RESUMO
There are 180,000 new Diabetes Mellitus cases in Mexico each year (1). This chronic, complex and multifactor disease requires an adequate nutritional management plan to be prescribed by family physicians. They should be trained to identify the potential difficulties in the patient's dietary schedule and orientate their management from an integrative point of view. The purpose of this study was to detect and measure family physician's clinical aptitudes for the nutritional management of Type 2 diabetes, in a representative family physician's sample from five Family Medicine Units of the Mexican Institute of Social Security in Guadalajara, Jalisco, Mexico. A structured and validated instrument was applied to 117 physicians from a total of 450 in Guadalajara, Jalisco. The main study variable was clinical aptitude for nutritional management of Type 2 diabetes. Aptitude levels were defined by an ordinal scale and related to the other variables using the median, Mann-Whitney's U test and Kruskal Wallis (KW) test. Global results showed a median of 30 points that relates to a low and a very low aptitude level for the 72% of physicians without statistical significance (KW: p>0.05) with the rest of variables. These results reflect family physician's difficulties to orientate the nutritional management of Type 2 diabetes, as well as the lack of work environments that facilitate case reflection and formative educational strategies.
Assuntos
Competência Clínica , Diabetes Mellitus Tipo 2/dietoterapia , Medicina de Família e Comunidade/normas , Médicos/psicologia , Padrões de Prática Médica , Feminino , Humanos , Julgamento , Masculino , Medicina , México , Médicos/normas , EspecializaçãoRESUMO
This paper seeks to quantify the magnitude of caesarean sections in Mexican public health-care institutions in recent years, to characterize the evolution of caesarean section rates (CSR) during the last decade, and to estimate the possible economic cost caused by the excess of caesareans performed in these institutions. The study is based on data obtained from the health sector, both for Mexico in the 5-year period 1993-97 and for the Mexican State of Jalisco between 1983 and 1998. Linear regression analysis was used to evaluate time series, and "excess of caesareans" was considered the number of caesarean deliveries performed above the admissible 15% CSR. The results reflect that on the national level, more than one-quarter of the deliveries handled by public institutions ended in caesarean section for each analyzed year, and if the deliveries performed in private institutions are included, the national rate is around 30%. A marked increase in CSR can be observed in Jalisco between 1983 and 1998 (almost 50%); and the cost for the nation of this CSR excess in financial terms is highly significant: several millions of dollars--obtained from public funds--are spent annually and unnecessarily by health services. The findings suggest that the increase in CSR is a public health problem that has not been satisfactorily faced by the health sector authorities. Many unnecessary caesareans would undoubtedly be avoided if the policies of these public health-care institutions were to consider, as a priority, both the known higher risk implicit in a caesarean for the health of the mother and child, and the economic impact on the country and its health institutions of the excessive number of caesareans performed yearly.
Assuntos
Cesárea/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Países em Desenvolvimento , Feminino , Mau Uso de Serviços de Saúde , Humanos , México/epidemiologia , Política Organizacional , Gravidez , Revisão da Utilização de Recursos de SaúdeRESUMO
OBJECTIVE: To prove the benefit of an educational intervention for controlling LDL cholesterol levels in LDL cholesterol. MATERIAL AND METHODS: A quasi-experimental study was conducted; diabetic patients were randomly allocated to an experimental and a control group. The experimental group consisted of 25 patients and the control group of 24 patients. The educational intervention was organized through a reflection-action process. LDL cholesterol levels were measured at baseline and monthly during the nine months of the study. The groups were controlled for age and sex. Statistical analysis included Wilcoxon's test for ordinal variables. RESULTS: The intervention group had a mean value of LDL cholesterol of 148.4 +/- 21.3, compared to 185 +/- 24.1 in the control group (p < or = 0.05). CONCLUSIONS: The participative educational intervention contributed to improving the levels of LDL cholesterol, by promoting a lifestyle change in type-2 diabetic patients.
Assuntos
LDL-Colesterol/sangue , Diabetes Mellitus Tipo 2/sangue , Educação de Pacientes como Assunto , Idoso , Glicemia/análise , Índice de Massa Corporal , Interpretação Estatística de Dados , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicaçõesRESUMO
To demonstrate the advantages of behavior-modifying education in the metabolic profile of the type-2 diabetes mellitus patient. A quasi-experimental study was performed with a control group. The experimental group was made up of 25 type-2 diabetic patients and the control group consisted of 24. The type of education carried out was a behavior modification. Baseline measurements and subsequent monthly measurements of serum glucose, total cholesterol and triglycerides were carried out during 9 months after the intervention. The groups were controlled according to age and sex. The statistical analysis was performed using the Student's and Wilcoxon's test to determine the difference. The experimental group in comparison with the control group in the measurement after the intervention achieved a mean difference in serum glucose of 64.2 mg/dl (p=0.001), in the cholesterol of 31.6 (p=0.008), and in the triglycerides of 50.8 (p=0.006). The behavior-modifying education is a better option than traditional intervention for metabolic control in type-2 diabetes mellitus patients.
Assuntos
Terapia Comportamental , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus Tipo 2/reabilitação , Educação de Pacientes como Assunto , Colesterol/sangue , Currículo , Diabetes Mellitus Tipo 2/sangue , Dieta para Diabéticos , Feminino , Seguimentos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Autocuidado , Fatores de Tempo , Triglicerídeos/sangueRESUMO
This study seeks, through a logistic regression model, to describe the pattern of breastfeeding duration in Guadalajara, Mexico, during 1993. A multistage random sample of children under 1 year of age (n = 1036) was studied; observational data regarding breastfeeding duration, obtained through a "status quo" procedure, were compared with prevalence rates obtained from the logistic regression model. Modeling the duration of breastfeeding during the first year of life rather than only analyzing observational data helps researchers to understand this process in a dynamic and quantitative way. For example, uncommon indicators of breastfeeding were derived from the model. These indicators are impossible to obtain from observational data. The prevalence curve estimated through the logistic model was adequately fitted to observed data: there were no significant differences between the number or distribution of breastfed infants observed and those predicted by the model. Moreover, the model revealed that less than 40% of the children were breastfed in the fourth month of life; the median age for weaning was 39.3 days; 55% of the potential breastfeeding in the first 4 months did not occur; and the greatest abandonment of breastfeeding in the first 4 months was observed in the first 60 days. Thus, logistic regression seems a suitable option to construct a population-based model that describes breastfeeding duration during the first year of life. The indicators derived from the model offer health care providers valuable information for developing programs that promote breastfeeding.
PIP: This study describes the pattern of breast-feeding duration in Guadalajara, Mexico, in 1993, using a logistic regression model. A multistage random sample of children under 1 year of age (n = 1036) was studied; observational data regarding breast-feeding duration, obtained through a "status quo" procedure, were compared with prevalence rates obtained from the logistic regression model. Modeling the duration of breast-feeding during the first year of life rather than only analyzing observational data helps researchers to understand this process in a dynamic and quantitative way. For example, uncommon indicators of breast-feeding were derived from the model. These indicators are impossible to obtain from observational data. The prevalence curve estimated through the logistic model was adequately fitted to observe data: there were no significant differences between the number or distribution of breast-fed infants observed and those predicted by the model. Moreover, the model revealed that less than 40% of the children were breast-fed in the fourth month of life. The median age for weaning was 39.3 days and about 55% of potential breast-feeding in the first 4 months did not occur. Lastly, the highest abandonment of breast-feeding in the first 4 months was observed in the first 60 days. Thus, logistic regression seems a suitable option to construct a population-based model that describes breast-feeding duration during the first year of life.
Assuntos
Aleitamento Materno/estatística & dados numéricos , Interpretação Estatística de Dados , Modelos Logísticos , Adulto , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , México , Avaliação das Necessidades , Inquéritos e Questionários , Fatores de Tempo , Saúde da População UrbanaRESUMO
Nutritional practices of diabetics reflect both human behavior and the health culture of such patients. They also represent how the diabetic deals with the health/illness issue. The purpose of this survey was to identify and relate nutritional practices with metabolic control, age, sex, years of schooling, and time since diagnosis of illness. The sample was taken from 114 cases selected through systematic random sampling in five family practice units in Guadalajara. Using thirteen structured, coded, and quantified questions of the Likert type, the study evaluated nutritional practice with a range of 0-65. Results showed that 21% of the diabetics had appropriate nutritional practices (>31 points), and when related with years of schooling and time since diagnosis of illness, they showed statistically significant differences (p=0.05). Simple regression showed that 9% of metabolic control can be explained by nutritional practices.
RESUMO
BACKGROUND: In recent years, tobacco consumption its associated health problems have increased in Mexico. This study aims to describe the effects of tobacco use on mortality in the State of Jalisco, Mexico, in 1990. METHODS: 22 smoking-related diseases, for which there are estimates of relative risks of death were selected; smoking-attributable mortality fractions for each disease per sex, were calculated. This made it possible to estimate smoking-attributable mortality rates, years of potential life lost (YPLL), due to tobacco uses and life expectancy at birth (LEB), excluding mortality due to smoking. RESULTS: Smoking-attributable deaths represent 8.7% of all registered deaths in 1990. Ab high proportion of theses deaths belonged to ancient people. The smoking-attributable rate was 4.91 per 10,000 inhabitans (6.33 for males and 3.58 for females); YPLL rates, due to tobacco use was 2.98 per 1,000 inhabitans younger than 65 years (3.99 for men and 2.02 for women). CONCLUSIONS: Smoking-attributable mortality PYLL rates were higher than those rates observed for infectious and parasitical diseases, and for endocrinal and digestive system disorders. Due to tobacco use, men die more frequently and at a younger age than women. In the absence of tobacco use, the LEB increase would be notorious.
Assuntos
Fumar/efeitos adversos , Tabagismo/mortalidade , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Expectativa de Vida , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Saúde Pública , Fatores SexuaisRESUMO
This study seeks to identify the incidence of unfavorable birth weight (UBW) -< 3000 grams, the factors associated with this condition, and the probability that a child has an UBW in the presence or absence of identified risk factors, in Tlaquepaque and Tonal , outlying areas of Greater Metropolitan Guadalajara, Mexico. A sample of live-born infants in 1991, children of mothers covered by the Mexican Institute of Social Security were selected from the study area; through multistage probabilistic sampling, random selection was made of Family Medical Units within the study areas, and of physicians' offices within those selected units; finally, all the liveborn infants in 1991 from these selected physicians' offices were studied: a total of 141 newborns were studied Mothers of the newborns chosen were interviewed; a questionnaire with different biomedical, socioeconomic, and demographic items was applied by social workers specially trained for the purpose. Logistic regression models were used lo estimate odds ratios (OR), with 95% confidence intervals (CI). The probability that a child would have UBW in the presence or absence of identified risk factors were also calculated. The results show that 22% of the infants studied were born weighing less than 3000 grams; four risk factors were statistically associated with UBW: mother's age of 35 or older (OR=18.47, CL 1.86-83.54); mother worked outside the home (OR= 3.14, C1:1.15-8.59); mother's pre-pregnancy low weight (OR= 5.04, CL1.04-24.47); and late detection of pregnancy (OR=2.64, CI: 1.02-6.84). In the presence of all the risk factors identified, there is a very high probability (0.97) that a child be born with birthweight less than 3000 g, and in the absence of these factors the probability is reduced substantially (0.04). The findings indicate the magnitude of the problem studied, but also the possibility of health services acting in a timely fashion, since the identified risk factors make it possible lo predict, with relative certainty, the birth of a child weighing less than 3000 g.
RESUMO
The aim of the present study is to determine the duration of breast-feeding by mothers covered by the Mexican Social Security Institute and living in Tlaquepaque and Tonalá, outlying areas of the city of Guadalajara, Mexico; to identify possible maternal factors associated with early weaning; and to consider the social importance of this phenomenon. A sample of live-born infants and their mothers were selected from the study area. The children had reached at least one month of age between May 1990 and April 1991. Through multistage probabilistic sampling, random selection was made of primary health care units within the study areas, of family physicians' offices within those units, and finally, of all children meeting the study criteria in each of those offices. After visits to 166 dwellings, 141 mothers were interviewed, or 91% of the projected sample size (155). A 33-item questionnaire was prepared for the interviews. The interviewers were social workers trained to do this work, which they carried out between June and July 1991. Logistic regression models were used to estimate the relative risk (RR) associated with each variable and the probability that the infant was weaned early because of the presence or absence of certain variables. To ensure valid results, several regression models were developed with a view to selecting the one that best fit the data. The population attributable risk (PAR) was also calculated. The findings indicate that few mothers breast-feed their children in these areas, since 34.8% of the children were breast-fed for less than one month. Three maternal risk factors were statistically associated with early weaning (p < 0.05): maternal age under 20 years (RR = 3.75; CI 95%: 1.53-9.19); single marital status (RR = 2.88; CI 95%: 1.08-7.69); and social class, i.e., the mother's belonging to a "non-worker" social group (RR = 2.72; CI 95%: 1.17-6.28). The probability of an infant being breast-fed for less than one month was 0.84 when the three maternal risk factors were present, and 0.15 when they were absent. The high estimated PAR reflects the high proportion of mothers who were under the age of 20 or did not belong to the working class. The results underscore the importance of reducing the effect of these risk factors so that breast-feeding can become more widely practiced in the population studied.
Assuntos
Aleitamento Materno/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , México , Risco , Fatores de Tempo , População UrbanaRESUMO
To investigate breast-feeding patterns and factors encouraging early weaning, a survey was conducted in Tonalá and Tlaquepaque, two suburbs within Guadalajara's metropolitan area, in 1991. For this purpose a multiphase probabilistic sample of infants born in these areas from May 1990 through April 1991 was selected. This was done by choosing at random primary health care units in the study areas, health posts associated with these units, and all infants meeting the above criteria at each selected post. A total of 166 homes was visited and interviews were conducted with 141 mothers (91% of the 155 predicted) in June and July 1991. These interviews made use of a 33-item questionnaire developed for the purpose; the interviewers were social workers previously trained in such activities. Logistic regression models were used to calculate the relative risk (RR) and probability of early weaning being associated with certain variables. To help ensure the validity of the results, several regression models were constructed for the purpose of selecting the one best fitting the data. In addition, the attributable population risk (APR) was calculated. The results indicate that failure to breast-feed and early weaning were prevalent in the study population, 34.8% of the study infants being breast-fed less than 1 month. Three risk factors were associated statistically (P < 0.05) with early weaning, these being maternal age < 20 years (RR = 3.75; 95% CI = 1.53-9.19), maternal marital status single (RR = 2.88; 95% CI = 1.08-7.69), and social status of the main family provider other than "worker"--i.e., employee, professional (RR = 2.72; 95% CI = 1.17-6.28). The likelihood that a study infant would have been breast-fed less than a month was 0.84 if the infant was exposed to all three of these identified risk factors and 0.15 if he or she was exposed to none of them. The high percentages of study mothers less then 20 years old and with a social status other than "worker" were reflected in high attributable population found for these variables. In general, the findings point up a need to reduce the influence of these risk factors and to prolong maternal breast-feeding in the study population.
Assuntos
Aleitamento Materno , Comportamento Materno , População Urbana , Adulto , Distribuição por Idade , Aleitamento Materno/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , México , Fatores de Risco , Inquéritos e Questionários , Fatores de Tempo , População Urbana/estatística & dados numéricos , DesmameRESUMO
In Cuba, the infant mortality rate (IMR) dropped by 65% between 1970 and 1986. The 1986 IMR - 13.6% - has put the country in the lead in Latin American mother and child health care. However, the behavior of the IMR is not homogeneous throughout the country. This paper seeks to identify by multiple regression techniques, those sociodemographic or health care factors which have determined the decline in the IMR and those variables which best explain the inter-regional differences in this indicator. Sociodemographic factors fundamentally explain the evolution of the IMR in Cuba; on the other hand, although in the first instance the proportion of live births of low weight and the crude birth rate explain the inter-regional differences in IMR levels every year, it can be seen that other socioeconomic variables really lie behind these differences.
Assuntos
Mortalidade Infantil , Cuba , Humanos , Lactente , Análise Multivariada , Fatores SocioeconômicosRESUMO
Economic and social risk factors for both postneonatal and exogenous mortality are evaluated for Cuban children for 1982. A national sample of children who died before their first year of age (cases) and a sample of survivors (controls) was selected for the study. A logistic regression approach was used to estimate relative and attributable risks. Probability of dying when specific factors are present was computed. Results point to the lack of sanitary installations within the house and overcrowding (three or more persons per room) as the most relevant risk factors for both postneonatal and exogenous mortality. It was also confirmed that the postneonatal component is an area deserving of attention the quest for in further reduction in infant mortality in Cuba.
Assuntos
Mortalidade Infantil , Cuba , Habitação/normas , Humanos , Lactente , Recém-Nascido , Análise de Regressão , Fatores de Risco , Estudos de Amostragem , Fatores SocioeconômicosRESUMO
Mortality risk in the first year of life is different according to climatological characteristics of the season's year. In this paper two periods are taken (1965-1971 and 1979-1985) with the purpose of analyzing seasonal variations in infant mortality and to determine seasonal differences between both periods and in each of them. This study may identify the existence of seasonality and the presence of overmortality in summer months. This seasonality is not similar in both periods because of the decrease in infant mortality rate and the changes in the cause of death structure. Author gives element to planning from a more realistic view evolution during the year of infant mortality rate in the country.
Assuntos
Mortalidade Infantil , Estações do Ano , Cuba , Humanos , LactenteRESUMO
PIP: The authors examine the extent to which changes in the structure of births in Cuba from 1978 to 1982 have affected early neonatal mortality. Factors considered include maternal age, birth weight, duration of pregnancy, and birth order. The results indicate that with the exception of maternal age, the changes that have occurred have had a favorable impact on neonatal mortality (SUMMARY IN ENG AND FRE)^ieng
Assuntos
Ordem de Nascimento , Peso ao Nascer , Idade Gestacional , Mortalidade Infantil , Idade Materna , Mortalidade , Gravidez , Fatores Etários , América , Biologia , Peso Corporal , Região do Caribe , Cuba , Demografia , Países Desenvolvidos , Países em Desenvolvimento , Características da Família , Relações Familiares , Feto , América Latina , América do Norte , Pais , Fisiologia , População , Características da População , Dinâmica Populacional , ReproduçãoRESUMO
PIP: Infant mortality data from England, France, and Costa Rica for periods from 1950 to 1980 are compared with similar data from Cuba to support the author's hypothesis that in capitalist countries infant mortality varies with socioeconomic class, whereas in Cuba infant mortality tends to be the same regardless of class. (summary in ENG, FRE)^ieng
Assuntos
Mortalidade Infantil , Mortalidade , Sistemas Políticos , Classe Social , América , Região do Caribe , América Central , Costa Rica , Cuba , Demografia , Países Desenvolvidos , Países em Desenvolvimento , Economia , Inglaterra , Europa (Continente) , França , América Latina , América do Norte , População , Dinâmica Populacional , Fatores Socioeconômicos , Reino UnidoRESUMO
PIP: Infant and child mortality in the western provinces of Cuba is analyzed using methods developed by Brass and adapted by Trussell. Consideration is given to regional differences and to differences between rural and urban areas. (summary in ENG, FRE)^ieng
Assuntos
Geografia , Mortalidade Infantil , Mortalidade , População Rural , População Urbana , América , Região do Caribe , Cuba , Demografia , Países Desenvolvidos , Países em Desenvolvimento , América Latina , América do Norte , População , Características da População , Dinâmica PopulacionalRESUMO
PIP: The socioeconomic and demographic factors associated with infant mortality in the municipality of Arroyo Naranjo, Cuba, are analyzed using data for 1979 and 1980. Factors considered include parity, living conditions, and the quality of health services. (summary in ENG, FRE)^ieng
Assuntos
Demografia , Serviços de Saúde , Habitação , Mortalidade Infantil , Mortalidade , Paridade , Seguridade Social , Fatores Socioeconômicos , América , Coeficiente de Natalidade , Região do Caribe , Cuba , Atenção à Saúde , Países Desenvolvidos , Países em Desenvolvimento , Economia , Fertilidade , Geografia , Saúde , América Latina , América do Norte , População , Dinâmica Populacional , Características de ResidênciaRESUMO
PIP: The factors affecting infant mortality in the municipality of Arroyo Naranjo, Havana, Cuba, are analyzed. The data are for the years 1979 and 1980, a period in which this municipality recorded the highest rates of infant mortality in the province. Factors considered include age of mother, level of education, and marital status. The data were obtained from health records and from interviews with mothers of deceased children under one year of age. (summary in ENG, FRE)^ieng