2015 life tables of population user of Jalisco's Instituto Mexicano del Seguro Social services / Tablas de vida 2015 de la población usuaria del Instituto Mexicano del Seguro Social de Jalisco

Background: The life table is a useful instrument to measure the impact of health care in a population. In this case we report the situation of the population that use the medical services of the Instituto Mexicano del Seguro Social in the state of Jalisco. Methods: We used the abridged Reed-Merrell method, which shows the life expectancy in five-year age groups. Results: In 2015 life expectancy for people with hospital insurance was 80.51 for women and 77.93 for men. For the total of insured women and men, life expectancy was 77.65 and 73.73 years, respectively. Conclusion: Compared with previous calculations, we observed a deceleration of the gain of life expectancy in both sexes, even though women keep more life expectancy than men.

Introducción: La tabla de vida es un valioso instrumento para medir el impacto de la atención médica en una población. En este caso reportamos la situación de la población usuaria de los servicios de salud del Instituto Mexicano del Seguro Social en el estado de Jalisco, México. Métodos: Se utilizó el método abreviado de Reed-Merrell, que muestra la esperanza de vida en grupos quinquenales de edad. Resultados: En 2015 la esperanza de vida en asegurados hospitalizados hombres fue de 77.93 años y en mujeres, de 80.51 años. Para el total de asegurados mujeres y hombres fue de 77.65 y 73.73, respectivamente. Conclusiones: Si se compara con cálculos previos, se observa una desaceleración en la ganancia de expectativa de vida en pacientes hospitalizados de ambos sexos, aunque se conserva una mayor esperanza para las mujeres.

[Cultural domain of the causes of diabetes in three generations of popular stratum in Guadalajara, Mexico]. / Dominio cultural sobre causas de diabetes en tres generaciones de estratos populares en Guadalajara, México.

BACKGROUND: The growing prevalence of diabetes must be confronted in several ways. Establishing the generational transmission of cultural knowledge offers some guidelines to prevent and control the disease. Once we identify and compare the semantic structures of shared knowledge we lay the foundations of a culturally comprehensive care. The objective was to characterize the main elements about cultural domain of the causes of diabetes in a population of grandparents, parents and children belonging to popular strata in Guadalajara, Jalisco, Mexico. METHODS: A cognitive anthropological study performed in 104 subjects selected randomly in Guadalajara. We applied the free listing technique in order to obtain the semantic model and the average of cultural knowledge on the causes of the disease through a consensus analysis.A cognitive anthropological study performed in 104 subjects selected randomly in Guadalajara. We applied the free listing technique in order to obtain the semantic model and the average of cultural knowledge on the causes of the disease through a consensus analysis. RESULTS: The studied groups were divided by generation: grandparents, parents and children. The data evidences intergenerational transmission, in form of a basic semantic structure, and a significant consensus around a single model. CONCLUSIONS: The semantic structure on the causes of the diabetes includes: a) the emotions, as traditional dimension; b) certain behaviours related with the lifestyle, as everyday dimension; c) some biomedical concepts, like an emergent dimension.

Introducción: la creciente prevalencia de diabetes se debe afrontar de diversas maneras. Determinar la transmisión generacional del conocimiento cultural ofrece pautas para la prevención y el control de la enfermedad. Al identificar y comparar las estructuras semánticas del conocimiento compartido, sentamos las bases de una atención culturalmente comprensiva. El objetivo es caracterizar los principales elementos relacionados con el dominio cultural sobre las causas de la diabetes en una población de abuelos, padres e hijos pertenecientes a estratos populares en Guadalajara, México. Métodos: estudio antropológico cognitivo en 104 personas seleccionadas al azar en el sector Libertad de Guadalajara, Jalisco, México. Se aplicaron técnicas de listas libres para obtener el modelo semántico y el promedio de conocimiento cultural sobre las causas del padecimiento por análisis de consenso. Resultados: los grupos estudiados se dividieron por generación de abuelos, padres e hijos. Se evidenció transmisión intergeneracional al presentar el conocimiento cultural una estructura semántica básica y un consenso significativo. Conclusiones: la estructura semántica sobre causas de la diabetes incluye como elementos: a) las emociones, como dimensión tradicional; b) conductas relacionadas al estilo de vida, como dimensión cotidiana; c) algunos conceptos biomédicos, como dimensión emergente.

Are differences between patient and provider explanatory models of diabetes associated with patient self-management and glycemic control?

In this study we test whether differences between patient and provider explanatory models of diabetes affect self-management and glucose control in type 2 diabetes patients. Diabetic patients (n=60) and family practice physicians (n=39) in Guadalajara, Mexico, responded to a structured explanatory model interview (130 questions on causes, symptoms, and treatments). A cultural consensus analysis indicated a widely shared model among physicians and provided a single shared set of answers to the questions. Patient-provider congruence in beliefs was assessed by comparing each patient's responses with the physician answer set. Congruence in beliefs predicted self-management behaviors (r=0.27, p=.03), more than educational level (r=0.16, p=.23), but was not predictive of A1C (r=0.12, p=.40). Differences between patient and physician explanatory models can adversely affect patient-directed activities and may indirectly affect glycemic control by affecting self-management. These differences may be due to low patient educational level and resulting problems in understanding biomedical approaches to diabetes.

Explanatory models of diabetes in the U.S. and Mexico: the patient-provider gap and cultural competence.

Successful management of type 2 diabetes requires support and collaboration between diabetic patients, their health care providers, family and community. Using data collected in 1994-2001, we describe illness beliefs of physicians, patients, and representative samples of community members in the US and Mexico. We test whether differences in conceptualizations of diabetes are greater across national and linguistic boundaries or between physicians and lay groups. Interviews were conducted in southern Texas on the Mexican border and in Guadalajara, Mexico. Culturally appropriate interview materials were developed with a mixed-methods approach. Qualitative interviews elicited beliefs about causes, risks, symptoms, and treatments for diabetes and salient themes were incorporated into structured interviews. A cultural consensus analysis was used to verify salient themes within each of the six samples. The consistency in responses in each of the six samples indicated a shared core of beliefs that transcended individual variations. The greatest differences occurred between physician and lay samples; patient and community models were more similar to one another than to the physician models. Differences between physicians and patients may affect optimal management of diabetes, but these differences do not appear to be simply a function of differences in national culture and language, as the largest differences occurred in Mexico. This suggests that rather than cultural competence per se, formal educational levels and class differences may also play an important role in patient understanding and the gap in patient-provider understanding.

Conocimiento y uso de las plantas medicinales en la zona metropolitana de Guadalajara / Knowledge and use of medicinal plants in the metropolitan area of Guadalajara

Se destaca el conocimiento popular de "herbolarios, hierberos, yerberos o yerbateros" sobre las plantas medicinales utilizadas en mercados de la Zona Metropolitana de Guadalajara (zmg), en comparación con estudios fitoquímicos. Se rescatan datos sobre la práctica médica herbolaria con técnicas de antropología cognitiva. Las especies más utilizadas son: árnica, cuachalalate, tila, gordolobo, salvia, cola de caballo y boldo. Los resultados demuestran que existe consenso sobre las plantas medicinales que se usan, su efectividad y la conveniencia económica en contraste con las medicinas de patente. Se enfatiza la importancia de la comprensión del uso y significado de la enfermedad, y de la adquisición del conocimiento a través de generaciones por parte de los hierberos como un patrón de conocimiento cultural.

Presión arterial en adolescentes mexicanos: clasificación, factores de riesgo e importancia / Classifying Mexican adolescents' high blood pressure, associated factors and importance

Objetivo Determinar características de riesgo y frecuencia de niveles de presión sanguínea de acuerdo a dos criterios clasificatorios: 7° Comité Nacional Conjunto (JNC-7) y 4° Reporte del grupo de trabajo para el diagnostico, evaluación y tratamiento de la hipertensión arterial en niños y adolescentes. En un grupo de escolares de 12 a 16 años de la ciudad de León, México. Métodos Estudio observacional, descriptivo, transversal de 458 adolescentes varones. Previo consentimiento informado de padres y estudiantes, se determino la presión arterial de acuerdo a normas internacionales y se aplico cuestionario para captación de datos clínico-epidemiológicos de los alumnos investigados. Posteriormente se clasifican niveles de presión arterial (normotensos, prehipertensos, e hipertensos) de acuerdo con los criterios JNC7 y del 4o Reporte del grupo de trabajo para el diagnostico, evaluación y tratamiento de la hipertensión arterial en niños y adolescentes. Resultados Se detectaron, según los criterios JNC-7 y 4° Reporte: 61,3 y 68,7 por ciento normotensos, 34,9 y 20,7 por ciento prehipertensos, y 3,7 y 10,4 por ciento hipertensos. 71 y 66 por ciento con antecedentes familiares de diabetes e hipertensión; 22 por ciento con sobrepeso y obesidad y 24 por ciento con antecedentes de ingesta de alcohol. Conclusiones Se sugiere utilizar el criterio del 4° Reporte para su aplicación en la clínica, mientras que el JNC 7 para estudios epidemiológicos. Destaca el concepto de prehipertensión y su tamizaje temprano para la prevención de la hipertensión arterial. Su aceptación, facilitará el desarrollo de acciones efectivas y eficaces de promoción de salud en cambios del estilo de vida.

Objective Determining characteristics regarding risk and high blood pressure (HBP) frequency in a group of 12 to 16 year-old students from the city of León, Mexico, according to two types of classification: the 7th Joint National Committee (JNC-7) and 4th report of the working group for diagnosis, evaluation and treatment of HBP in children and adolescents. Methods This was an observational, descriptive cross-sectional study of 458 male students. HBP was determined according to international standards after parents and students' informed consent had been obtained and they answered a questionnaire for recording clinical-epidemiological data. Blood pressure levels were classified as being normal, pre-HBP and hyper-HBP in accordance with the guidelines issued by the 7th National Joint Committee for detecting, evaluating and treating HBP (JNC-7) and the 4th report of the working group for diagnosis, evaluation and treatment of HBP in children and adolescents. Results 61.3 percent and 68.7 percent were found to have normal blood pressure, 34.9 percent and 20.7 percent were pre-HBP and 3.7 percent and 10.4 percent hyper-HBP according to JNC-7 and 4th report guidelines, respectively, whilst 71 percent and 66 percent had a family background of diabetes and HBP, 22 percent were overweight and obese and 24 percent had a background of alcohol consumption. Conclusions It is suggested that 4th report guidelines should be adopted in clinical practice whilst JNC-7 guidelines should be used for epidemiological studies. Accepting the pre-HBP concept and its early detection for preventing HBP will facilitate effective health promotion regarding changes in lifestyle.

[Classifying Mexican adolescents' high blood pressure, associated factors and importance]. / Presión arterial en adolescentes mexicanos: clasificación, factores de riesgo e importancia.

OBJECTIVE: Determining characteristics regarding risk and high blood pressure (HBP) frequency in a group of 12 to 16 year-old students from the city of León, Mexico, according to two types of classification: the 7th Joint National Committee (JNC-7) and 4th report of the working group for diagnosis, evaluation and treatment of HBP in children and adolescents. METHODS: This was an observational, descriptive cross-sectional study of 458 male students. HBP was determined according to international standards after parents and students' informed consent had been obtained and they answered a questionnaire for recording clinical-epidemiological data. Blood pressure levels were classified as being normal, pre-HBP and hyper-HBP in accordance with the guidelines issued by the 7th National Joint Committee for detecting, evaluating and treating HBP (JNC-7) and the 4th report of the working group for diagnosis, evaluation and treatment of HBP in children and adolescents. RESULTS: 61.3 % and 68.7 % were found to have normal blood pressure, 34.9 % and 20.7 % were pre-HBP and 3.7 % and 10.4 % hyper-HBP according to JNC-7 and 4th report guidelines, respectively, whilst 71 % and 66 % had a family background of diabetes and HBP, 22 % were overweight and obese and 24 % had a background of alcohol consumption. CONCLUSIONS: It is suggested that 4th report guidelines should be adopted in clinical practice whilst JNC-7 guidelines should be used for epidemiological studies. Accepting the pre-HBP concept and its early detection for preventing HBP will facilitate effective health promotion regarding changes in lifestyle.

Susto and nervios: expressions for stress and depression.

Folk illnesses that are cultural constructions of psychological distress offer a vehicle for the cross-cultural study of stress and stress-related morbidity. This study explores the relationship between the Latin American folk illnesses susto and nervios and mental health. We hypothesize that these folk illnesses are distinct and that there is a stronger association between current levels of stress and depressive symptoms with past experience of nervios than with susto, because the cultural constructions of these folk illnesses reflect chronic and acute concepts of distress, respectively. Interviews were conducted in Guadalajara, Mexico, where participants responded to questions about their socio-demographic characteristics, stress, depressive symptoms, and whether they had experienced susto or nervios. Susto and nervios are very prevalent and occur across sociodemographic subgroups, with the exception that nervios occurred more often in women (p < 0.05). Susto was significantly associated with stress and depressive symptoms (p < 0.05), but nervios had a much stronger association (p < 0.0001), even after controlling for gender. Susto and nervios were expressions of psychological distress; most of those with depression reported susto and/or nervios. This study validates the link between these folk illnesses and stress and depression and may, ultimately, facilitate cross-cultural research on stress.

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

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.

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.

The relative effect of self-management practices on glycaemic control in type 2 diabetic patients in Mexico.

OBJECTIVE: In this study, we examined the relative impact of self-management activities on glycaemic control in a population at high risk for developing complications. METHODS: Patients diagnosed with diabetes mellitus of at least 1 year in duration at 30 years of age or older were sampled from the Instituto de Mexico Seguro Social (IMSS) Family Medicine Clinics in Guadalajara, Mexico (n=800). Demographic, clinical and health behaviour variables were used to predict good/poor glycaemic control, as measured by haemoglobin Alc (A1C). RESULTS: Most (72.24%) patients had poor control (A1C > or = 7.0). Hyperglycaemia was significantly associated with factors not under patient control, such as having diabetes for a longer time [odds ratio (OR) = 2.40, 95% confidence interval (CI) 1.39, 4.14], having a first-degree relative with diabetes (OR= 1.52; 95% CI 1.06, 2.19), and being prescribed anti-diabetic medications, e.g. insulin (OR = 7.88, 95% CI 2.42, 25.63). After controlling for these variables, the only self-management variable that reduced the likelihood of hyperglycaemia was following a special diet (OR=0.49; 95% CI 0.32, 0.76). Furthermore, depression had an important effect on self-management, as those with lower levels of depressive symptoms were more likely to follow a diet and exercise. DISCUSSION: While patients in this population have little control over many factors associated with glycaemic control, an important exception is diet. However, because of the adverse effect of depression on dieting, both depression management and dietary education are important for this population.

UISESS scale for staging and classifying clinical-epidemiological risk in type 2 diabetes mellitus and for establishing multidisciplinary preventive actions.

PURPOSE: The goal of this study is the creation and use of a five-stage scale for the description of the health status of a type 2 diabetes mellitus patient population, as individuals and as a set. The scale, named UISESS, ranges from the pre-pathological to the sequelae stage, and can help orient multidisciplinary prevention actions. SETTING AND SAMPLING: A sample of nondiabetics (n = 404), together with a census of all type 2 diabetic patients (n = 2,702) over 30 years of age, were obtained from a family medicine clinic of the Mexican Federal Social Security System (IMSS) in Guadalajara, Mexico. DESIGN AND METHOD: A descriptive study in which the Natural History of the Disease and an epidemiological focus on risk were used to create the UISESS scale. Case histories of a total of 3,106 persons from a family practice clinic were used. The data was classified in five stages and three risk control levels were used for analysis. RESULTS: In the type 2 diabetic group, the average age was 57.6 years; 58% were women. In the nondiabetic group, the average age was 55.38 years; 63% were women. The UISESS scale was applied. A large majority (86%) of the studied type 2 diabetic patients were classified within unfavorable stages for controlling their illness, and 65% of the 3,106 people were at high or very high risk of increasing deterioration of their health status. CONCLUSIONS: The UISESS scale appears to be a useful tool to detect the distribution, evolution and control of type 2 diabetes in a population attended at the outpatient clinic of a family medicine unit, according to the Natural History of the Disease.

A comparison of community and physician explanatory models of AIDS in Mexico and the United States.

The goal of this research was to explore differences between lay and professional explanatory models both within and between two countries. We test which effect is stronger, country of residence or professional/lay status, in determining similarities and differences of explanatory models of AIDS. Interviews conducted in Guadalajara, Jalisco (Mexico) and the Edinburg-McAllen area of south Texas (United States) elicited explanatory models of AIDS. Two pairs of samples were interviewed: a physician and community sample in Mexico and a physician and community sample in the United States. Comparisons of the explanatory models indicated that there was a shared core model of AIDS across all four samples, but that physicians' models were more similar to those of lay people in their own communities than either was to samples across the border.

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.