la probabilidad de que el lactante fuera destetado precozmente en presencia o ausencia de ciertas variables. Para garantizar la validez de los resultados obtenidos, se construyeron varios modelos de regresión, con el propósito de seleccionar el que mejor se ajustara a los datos